Webinar - Amplify EyeCare

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Vision and Learning

Join our webinar on December 2 ,2021
8pm-9pm

Double vision quiz

The following quiz has 3 parts:

Symptoms
Medical history
Scenarios that involve our eyes

Please rank how relevant any of the following symptoms are to you on a typical day, from a scale of 0 to 4.

0 = I never experience this symptom

1 = I seldom experience this symptom

2 = Every now and then I experience this symptom

3 = I frequently experience this symptom

4 = I always experience this symptom

A. SYMPTOMS

	0	1	2	3	4
Dizziness
Headache
Neckache
Nausea
Anxiety
Unsteady walking
Sensitivity to light
Difficulty with reading
Facial pain
Dry eyes

Have you undergone eye surgery?

Yes

Do you have a lazy eye?

Yes

Do you have a learning disability?

Yes

Have you suffered from a traumatic brain injury?

Yes

Were you in a car accident?

Yes

Please select the accurate answer that best describes how common your experience is with these scenarios:

0 = never

1 = once a month

2 = around once a week

3 = a few times a week

4 = every day

If you wear an optical correction, please answer the following questions, as they pertain to when you are wearing your glasses or contact lenses.

Scenarios

	0	1	2	3	4
When you move your eyes, do you feel pain?
Do you notice yourself closing one eye when you’re looking up close?
Do you notice yourself closing one eye when you’re accomplishing tasks at a distance?
Do you skip lines or find yourself losing your place when you’re reading?
Do you tend to use your finger or something like a ruler to keep your place on the page when you’re reading?
Do you notice that when you are doing work up close, such as being on the computer, reading, etc, that you get nauseous, dizzy or light headed?
Do you notice yourself drifting to one side when you walk?
Do you get car sick?
Do you experience blurry vision when looking at targets at a distance, such as watching TV or looking at the board at school?
Do you experience blurry vision when looking at targets up close?
Have you noticed that you have a hard time judging how far away an object is from you?
When you look out to the distance, do you notice that you’re seeing shadows in your vision or that what you are viewing appears to be overlapping with another image?
When you look up close, do you notice that you’re seeing shadows in your vision or that what you are viewing appears to be overlapping with another image?
Do you notice that you get tired when trying to perform tasks up close, such as reading or being on the computer?
Do you notice yourself blinking intensely when you go from looking at a distance, such as watching TV, to looking at something up close, like your cellphone?

If any of your answers were a 4, it is advisable to come see us, and any score above 12 is a sign that it’s a very good idea to be evaluated for double vision.

There is a possibility that double vision is causing the symptoms that you are experiencing and we welcome you to schedule an eye exam.

If you would like a vision therapist to look over your quiz and contact you about your results, please fill out this form.

Closest Amplify EyeCare Location

First Name

Last Name

Phone/Mobile

Play Video

Vision After Traumatic Brain Injury

Join our webinar on December 9, 2021
8pm-9pm

Double vision quiz

The following quiz has 3 parts:

Symptoms
Medical history
Scenarios that involve our eyes

Please rank how relevant any of the following symptoms are to you on a typical day, from a scale of 0 to 4.

0 = I never experience this symptom

1 = I seldom experience this symptom

2 = Every now and then I experience this symptom

3 = I frequently experience this symptom

4 = I always experience this symptom

A. SYMPTOMS

	0	1	2	3	4
Dizziness
Headache
Neckache
Nausea
Anxiety
Unsteady walking
Sensitivity to light
Difficulty with reading
Facial pain
Dry eyes

Have you undergone eye surgery?

Yes

Do you have a lazy eye?

Yes

Do you have a learning disability?

Yes

Have you suffered from a traumatic brain injury?

Yes

Were you in a car accident?

Yes

Please select the accurate answer that best describes how common your experience is with these scenarios:

0 = never

1 = once a month

2 = around once a week

3 = a few times a week

4 = every day

If you wear an optical correction, please answer the following questions, as they pertain to when you are wearing your glasses or contact lenses.

Scenarios

	0	1	2	3	4
When you move your eyes, do you feel pain?
Do you notice yourself closing one eye when you’re looking up close?
Do you notice yourself closing one eye when you’re accomplishing tasks at a distance?
Do you skip lines or find yourself losing your place when you’re reading?
Do you tend to use your finger or something like a ruler to keep your place on the page when you’re reading?
Do you notice that when you are doing work up close, such as being on the computer, reading, etc, that you get nauseous, dizzy or light headed?
Do you notice yourself drifting to one side when you walk?
Do you get car sick?
Do you experience blurry vision when looking at targets at a distance, such as watching TV or looking at the board at school?
Do you experience blurry vision when looking at targets up close?
Have you noticed that you have a hard time judging how far away an object is from you?
When you look out to the distance, do you notice that you’re seeing shadows in your vision or that what you are viewing appears to be overlapping with another image?
When you look up close, do you notice that you’re seeing shadows in your vision or that what you are viewing appears to be overlapping with another image?
Do you notice that you get tired when trying to perform tasks up close, such as reading or being on the computer?
Do you notice yourself blinking intensely when you go from looking at a distance, such as watching TV, to looking at something up close, like your cellphone?

If any of your answers were a 4, it is advisable to come see us, and any score above 12 is a sign that it’s a very good idea to be evaluated for double vision.

There is a possibility that double vision is causing the symptoms that you are experiencing and we welcome you to schedule an eye exam.

If you would like a vision therapist to look over your quiz and contact you about your results, please fill out this form.

Closest Amplify EyeCare Location

First Name

Last Name

Phone/Mobile

Volume I: Vision & Learning

Help your student succeed in class by understanding their vision

Play Video

A webinar for educators by pediatric optometrists Dr. Nat Wernik and Dr. Sarah Pinkhasov

Recorded: February 22, 2022

Facebook Live

YOUTUBE Live

Play Video

Sports Vision

Join our webinar on January 6, 2022
8pm-9pm

Double vision quiz

The following quiz has 3 parts:

Symptoms
Medical history
Scenarios that involve our eyes

Please rank how relevant any of the following symptoms are to you on a typical day, from a scale of 0 to 4.

0 = I never experience this symptom

1 = I seldom experience this symptom

2 = Every now and then I experience this symptom

3 = I frequently experience this symptom

4 = I always experience this symptom

A. SYMPTOMS

	0	1	2	3	4
Dizziness
Headache
Neckache
Nausea
Anxiety
Unsteady walking
Sensitivity to light
Difficulty with reading
Facial pain
Dry eyes

Have you undergone eye surgery?

Yes

Do you have a lazy eye?

Yes

Do you have a learning disability?

Yes

Have you suffered from a traumatic brain injury?

Yes

Were you in a car accident?

Yes

Please select the accurate answer that best describes how common your experience is with these scenarios:

0 = never

1 = once a month

2 = around once a week

3 = a few times a week

4 = every day

If you wear an optical correction, please answer the following questions, as they pertain to when you are wearing your glasses or contact lenses.

Scenarios

	0	1	2	3	4
When you move your eyes, do you feel pain?
Do you notice yourself closing one eye when you’re looking up close?
Do you notice yourself closing one eye when you’re accomplishing tasks at a distance?
Do you skip lines or find yourself losing your place when you’re reading?
Do you tend to use your finger or something like a ruler to keep your place on the page when you’re reading?
Do you notice that when you are doing work up close, such as being on the computer, reading, etc, that you get nauseous, dizzy or light headed?
Do you notice yourself drifting to one side when you walk?
Do you get car sick?
Do you experience blurry vision when looking at targets at a distance, such as watching TV or looking at the board at school?
Do you experience blurry vision when looking at targets up close?
Have you noticed that you have a hard time judging how far away an object is from you?
When you look out to the distance, do you notice that you’re seeing shadows in your vision or that what you are viewing appears to be overlapping with another image?
When you look up close, do you notice that you’re seeing shadows in your vision or that what you are viewing appears to be overlapping with another image?
Do you notice that you get tired when trying to perform tasks up close, such as reading or being on the computer?
Do you notice yourself blinking intensely when you go from looking at a distance, such as watching TV, to looking at something up close, like your cellphone?

If any of your answers were a 4, it is advisable to come see us, and any score above 12 is a sign that it’s a very good idea to be evaluated for double vision.

There is a possibility that double vision is causing the symptoms that you are experiencing and we welcome you to schedule an eye exam.

If you would like a vision therapist to look over your quiz and contact you about your results, please fill out this form.

Closest Amplify EyeCare Location

First Name

Last Name

Phone/Mobile

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Webinar Series

Our Webinars

Vision and Learning

Vision After Traumatic Brain Injury

Volume I: Vision & Learning

Help your student succeed in class by understanding their vision

A webinar for educators by pediatric optometrists Dr. Nat Wernik and Dr. Sarah Pinkhasov

Sports Vision

Amplify EyeCare Practices

Children's Vision Services

Dry Eye