| Condition |
T |
B |
F |
VP |
| Reread words or lines |
X |
X |
|
|
| Unusually tired after completing a visual task |
X |
X |
X |
|
| Vision blurs at distance when looking up from near work |
|
X |
X |
|
| Poor spelling skills |
|
|
|
X |
| Difficulty tracking moving objects |
X |
X |
|
|
| Clumsiness or poor coordination |
X |
X |
X |
X |
| Difficulty with eye‐hand coordination sports such as baseball |
X |
X |
|
X |
| Poor word recall & recognition |
|
|
|
X |
| Difficulty following instructions (written or verbal) |
|
|
|
X |
| Unable to remember a series of tasks |
|
|
|
X |
| Losing awareness of surroundings when concentrating |
X |
X |
X |
X |
| You must feel things to “see” them |
|
|
|
X |
| Excessive blinking |
X |
X |
X |
|
| Dry eyes |
X |
X |
X |
|
| Totals |
19 |
22 |
13 |
19 |
| Maximum Possible |
69 |
84 |
54 |
55 |
