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| No. | Question | Always | Often | Regularly | Some times | Never |
|---|---|---|---|---|---|---|
| 1 | Do you feel or notice sensitivity to light ? | |||||
| 2 | Do you feel or notice sandy feeling ? | |||||
| 3 | Do you feel or notice irritation and general sensitivity ? | |||||
| 4 | Do you feel or notice blurry vision ? | |||||
| 5 | Do you feel or notice decreased vision ? | |||||
| 6 | Is your visual comfort affected during reading ? | |||||
| 7 | Is your visual comfort affected during driving at night ? | |||||
| 8 | Is your visual comfort affected during using digital screens (PC, smartphone, …) ? | |||||
| 9 | Is your visual comfort affected during watching TV ? | |||||
| 10 | Do your eyes suffer in windy weather conditions ? | |||||
| 11 | Do your eyes suffer in dry air or air-conditioned places ? |
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