COVD Quality of Life Checklist

To take the vision quiz, check the column which best represents the occurrence of each symptom.








ABlur when looking at near
AHeadaches with near work
ASees worse at end of the day
ADifficulty copying from the Chalkboard
AAvoids near work/reading
AHolds head too close to the page
BHas double vision
BWords run together while reading
BEyes burn, itch, or seem watery
BFalls asleep while reading
BCloses one eye or tilts head while reading
ORDizzy or nauseous with near work
ORWrites up or down hill
ORPoor/inconsistent in sports
ORAvoids sports/games
ORPoor hand-eye coordination/poor handwriting
ORClumsy/knocks things over
ORCar/motion sickness
OMSkips or repeats lines when reading
OMMisaligns digits/columns of numbers
PReading comprehension is poor
PTrouble keeping attention on reading
PSays “I can’t” before trying
PDoes not use his/her time well
PDoes not make change well with money
PLoses belongings/things
PForgetful/poor memory
ALLDifficulty completing assignments on time
ALLDoes 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.