Questions on vision impairment and blindness from the National Health Interview Survey Core Questionnaire and 2002 Vision Supplement

1. Do you have any trouble seeing, even when wearing glasses or contact lenses?

(1) Yes (2) No (7) Refused (9) Don't know

2. Are you blind or unable to see at all?

(1) Yes (2) No (7) Refused (9) Don't know

3. Have you EVER been told by a doctor or other health professional that you had…

(1) Yes (2) No (7) Refused (9) Don't know

a. Diabetic retinopathy?

b. Cataracts?

c. Glaucoma?

d. Macular degeneration?

4. During the past 12 months, have you had . . . ?

a. Diabetic retinopathy?

b. Cataracts?

c. Glaucoma?

d. Macular degeneration?

5. Do you use any vision rehabilitation services, such as job training, counseling, or training in daily living skills and mobility?

(1) Yes (2) No (7) Refused (9) Don't know

6. Do you use any adaptive devices such as telescopic or other prescriptive lenses, magnifiers, large print or talking materials, CCTV, white cane, or guide dog?

(1) Yes (2) No (7) Refused (9) Don't know

7. Even when wearing glasses or contact lenses, because of your eyesight, how difficult is it for you . . .

[SHOW CARD (0) Not at all difficult (1) Only a little difficult (2) Somewhat difficult (3) Very difficult (4) Can't do at all (6) Do not do this activity (7) Refused (9) Don't know]

a. To read ordinary print in newspapers?

b. To do work or hobbies that require you to see well up close such as cooking, sewing, fixing things around the house, or using hand tools?

c. To go down steps, stairs or curbs in dim light or at night?

d. To drive during daytime in familiar places?

e. To notice objects off to the side while you are walking along?

f. To find something on a crowded shelf?

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