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Eye Disease Awareness Questionnaire
This questionnaire has been designed to research how many people are aware of the major eye diseases, and how much they know about treatments if they have been diagnosed with eye disease(s). The items are derived from the ones used in previous epidemiological studies in Australia and Singapore.
References:
1. Livingston PM, et al. Knowledge, attitudes, and self care practices associated with age related eye disease in Australia. Br J Ophthalmol. 1998;82:780-5.
2. Huang OS, et al. Lack of awareness of common eye conditions in the community. Ophthalmic Epidemiol. 2013;20:52-60.
Study ID
Participants full name
Date of birth
Gender
What is your highest completed educational level?
Have you ever been told by a doctor that you have cataract?
How would you describe it? (open-ended question)
If no, Have you ever heard of the eye condition cataract?
How would you describe it? (open-ended question)
How was it treated?
| Right eye | Left eye | |
| Surgery | ||
| YAG laser after cataract surgery | ||
| No treatment | ||
| Don't know |
When was the last surgery treatment?
| Right eye | Left eye | |
| e.g., dd/mm/yyyy | ____________ | ____________ |
Where was it treated?
| Right eye | Left eye | |
| Tertiary level hospital | ||
| County-level hospital | ||
| Mobile medical team |
Have you ever been told by a doctor that you have glaucoma?
How would you describe it? (open-ended question)
If no, Have you ever heard of the eye condition glaucoma?
How would you describe it? (open-ended question)
How was it treated?
| Right eye | Left eye | |
| Laser | ||
| Surgery | ||
| Eye drops | ||
| No treatment | ||
| Don't know |
When was the last laser/surgery treatment?
| Right eye | Left eye | |
| e.g., dd/mm/yyyy | ____________ | ____________ |
Where was it treated?
| Right eye | Left eye | |
| Tertiary level hospital | ||
| County-level hospital | ||
| Mobile medical team |
Have you ever been told by a doctor that you have macular degeneration?
How would you describe it? (open-ended question)
If no, Have you ever heard of the eye condition macular degeneration?
How would you describe it? (open-ended question)
How was it treated?
| Right eye | Left eye | |
| Laser | ||
| Intraocular injection | ||
| Surgery | ||
| Eye drops | ||
| No treatment | ||
| Don't know |
When was the last laser/injection/surgery treatment?
| Right eye | Left eye | |
| e.g., dd/mm/yyyy | ____________ | ____________ |
Where was it treated?
| Right eye | Left eye | |
| Tertiary level hospital | ||
| County-level hospital | ||
| Mobile medical team |
Have you ever been told by a doctor that you have diabetic retinopathy?
How would you describe it? (open-ended question)
If no, Have you ever heard of the eye condition diabetic retinopathy?
How would you describe it? (open-ended question)
How was it treated?
| Right eye | Left eye | |
| Laser | ||
| Intraocular injection | ||
| Surgery | ||
| Eye drops | ||
| No treatment | ||
| Don't know |
When was the last laser/injection/surgery treatment?
| Right eye | Left eye | |
| e.g., dd/mm/yyyy | ____________ | ____________ |
Where was it treated?
| Right eye | Left eye | |
| Tertiary level hospital | ||
| County-level hospital | ||
| Mobile medical team |
