Subscale 1 = short version of the visual functioning scale (SVFVS) |
|
Q1 |
At the present time, would you say your eyesight using both eyes (with glasses or contact lenses, if you wear them) is excellent, good, poor, very poor, or are you completely blind? |
Q2 |
How much difficulty do you have reading ordinary print in newspapers? |
Q3 |
How much difficulty do you have doing work or hobbies that require you to see well up close, such as cooking, sewing, fixing things around the house, or using hand tools? |
Q4 |
Because of your eyesight, how much difficulty do you have finding something on a crowded shelf? |
Q5 |
How much difficulty do you have reading street signs or the names of stores? |
Q6 |
Because of your eyesight, how much difficulty do you have going down steps, stairs, or curbs in dim light or at night? |
Q7 |
Because of your eyesight, how much difficulty do you have visiting with people in their homes, at parties, or in restaurants? |
Subscale 2 = short version of the socioemotional scale (SVSES) |
|
Q1 |
Do you accomplish less than you would like because of your vision? |
Q2 |
Are you limited in how long you can work or do other activities because of your vision? |
Q3 |
I stay home most of the time because of my eyesight. |
Q4 |
I have much less control over what I do, because of my eyesight. |
Q5 |
Because of my eyesight, I have to rely too much on what other people tell me. |
Q6 |
I worry about doing things that will embarrass myself or others because of my eyesight |