Table 1.

Questionnaire to evaluate children’s history for ophthalmologic care, parental myopia, and the amount of near-work and outdoor activity

1. Has your child undergone eye surgery?	□ Yes □ No
※ if any,
□ Strabismus □ Ptosis □ Epiblepharon □ Others ( )
2. Has your child been diagnosed with ocular diseases?	□ Yes □ No
※ If any,
□ Strabismus □ Amblyopia □ Ptosis □ Epiblepharon □ Others ( )
3-1. Dose the child’s father have myopia?	□ Yes □ No □ Don’t know
3-2. Does the child’s mother have myopia?	□ Yes □ No □ Don’t know
※ How do you know you have myopia?
Myopia means near sightedness. If you have myopia, you can see near things well, but images blur when you are looking at far things, assuming that you are <40 years of age. If you wear glasses, you can check with your glasses. If you place your glasses near a newspaper and the letters look smaller than their original size, you are wearing glasses to correct for myopia.
4. How many times does your child read books for more than 30 minutes per week?	_______ time(s)
5. How many hours does your child read books per week?	_______ hour(s)
6. How many hours does your child use a computer per week?	_______ hour(s)
7. How many hours does your child use a smart phone per week?	_______ hour(s)
8. How many times does your child do outdoor activity per week?	_______ time(s)
9. How many hours does your child do outdoor activity per week?	_______ hour(s)
10. How many hours does your child expose to the sun light per week?	_______ hour(s)