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General information
| Question text: | Has a doctor ever told you that you have any of the below eye diseases or conditions: (please check all that apply) |
| Answer type: | Check boxes |
| Answer options: | 1 Cornea problem, affecting the front clear part of the eye 2 Glaucoma, a problem with eye pressure that affects the optic nerve 3 Cataract, cloudy areas in the lens of the eye that can impede your vision 4 Diabetes-related eye disease like diabetic retinopathy 5 Macular degeneration, an age-related disease of the light-sensing nerves in the back of your eye 6 Retinal vessel blockage, which can result in bleeding and swelling within the light-sensing nerves in the back of your eye 7 Retinal tear or detachment, a problem with separation of the light-sensing layer of nerves from the back of your eye 8 An eye injury or infection 9 Uveitis or scleritis, a problem with inflammation affecting the eye 10 A problem with the eyelid 11 Problems with your vision that require glasses or contacts such as near-sightedness (myopia), far-sightedness (hyperopia), difficulty reading up close (presbyopia), or astigmatism 12 Other, please specify: ~pm001_other 13 I have never been told by a doctor that I have an eye disease or condition |
| Label: | any eye diseases or conditions |
| Empty allowed: | One-time warning |
| Error allowed: | Not allowed |
| Multiple instances: | No |