COVD Quality of Life Checklist
To take the vision quiz, check the column which best represents the occurrence of each symptom.
|A||Blur when looking at near|
|A||Headaches with near work|
|A||Sees worse at end of the day|
|A||Difficulty copying from the Chalkboard|
|A||Avoids near work/reading|
|A||Holds head too close to the page|
|B||Has double vision|
|B||Words run together while reading|
|B||Eyes burn, itch, or seem watery|
|B||Falls asleep while reading|
|B||Closes one eye or tilts head while reading|
|OR||Dizzy or nauseous with near work|
|OR||Writes up or down hill|
|OR||Poor/inconsistent in sports|
|OR||Poor hand-eye coordination/poor handwriting|
|OR||Clumsy/knocks things over|
|OM||Skips or repeats lines when reading|
|OM||Misaligns digits/columns of numbers|
|P||Reading comprehension is poor|
|P||Trouble keeping attention on reading|
|P||Says “I can’t” before trying|
|P||Does not use his/her time well|
|P||Does not make change well with money|
|ALL||Difficulty completing assignments on time|
|ALL||Does not judge distance accurately|
Your Final Score:
Score below 15 – Schedule for a routine eye exam
Score 16-24 — Schedule for visual functional problems
Score >25 — Schedule for a developmental vision evaluation
Call 410-730-8878 to make your appointment today!
More Quizzes and Checklists
• Preschoolers Visual Development
A detailed checklist for parents of Preschoolers. What are the normal stages and ages for visual development? Is your child’s vision developing normally?
• Vision and Learning Disabilities
A short checklist for parents with information on learning disabilities and vision from the American Optometric Association.
• Learning-related Vision Problems
A vision screening quiz for parents and teachers. This multiple-choice quiz gives a numerical score with recommendations.
Ellicott City Total Eye Care serves Ellicott City, Columbia, Laurel, Elkridge, Eldersburg, Baltimore, Catonsville, Randallstown, Olney, Maple Lawn, Dayton and surrounding communities. Call 410-730-8878 to schedule an appointment.