Quality of Life Survey

Once you submit the survey, you will be able to view your results and if you wish; choose to share the data with us.


The College of Optometrists in Vision Development (COVD) has developed a survey of common visual symptoms related with binocular vision disorders and visual-related learning problems. A symptom score of 20 or greater indicates that visual problems could be affecting every day activities such as reading, learning, and near tasks. Take the survey to determine whether or not you could benefit from a comprehensive eye health and vision exam- including the extra testing necessary to diagnose and treat binocular vision disorders.

Headaches with near work.

Words run together or blur when reading.

Burning, itchy, or watery eyes.

Skipping/repeating lines while reading.

Tilting head or closing one eye when reading.

Difficulty copying from a chalkboard.

Avoiding near work or reading.

Omitting small words when reading.

Writing uphill or downhill.

Misaligning digits/columns of numbers.

Poor reading comprehension.

Holding books or near work very close to eyes.

Short attention span with near work.

Difficulty completing assignments on time.

Saying "I can't" before trying something.

Clumsiness and knocking things over.

Poor use of time.

Losing belongings or misplacing things.

Forgetting things.

Do you wish to share the information with us?