| Condition |
T |
B |
F |
VP |
| Reverse letters, numbers or words |
|
|
|
X |
| Headaches after intense visual activities such as reading or computer work |
X |
X |
X |
|
| Eyes hurt or feel tired after close work |
X |
X |
X |
|
| Unusually tired after completing a visual task |
X |
X |
X |
|
| Crooked or poorly spaced writing |
|
|
|
X |
| Poor spelling skills |
|
|
|
X |
| Misalign letters or numbers |
|
|
|
X |
| Does not know math facts automatically |
|
|
|
X |
| Unable to remember a series of tasks |
|
|
|
X |
| Below grade level on standardized tests |
X |
X |
X |
X |
| Feel sleepy while reading |
X |
X |
X |
|
| Restless when working at a desk |
X |
X |
X |
X |
| Excessive blinking |
X |
X |
X |
|
| Excessive eye rubbing |
X |
X |
X |
|
| Totals |
18 |
18 |
18 |
23 |
| Maximum Possible |
69 |
84 |
54 |
55 |
