1. What is your age group?

Under 21

21 – 39

40 – 55

55 or older

2. Do you wear glasses or contact lenses for vision correction?

Yes, glasses

Yes, contact lenses

Both glasses and contact lenses

No, I do not wear vision correction

3. Has your prescription remained stable for the past 18 months?

Yes, my prescription has not changed

No, my prescription has changed

4. Do you have any of the following eye conditions? (Select all that apply)

Dry eyes

Cataracts

Glaucoma

Keratoconus

Macula disease or Diabetes

None

5. Are you currently pregnant or breastfeeding? (Hormonal changes can affect vision stability)

Yes

No

6. Have you ever had an eye injury, eye surgery, or any corneal disease?

Yes

No

7. Do you experience difficulty seeing clearly at night or with glare sensitivity?

Yes, I struggle with night vision/glare

No, I have no issues

8. Do you have any medical conditions such as diabetes or autoimmune diseases that affect healing?

Yes

No

9. What is your main goal with laser vision correction?

I want to reduce or eliminate my need for glasses/contact lenses

I want better vision for sports and an active lifestyle

I want more convenience in daily life

I’m just curious about my options

Please provide your contact information to complete the quiz.

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