Do you think you are not able to see things clearly or there is strain on your eyes?
		Yes		No

Do you bump into objects to the side of your path while walking?
		Yes		No

When entering a dark room (such as cinema), do your eyes take a long time to adjust to be able to see things around you?
		Yes		No

Do you see halos around lights or experience dull pain around the eye after remaining in dim light for some time?
		Yes		No

Are you experiencing sudden double vision?
		Yes		No

Do you see flashes of light or showers of black spots?
		Yes		No

Have you noticed a sudden increase in the number of black spots or floaters in your vision?
		Yes		No

Have your friends noticed that your eyes seems to turn away slightly when you are tired?
		Yes		No