| 7 | Because of your eyesight, how much difficulty do you have finding something on a crowded shelf? |
| 10 | Because of your eyesight how much difficulty do you have noticing objects off to the side while you are walking? |
| 14 | Because of your eyesight how much difficulty do you have going out to see movies, plays or sorts events? |
| 15c | If currently driving: How much difficulty do you have driving during the daytime in familiar places? |
| 20 | I stay home most of the time because of my eyesight? |
| 24 | I need a lot of help from others because of my eyesight? |
| A2 | How would you rate your eyesight now (with glasses or contact lens on, if you wear them)? |
| A7 | Because of your eyesight, how much difficulty do you have taking part in active sports or other outdoor activities that you enjoy (like golf, bowling, jogging, or walking)? |
| A11a | Do you have more help from others because of your vision? |
| A11b | Are you limited in the kinds of things you can do because of your vision? |
| A13 | I don’t go out of my home alone, because of my eyesight? |