Visual Stress Questionnaire

1. Reading and Near Work
Words blur or move on the pageLetters or lines double up or disappearI lose my place when readingI need to re-read text to understand itI read more easily with colored paper or background

2. Pattern Sensitivity
Stripes, checks, or repetitive patterns cause discomfortStrong contrasts (e.g. black text on bright white paper) are uncomfortableGeometric patterns (grids, escalators, blinds) make me dizzy or tired

3. Light Sensitivity
I am sensitive to bright sunlightFluorescent or LED lights bother meGlare from screens, paper, or shiny surfaces cause strainSymptoms change depending on time of day or lighting conditions

4. Headaches and Eye Discomfort
I get headaches after reading or screen useI feel pressure or strain around the eyesHeadaches are worse in bright light

5. Screen Use
I struggle with computer or phone useI notice text blurs or shimmers when scrollingI need to adjust screen brightness or color to cope

6. Daily Impact
I avoid reading or limit the amount I readNight driving or glare is difficultMy work or study is affectedSunglasses or colored filters sometimes make me more comfortable

7. Family Link
A family member has similar symptomsI have tried tinted glasses and noticed a difference

8. Dry Eyes
I suffer from dry eyesDry eye drops do not help me much