Table 4.

Modified glaucoma symptom scale

Have you experienced any of the following problems in the last 4 weeks?
(Please respond for both the left and right eye.)
a. Burning, Smarting, Stinging
Left Eye		Right Eye
☐ Yes	How bothersome has it been?	☐ Yes	How bothersome has it been?
	______ Very		______ Very
	______ Somewhat		______ Somewhat
	______ A Little		______ A Little
☐ No (Not at all bothersome)		☐ No (Not at all bothersome)
b. Tearing
c. Dryness
d. Itching
e. Soreness, Tiredness
f. Blurry/Dim Vision
g. Feeling of Something in Your Eye
h. Hard to See in Daylight
i. Hard to See in Dark Place
j. Halos Around Lights