Age-Related Macular Degeneration - Living Well With Low Vision

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- Resources for Eyecare Professionals
- A Low Vision Rehabilitation Delivery Model

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Patients
Caregivers
Healthcare Professionals
- Resources for Eyecare Professionals
- A Low Vision Rehabilitation Delivery Model

Age-Related Macular Degeneration0 of 21 completed

1: Do you have dry or wet AMD? (This is very important, so if you aren’t sure, please call your clinic.)
Dry (atrophic age-related macular degenerationWet (neovascular age-related macular degeneration
2: Is your condition bilateral (both eyes) or unilateral (one eye)?
both eyes (bilateral)one eye (unilateral)
3: Which stage of AMD best describes your condition?
early (no visual symptoms)Intermediate (dim and/or distorted vision in affected eye)Advanced (areas of vision loss in affected eye)
4: Do you wear either prescription glasses or contacts?
yesno
5: How is the central vision in your best eye with lens correction?
fair-to-good central visionpoor central vision
6: Are your eyes overly sensitive to glare and/or bright light?
yesno
7: Do you take either the AREDS or AREDS-2 formulation of antioxidants and zinc?
yesno
8: Do you have one or more chronic conditions other than AMD (such as heart disease or diabetes)?
yesno
9: Do you get at least 20 minutes of productive exercise (equal to a brisk walk) every day?
yesno
10: Do you currently smoke tobacco?
yesno
11: Which generally describes your regular diet?
healthy (mostly high antioxidant salads, fruits, vegetables, lean meats and fish)unhealthy (mostly prepared foods high in cholesterol and saturated fats)moderately healthy/unhealthy
12: Are you experiencing feelings of depression that you can’t seem to shake?
yesno

13: How often do you engage in activities outside of the home (traveling, volunteering, participating in or attending events, etc.)?
Less than 2 hours a weekUp to 5 hours a weekMore than 5 hours a week
14: Do you live alone in your home or apartment?
yesno
15: Is there someone whom you consider to be your regular caregiver?
yesno
16: Do you drive or have access to transportation?
I drive.I don't drive. I DO have access to transportation.I don't drive. I DO NOT have available transportation.
17: Are you employed either full or part time?
yesno
18: How are you doing financially?
okayI need assistance.
19: Are you an active member of a support group, church, retirement community or do you have other opportunities to be with others?
yesno
20: Are you currently a student?
yesno
21: Do you live in the United States?
YesNo

Your Personalized Results

Congrats! You finished the survey. Now what? View your guide online below or click the button to download a PDF copy.

Your Personalized Results

Congrats! You finished the survey. Now what? View your guide online above or click the button to download a PDF copy.

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