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Dry Eye Research Survey
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Please indicate your age range.
20 or Younger
21-30
31-40
41-50
51-60
61-70
71-80
81 or Older
Clear selection
Please state if the cause of your dry eye has been identified. For example, Graft vs. Host disease, Sjorgen's Syndrome, LASIK, etc.
Your answer
On a scale of 1 to 10, 1 being not an issue and 10 being unbearable, how much of a hindrance are dry eye symptoms to your daily life?
1
2
3
4
5
6
7
8
9
10
Clear selection
How have the symptoms of dry eye negatively impacted your day to day life? Please provide examples.
Your answer
What dry eye treatments are you currently using?
Artificial Tears
Eye lubricants
Restasis
Autologous Serum Tears
Tear Duct Plugs
Other:
What dry eye treatments have you used in the past and do not currently use?
Artificial Tears
Eye lubricants
Restasis
Autologous Serum Tears
Tear Duct Plugs
Other:
For each previous dry eye treatment, why did you choose to discontinue use?
For example, it was not effective, you experience side effects, it was inconvenient, etc.
Your answer
Approximately how much money per month do you spend on your current dry eye treatments?
Your answer
If you have previously or currently used Autologous Serum Tears, do you experience any issues using this therapy as prescribed? Please provide examples.
Your answer
Have you ever experienced difficulty in administering any other dry eye therapies? Please provide examples.
Your answer
Is there anything else you would like to share regarding your dry eye symptoms, treatments, or dry eye routine?
Your answer
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