Ten Questions
Which Indicate Functional Deficits
Due to Visual Impairment
(adapted from the VF-25 developed by the Cataract Patient Outcomes Research Team)
1)Do you have difficulty, even with glasses or a magnifier, reading small print, such as labels on medicine bottles, a telephone book, or food labels?
If yes, how much difficulty do you currently have?
1. a little
2. a moderate amount
3. a great deal
4. unable to do the activity because of vision loss
2)Do you have difficulty, even with glasses, recognizing people when they are close to you?
If yes, how much difficulty do you currently have?
1. a little
2. a moderate amount
3. a great deal
4. unable to do the activity because of vision loss
3)Do you have difficulty, even with glasses, seeing steps, stairs, or curbs?
If yes, how much difficulty do you currently have?
1. a little
2. a moderate amount
3. a great deal
4. unable to do the activity because of vision loss
4)Do you have difficulty, even with glasses, writing checks or filling out forms?
If yes, how much difficulty do you currently have?
1. a little
2. a moderate amount
3. a great deal
4. unable to do the activity because of vision loss
5)Do you have difficulty, even with glasses, pouring liquids, setting the oven or burner dials, operating the microwave, chopping, or cutting up foods?
If yes, how much difficulty do you currently have?
1. a little
2. a moderate amount
3. a great deal
4. unable to do the activity because of vision loss
6)Do you have difficulty, even with glasses, identifying coins and bills and accurately making change?
If yes, how much difficulty do you currently have?
1. a little
2. a moderate amount
3. a great deal
4. unable to do the activity because of vision loss
7)Do you have difficulty, even with glasses, eating neatly, selecting matching clothing, clipping your nails, applying toothpaste to your toothbrush?
If yes, how much difficulty do you currently have?
1. a little
2. a moderate amount
3. a great deal
4. unable to do the activity because of vision loss
8)Do you have difficulty, even with glasses, identifying your medications, monitoring your medical condition?
If yes, how much difficulty do you currently have?
1. a little
2. a moderate amount
3. a great deal
4. unable to do the activity because of vision loss
9)Do you have difficulty, even with glasses, watching television?
If yes, how much difficulty do you currently have?
1. a little
2. a moderate amount
3. a great deal
4. unable to do the activity because of vision loss
10)Do you have difficulty, even with glasses, doing fine handiwork like sewing, knitting, carpentry?
If yes, how much difficulty do you currently have?
1. a little
2. a moderate amount
3. a great deal
4. unable to do the activity because of vision loss