Quality of Life Survey

Headaches with near work

Words run together while reading

Burning, itchy, or watery eyes

Skipping/repeating lines while reading

​​​​​​​Tilting head or closing one eye when reading

Difficulty copying from a chalkboard

Avoiding near work or reading

Omitting small words when reading

Writing uphill or downhill

​​​​​​​Misaligning digits/columns of numbers

Poor reading comprehension

Holding books or near work very close to eyes

Short attention span with near work

Difficulty completing assignments on time

Saying "I can't" before trying something

​​​​​​​Clumsiness and knocking things over

Poor use of time

Losing belongings or misplacing things

Forgetting things