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. 2021 Sep 24;10(4):1033–1044. doi: 10.1007/s40123-021-00396-5

Table 2.

Patient questionnaire

Parameter

1 Do you experience any night vision disturbance currently? If YES, which eye?

□ No □ Yes (operated eye, unoperated eye, or both eyes)

2 During the last week, have you experienced interocular visual differences at night? If YES, which eye is better in term of night vision?

□ No □Yes (operated eye or unoperated eye)

3 During the last week, have you experienced glare at night? If so, which eye? And rate it as mild, moderate, or severe.

□ No □ Yes (operated eye, unoperated eye, or both eyes) □ Mild □ Moderate □ Severe

4 During the last week, have you experienced halos (rings around lights) at night? If so, which eye? And rate it as mild, moderate, or severe.

□ No □ Yes (operated eye, unoperated eye, or both eyes) □ Mild □ Moderate □ Severe

5 During the last week, have you experienced starburst around lights at night? If so, which eye? And rate it as mild, moderate, or severe.

□ No □ Yes (operated eye, unoperated eye, or both eyes) □ Mild □ Moderate □ Severe

6 During the last week, have you experienced any visual distortion as you normally function at night? If so, which eye? And rate it as mild, moderate, or severe.

□ No □ Yes (operated eye, unoperated eye, or both eyes) □ Mild □ Moderate □ Severe

7 The overall satisfaction score (on a scale of 1–10, 1 = low satisfaction and 10 = high) with your refractive surgery outcomes is ___.

Mild: symptoms noted to affect light sources, but functions were not interfered; Moderate: symptoms noted and usual activity were affected, especially when driving or looking at light sources; Severe: certain activities, such as driving or looking at light sources, were restrained by symptoms