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Warren Eye Care Center
John Warren, OD
Nina
Terri
Erin
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Ocular Surface Disease Index (OSDI)
Name:
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How long have you experienced dry eye disease?
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Have you experienced any of the following
during the last week?
Eyes that are sensitive to light?
4 - All of the time
3 - Most of the time
2 - Half of the time
1 - Some of the time
0 - None of the time
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Eyes that feel gritty?
4 - All of the time
3 - Most of the time
2 - Half of the time
1 - Some of the time
0 - None of the time
Invalid Input
Painful or sore eyes?
4 - All of the time
3 - Most of the time
2 - Half of the time
1 - Some of the time
0 - None of the time
Invalid Input
Blurred vision?
4 - All of the time
3 - Most of the time
2 - Half of the time
1 - Some of the time
0 - None of the time
Invalid Input
Poor vision?
4 - All of the time
3 - Most of the time
2 - Half of the time
1 - Some of the time
0 - None of the time
Invalid Input
Have problems with your eyes limited you in performing any of the following
during the last week?
Reading?
4 - All of the time
3 - Most of the time
2 - Half of the time
1 - Some of the time
0 - None of the time
N/A
Invalid Input
Driving at night?
4 - All of the time
3 - Most of the time
2 - Half of the time
1 - Some of the time
0 - None of the time
N/A
Invalid Input
Working with a computer or bank machine (ATM)?
4 - All of the time
3 - Most of the time
2 - Half of the time
1 - Some of the time
0 - None of the time
N/A
Invalid Input
Watching TV?
4 - All of the time
3 - Most of the time
2 - Half of the time
1 - Some of the time
0 - None of the time
N/A
Invalid Input
Have your eyes felt uncomfortable in any of the following situations
during the last week?
Windy conditions?
4 - All of the time
3 - Most of the time
2 - Half of the time
1 - Some of the time
0 - None of the time
N/A
Invalid Input
Places or areas with low humidity (very dry)?
4 - All of the time
3 - Most of the time
2 - Half of the time
1 - Some of the time
0 - None of the time
N/A
Invalid Input
Areas that are air conditioned?
4 - All of the time
3 - Most of the time
2 - Half of the time
1 - Some of the time
0 - None of the time
N/A
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Phone: (262) 752-2020
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