SPEED Dry Eye Questionnaire Have you experienced Dryness, Grittiness, or Scratchiness?(Required) At this visit Within the past 72 hours Within the past 3 months None of the above What is the frequency of the Dryness, Grittiness or Scratchiness? Never Sometimes Often Constant What is the severity of the Dryness, Grittiness or Scratchiness? No problems Tolerable. Not perfect, but not uncomfortable Uncomfortable. Irritating, but does not interfere with my day Bothersome. Irritating and interferes with my day Intolerable. Unable to perform my daily tasks Have you experienced Soreness or Irritation?(Required) At this visit Within the past 72 hours Within the past 3 months None of the above What is the frequency of the Soreness or Irritation? Never Sometimes Often Constant What is the severity of the Soreness or Irritation? No problems Tolerable. Not perfect, but not uncomfortable Uncomfortable. Irritating, but does not interfere with my day Bothersome. Irritating and interferes with my day Intolerable. Unable to perform my daily tasks Have you experienced Burning or Watering?(Required) At this visit Within the past 72 hours Within the past 3 months None of the above What is the frequency of the Burning or Watering? Never Sometimes Often Constant What is the severity of the Burning or Watering? No problems Tolerable. Not perfect, but not uncomfortable Uncomfortable. Irritating, but does not interfere with my day Bothersome. Irritating and interferes with my day Intolerable. Unable to perform my daily tasks Have you experienced Eye Fatigue?(Required) At this visit Within the past 72 hours Within the past 3 months None of the above What is the frequency of the Eye Fatigue? Never Sometimes Often Constant What is the severity of the Eye Fatigue? No problems Tolerable. Not perfect, but not uncomfortable Uncomfortable. Irritating, but does not interfere with my day Bothersome. Irritating and interferes with my day Intolerable. Unable to perform my daily tasks Do you use eye drops for lubrication? Yes No how often?This field is hidden when viewing the formScoreName(Required) First Last Email(Required) Δ
