Dry Eye Quiz

SPEED™ Questionnaire

For the Standardized Patient Evaluation of Eye Dryness (SPEED) Questionnaire, please answer the following questions by checking the box that best represents your answer. Select only one answer per question.

Contact Information

What symptoms are you experiencing?*

Gritty, dry, or scratchy eyesSore and irritated eyesBurning and watering eyesFluctuating visionFluctuating visionItchy eyesTired eyesSensitivity to lightMucus in and around the eyesRed eyesNone of the above

Do you suffer from any of the following?*

RosaceaAtopic or seborrhoea dermatitisHormone imbalance such as thyroid disease or sex hormone problemsSjogren syndromeAcnePsoriasisConnective tissue disease such as rheumatoid arthritisDry mouth, throat or vaginaNone of the above

What is your usual environment?*

Office-based workAir-conditionedAir pollutionSmokeyWindyExtreme heatHeated environmentPoor lightingOutdoorsDustyLow humidityExtreme cold

What best describes you?*

I wear eye makeupI spend more than four hours a day in front of screensI take natural breaks away from my computer every 20-30 minutesI often use eye dropI have eye irritation and grittiness that gets progressively worse throughout the dayMy face sweats a lotI spend less than 4 hours a day in front of screensI often go to swimming poolsI have eye irritation when I wake up from sleep

Do you wear contact lenses?*

NeverSometimesAlways

Did you have LASIK Laser Eye Surgery?*

YesNo

How many glasses of water do you drink in a day?*

What is your diet like?*

Are you often surrounded by cigarette smoke?*

YesNo

Do you take any medication?*

NoYes, for high blood pressureYes, I'm on hormone replacement therapyYes, for depressionYes, for my allergiesYes, for my acne (something like isotretinoin)Yes, for another condition not mentioned

Thank you for taking our quiz!

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You might be experiencing symptoms of dry eye.

Based on your responses, there could be one or more factors contributing to the discomfort in your eyes. We recommend scheduling an appointment with Dr. Raley to explore options for preventing and managing dry eye symptoms. Our team is here to provide personalized care and support, ensuring your comfort and well-being.

Great news! It's highly likely that you have a low risk of experiencing dry eye syndrome.

We understand the importance of maintaining good eye health for clear vision and protection against eye infections, so we want to make sure you don't take any chances. When it comes to eye conditions, early treatment is key to achieving the best outcomes. That's why we encourage you to schedule an appointment with Dr. Raley. We can discuss your eye health and explore options to prevent any potential dry eye symptoms. Rest assured, we're here to provide personalized care and ensure your comfort throughout the process.

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