Myopia Management Quiz

*DISCLAIMER: This quiz is not designed to constitute advice as to your visual health or, more particularly, to provide a diagnosis. An accurate diagnosis for vision problems and conditions can only be made by an eye practitioner following a complete eye examination.

Myopia (nearsightedness) can cause serious eye conditions, especially later in life. If your child has myopia, fill in the quiz below and your eye doctor will contact you to discuss their risk of myopia progression and how it can be prevented.

1. Age when your child was first diagnosed with myopia

• Never diagnosed
• Younger than 5
• 5-10
• 10-15
• 16 and older

2. What is the child’s ethnic background?

• Asian/Pacific Islander
• Caucasian
• African American
• Hispanic
• Other

3. Which family members have myopia?

• Father
• Mother
• Brother
• Sister

4. On average, how many hours per day does your child spend outdoors?

• Less than 30 minutes
• 30 to 60 minutes
• 1-2 hours
• More than 2 hours

5. On average, how many hours per day does your child spend reading from a book, or looking at a computer, tablet, or cell phone screen?

• Less than 30 minutes
• 30 to 60 minutes
• 1 to 2 hours
• More than 2 hours

6. When using a tablet or cell phone, or while reading a book does your child hold it less than 30 cms from their face?

• Yes
• No

7. Do you consider your child a bookworm?

• Yes
• No

8. Does your child experience eyestrain when working on the computer?

• Yes
• No

9. If your child wears glasses, does he or she leave them on when reading?

• Yes
• No

Our team will contact you to discuss your results within 24-48 business hours. You can also call the office at (609) 386-0202 to check on your results.

• Parent’s or Guardian’s Name
• Phone
• Email
• Child’s First Name
• Age