| Condition |
T |
B |
F |
VP |
| Substitute words while reading or copying |
X |
X |
X |
|
| Reread words or lines |
X |
X |
|
|
| Read very slowly |
X |
X |
X |
|
| Close (within 7‐8″) to reading and/or writing material |
|
X |
X |
|
| Squint, close or cover one eye while reading |
|
X |
|
|
| Tilt head in an unusual posture when reading or writing |
|
X |
|
|
| Unusually tired after completing a visual task |
X |
X |
X |
|
| Vision blurs at distance when looking up from near work |
|
X |
X |
|
| Difficulty with eye‐hand coordination sports such as baseball |
X |
X |
|
X |
| Does not know math facts automatically |
|
|
|
X |
| Feel sleepy while reading |
X |
X |
X |
|
| Restless when working at a desk |
X |
X |
X |
X |
| You must feel things to “see” them |
|
|
|
X |
| Dry eyes |
X |
X |
X |
|
| Watery eyes |
X |
X |
X |
|
| Sensitivity to light |
X |
X |
X |
|
| Totals |
22 |
34 |
22 |
10 |
| Maximum Possible |
69 |
84 |
54 |
55 |
