2. What are you currently wearing? *

3. Without glasses and/or contacts: *

I have trouble reading and seeing things up close

I have trouble driving and seeing things that are far away

I have trouble seeing both far and near

4. Do you currently experience any of the following symptoms? *

6. Have you ever been told you have cataracts and need surgery? *

Yes

No

7. What would be your goal outcome after cataract surgery?

I am fine with needing glasses all the time

I would like to limit my needs for glasses only to reading

I would like to eliminate the need for glasses all together

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