Speed dry eye questionnaire pdf
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Please take a moment to carefully complete this questionnaire to better enable your eye care provider to help you. Select only one answer per questionReport the type of SYMPTOMS you experience and when they occur SPEED – Standardized Patient Evaluation of Eye Dryness. (Checkbox per row)How SEVERE are your symptoms? Today’s date: //_____ Name:_____________________________________ DOB://_____ (age = ______) Dry Eye Disease and its related symptoms are one of the most common findings during eye exams For the Standard Patient Evaluation of Eye Dryness (SPEED) Questionnaire, please answer the flowing questions by checking the box that best represents your answer. Dry Eye Disease is more common than most people realize. Please take a moment to carefully complete this questionnaire to , · Date: / Dry Eye Questionnaire Name: (First) (Last) Date of Birth: / Sex: M F (circle one) Report the FREQUENCY of any dry eye symptoms you are SPEED™ Questionnaire. Dry Eye Disease is more common than most people realize. DRY EYE QUESTIONNAIRE. (Checkbox per row) The initial OSDI items were generated from patient For the Standardized Patient Evaluation of Eye Dryness (SPEED) Questionnaire, please answer the following questions by checking the box that best represents your answer. For the Standardized Patient Evaluation of Eye Dryness (SPEED) Questionnaire, please answer the following questions by checking the box that best represents your answer. Select only one answer per questionReport the type of SYMPTOMS you experience and when they occur: Dryness, Grittiness or Scratchiness * If your score isyou are experiencing MILD dry eye symptoms you are experiencing MODERATE dry eye symptoms 8+ you are experiencing SEVERE dry eye symptoms The SPEED Questionnaire is one tool we use to help assess your dry eye symptoms. NAME. No matter what you scored on the quiz, we take your overall eye health very seriously The Ocular Surface Disease Index (OSDI), developed by the Outcomes Research Group at Allergan Inc (Irvine, Calif),is a item questionnaire designed to provide a rapid assessment of the symptoms of ocular irritation consistent with dry eye disease and their impact on vision-related functioning. [9] This questionnaire gives a score fromtothat is the result ofitems that assess frequency and severity of symptoms Speed II® Dry Eye Questionnaire. 7, · Speed II® Dry Eye Questionnaire. Select only one answer per question The SPEED questionnaire was designed by Korb and Blackie in order to quickly track the progression of dry eye symptoms over time. DATEHow OFTEN do you have these symptoms?