General Functioning

( 1) Do you have any difficulty, even with glasses, reading small print, such as labels on medicine bottles, a telephone book, food labels?

( 2) Do you have any difficulty, even with glasses, reading a newspaper or a book?

( 3) Do you have any difficulty, even with glasses, reading a large-print book or large-print newspaper or numbers on a telephone?

( 4) Do you have any difficulty, even with glasses, recognizing people when they are close to you?

( 5) Do you have any difficulty, even with glasses, seeing steps, stairs or curbs?

( 6) Do you have any difficulty, even with glasses, reading traffic signs, street signs, or store signs?

( 7) Do you have any difficulty, even with glasses, doing find handwork like sewing, knitting, crocheting, carpentry?

( 8) Do you have any difficulty, even with glasses, writing checks or filling out forms?

( 9) Do you have any difficulty, even with glasses, playing games such as bingo, dominos, card games, mahjong?

(10) Do you have any difficulty, even with glasses, taking part in sports like bowling, handball, tennis, golf?

(11) Do you have any difficulty, even with glasses, cooking?

(12) Do you have any difficulty, even with glasses, watching television?

  

  

(13) Do you currently drive a car?

▪ if Yes, go to 14

▪ if No, go to 16

  

(14) How much difficulty do you have driving during the day because of your vision?

▪ no difficulty (4 points)

▪ a little difficulty (3 points)

▪ a moderate amount of difficulty (2 points)

▪ a great deal of difficulty (1 point)

  

(15) How much difficulty do you have driving at night because of your vision?

▪ no difficulty (4 points)

▪ a little difficulty (3 points)

▪ a moderate amount of difficulty (2 points)

▪ a great deal of difficulty (1 point)

  

(16) Have you ever driven a car?

▪ if Yes, go to 17

▪ if No, stop

  

(17) When did you stop driving?

▪ less than 6 months ago

▪ 6-12 months ago

▪ more than 12 months ago

  

(18) Why did you stop driving?

▪ vision

▪ other illness

▪ other reason

  

Scoring

An item is not included in scoring if the person does not do the activity for some reason other than their vision.

Scores on all activities that the person performed or did not perform because of vision were then averaged, yielding a value from 0 to 4.

This value was multiplied by 25, giving a final score from 0 to 100.

▪ a score of 100 indicates able to do all applicable activities

▪ a score of 0 indicates unable to do all applicable activities because of vision