Table 4:
Child 12–17 Year Pediatric Eye Questionnaires (PedEyeQ)
| PedEyeQ -Functional vision: Child 12–17 years |
| 1. Do your eyes make it hard to learn? |
| 2. Do your eyes make it hard to play sports? |
| 3. Do you have a hard time seeing? |
| 4. Do you need special help at school because of your eyes? |
| 5. Do you need help with certain things because of your eyes? |
| 6. Do you have to do things differently than other people because of your eyes? |
| 7. Do your eyes make it hard to concentrate? |
| 8. Is it hard to see the board at school? |
| 9. Is it hard to see steps when you walk? |
| 10. Do you run into things because of your eyes? |
| PedEyeQ -Bothered by eyes / vision: Child 12–17 years |
| 1. Does it bother you that you need help with certain things because of your eyes? |
| 2. Does it bother you to have to do things differently because of your eyes? |
| 3. Does it bother you because your eyes make it hard to learn? |
| 4. Does it bother you because your eyes make it hard to play sports? |
| 5. Does it bother you because you have a hard time seeing? |
| 6. Does it bother you to need special help at school because of your eyes? |
| 7. Does it bother you because your eyes make it hard to concentrate? |
| 8. Does it bother you because your eyes make it hard to do certain things? |
| 9. Does it bother you because it’s hard to see the board at school? |
| 10. Are you bothered by the things you have to do to make your eyes better? |
| PedEyeQ -Social: Child 12–17 years |
| 1. Are you bothered by how your eyes look? |
| 2. Do your eyes make you feel unsure of yourself? |
| 3. Does it bother you when other people say things or ask questions about your eyes? |
| 4. Do you feel “different” because of your eyes? |
| 5. Does it bother you that you get extra attention because of your eyes? |
| 6. Does it bother you when people look/stare at you because of your eyes? |
| 7. Are you shy because of your eyes? |
| 8. Do you get teased because of your eyes? |
| 9. Do you worry about what other people think about you because of your eyes? |
| 10. Do you worry about getting teased because of your eyes? |
| PedEyeQ -Frustration / worry: Child 12–17 years |
| 1. Do you hate going to the eye doctor? |
| 2. Is taking care of your eye condition hard for you? |
| 3. Are you frustrated because your eyes aren’t getting better? |
| 4. Do you worry about getting hurt because of your eyes? |
| 5. Do you worry about your eyes getting worse? |
| 6. Do you worry that your eyes will make it hard to do things when you’re older? |
| 7. Do you worry about not being able to do things because of your eyes? |
| 8. Do you worry about your eyes? |
| 9. Do you worry about what you might have to do to make your eyes better? |
Formatted questionnaires with response options, instructions, and Rasch scoring are freely available at www.pedig.net. Each domain can be administered separately or in any combination, and is scored separately.