Symptoms Survey

Symptoms Survey

Headaches associated with near work
Words run together when reading
Burning, stinging, watery eyes
Skipping or repeating lines when reading
Head tilt or closing one eye when reading
Difficulty copying from the chalkboard
Avoidance of reading and near work
Omitting small words when reading
Writing uphill or downhill
Mis-aligning digits in columns of numbers
Reading comprehension declining over time
Holding reading material too close
Short attention span
Difficulty completing assignments in reasonable time
Saying "I can't" before trying
Tendency to knock things over on desk or table
Difficulty with time management
Misplaces or loses papers, objects, belongings
Forgetful, poor memory

Your total vision score: 0

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According to the American Optometric Association, a score of 20 or more points* or the persistence of 1-2 symptoms indicates the need for a Functional Vision Exam. (*JAM Optom Assoc 2006; 77:116-123)

Even if the score is less than 20, and you have a concern with your child’s academic or overall performance, a Functional Vision Exam is a definitive way to rule out whether vision is contributing to those challenges.

​​​​​​​These surveys are not a substitute for consulting a physician and do not provide diagnoses.

Our doctors specialize in diagnosing and treating vision dysfunctions that impact school, work, sports and performance in daily activities. This includes reading, comprehension, sustaining attention, driving and many other activities as well as behaviors. Contact us if you have questions regarding your symptoms at (216) 468-8020.
ArleeVa123! none 1:00 PM - 6:00 PM 2:00 PM - 6:00 PM 9:00 AM- 6:00 PM 9:00 AM - 6:00 PM 3:00 PM - 6:00 PM Closed Closed optometrist