| Condition |
T |
B |
F |
VP |
| Skip lines while reading or copying |
X |
X |
|
|
| Skip words while reading or copying |
X |
X |
|
|
| Substitute words while reading or copying |
X |
X |
X |
|
| Reread words or lines |
X |
X |
|
|
| Tilt head in an unusual posture when reading or writing |
|
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 |
|
| Crooked or poorly spaced writing |
|
|
|
X |
| Misalign letters or numbers |
|
|
|
X |
| Unable to make a picture in your mind while reading |
|
|
|
X |
| Feel sleepy while reading |
X |
X |
X |
|
| Car sickness or motion sickness |
X |
X |
X |
|
| Dry eyes |
X |
X |
X |
|
| Watery eyes |
X |
X |
X |
|
| Sensitivity to light |
X |
X |
X |
|
| Totals |
25 |
28 |
16 |
12 |
| Maximum Possible |
69 |
84 |
54 |
55 |
