SURAVISION
Cataracts Self-Test
What is your Age range?
18-29
30-44
45-59
60+
Do you wear...
Glasses
Contacts
Glasses & Contacts
Readers
Bifocals / Progressives
I don't wear anything(but I should!)
Without your corrective lenses, do you have...
Trouble seeing far away
Trouble seeing up close
Overall blurry vision
Trouble reading only
Have you ever been told you have astigmatism?
Yes!
No.
Where should we contact you with your results?
What's a good phone number for you?
(So we can contact you if you qualify for a LASIK evaluation. Our team may reach out to you via call, email and/or SMS. Opt-out at any time.)
Send
Step
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of
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Consent
I agree to the privacy policy.
Is it time for a cataract surgery evaluation?
Take this short quiz to find out more...
This should not be considered medical advice or diagnosis. A full appointment is necessary to determine candidacy.
Have you been told you have cataracts?
(Required)
Yes
No
Do you have difficulty driving at night?
(Required)
Yes
No
Do you have trouble reading road signs while driving?
(Required)
Yes
No
Does your vision seem blurry or dim?
(Required)
Yes
No
When reading small print, do you need a brighter light to see?
(Required)
Yes
No
"After cataract surgery, I would like to see well..."
(Required)
Up close
without always relying on readers or bifocals.
Far away
without always relying on glasses.
Up close & far away
w/o relying on readers or bifocals.
At night
without the need for glasses.
I'm fine wearing readers and bifocals all the time.
What is your age range?
(Required)
18-29
30-44
45-59
60+
Name
(Required)
First
Last
Where should we contact you with your results?
(Required)
What's a good phone number for you?
(Required)
(So we can contact you if you qualify for a LASIK evaluation. Our team may reach out to you via call, email and/or SMS. Opt-out at any time.)
Consent
I agree to receive communications by text message about my inquiry. You may opt out by replying STOP or ask for more information by replying HELP. Message frequency varies. Message and data rates may apply. You may review our
Privacy Policy
to learn how your data is used.
SURAVISION
Cataracts Self-Test