Self-Evaluation Test


Name:
Phone:
E-Mail:

How interested are you in seeing at a distance, driving or playing golf without glasses after your cataract surgery?
It’s very important to me NOT to wear glasses for distance vision.

It’s not important to me. I do not mind wearing glasses.
Are you interested in seeing well up close (reading) without glasses after your cataract surgery?
It’s very important to me NOT to wear reading glasses.

It’s not important to me. I do not mind wearing reading glasses to see things up close.
If you had to wear glasses after your vision treatment for one of the following activities, which one would you most be willing to wear glasses for?
Reading fine print

Using a computer or cooking

Driving a car
If you could have good vision for driving during the day without glasses, and good near vision without glasses in most situations, would you be able to tolerate some halos and glare around lights at night?
Yes

No
If you could have good distance vision day and night, and good vision for computer work, without glasses, would you be willing to wear glasses for reading fine print and small type?
Yes

No
In our daily lives there are different things we do that require us to SEE at different distances. We have grouped some of these vision activities into 5 lifestyle zones. Think about the things in life you want to do the most without depending on glasses after cataract surgery. Which group is the most important
Newsprint, books, reading maps or sewing.

Computer screens, menus, price tages or headlines.

Watching TV, cooking, cleaning or indoor activties.

Driving, playing golf, seeing road signs.

Night Driving, watching movies.
Consider your personality. Based on the options scale below how would you rank your personality?
Easy Going

In the middle

Perfectionist

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Lasik - Laser Eye Surgery Pannsylvania

If you are seeking LASIK in Pennsylvania call us today to get the answers you have been seeking. We offer free LASIK consultations so that our patients can make informed decisions from experienced professionals.

LASIK

Would you like to find out if you are a LASIK candidate? If so please take our self-evaluation test and one of our staff will be in touch with you to discuss your LASIK candidacy.

Cataract patients now have an option to see at both near and far distances after cataract surgery! Individuals suffering from cataracts previously had only a mono-focal lens implant option after surgery. NEW multi-focal IOL technology can now decrease dependence on glasses after surgery. If you are seeking the Rezoom™ or ReSTOR® IOL lens options Dr. Chesen is a certified cataract surgeon in Pennsylvania. Your source for Pennsylvania cataract surgery!

Intraocular Lens

3 STEPS TO BETTER VISION

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