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Physicians
Ihor Zachary, MD, FACS
Michael Zgrabik, MD, FACS
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Ophthalmology
Cosmetic Procedures
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>
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What is a Cataract?
Cataract Surgery
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ORA System™
Intraocular Lenses
Post-operative Cataract Surgery Instructions
Cataract Surgery Videos
Cataract Self-Assessment Test
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What is Glaucoma?
Glaucoma Surgery
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Cleveland Eye and Laser Surgery Center
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CATARACT SELF-ASSESSMENT TEST
*
Indicates required field
Name
*
First
Last
Date of Birth (MM/DD/YYYY)
*
Email
*
Phone Number
*
1. How interested are you in seeing at a distance, driving or playing golf without glasses after your cataract surgery?
Choose One
*
It's very important to me to NOT wear glasses for distance vision.
It's not important to me. I do not mind wearing glasses.
2. Are you interested in seeing well up close (reading) without glasses after your cataract surgery?
Choose One
*
It's very important to me NOT to wear reading glasses.
It's not important to me. I do not mind wearing reading glasses to see things up close.
3. If you wear glasses after your vision treatment for one of the following activities, which one would you most be willing to wear glasses for?
Choose One
*
Reading fine print
Using a computer or cooking
Driving a car
4. If you could have good vision for driving during the day without glasses, and good near vision without glasses in most situations, would you be able to tolerate some halos and glare around lights at night?
Choose One
*
Yes
No
5. If you could have good distance vision day and night, and good vision for computer work without glasses, would you be willing to wear glasses for reading fine print and small type?
Choose One
*
Yes
No
6. In our daily lives there are different things we do that require us to see at different distances. We have grouped some of these vision activities into 5 lifestyle zones. Think about the things in life you want to do the most without depending on glasses after cataract surgery. Which group is most important?
Choose One
*
Newsprint, books, reading maps or sewing
Computer screens, menus, price tags or headlines
Watching TV, cooking, cleaning or indoor activities
Driving, playing golf, seeing road signs
Night driving, watching movies
7. Consider your personality. Based on the options scale below, how would you rank your personality?
Choose One
*
Easy going
In the middle
Perfectionist
Submit
Home
Physicians
Ihor Zachary, MD, FACS
Michael Zgrabik, MD, FACS
Services
Ophthalmology
Cosmetic Procedures
Contact Lenses
On-Site Optical Shop
Billing/Insurance Department
Surgical/Diagnostic Department
EYE CENTERS
General Eye Care Center
>
Refractive Error
Pediatric Ophthalmology
Ocular Migraine
How to Insert Eye Drops
Optical Shop
Cataract Center
>
What is a Cataract?
Cataract Surgery
Laser-Assisted Cataract Surgery
ORA System™
Intraocular Lenses
Post-operative Cataract Surgery Instructions
Cataract Surgery Videos
Cataract Self-Assessment Test
Oculoplastics Center
>
Common Eyelid Problems
Eyelid Skin Cancer
Orbital Trauma
Tearing
Eye Removal
Eyelid Surgery
Cosmetic Center
>
Neuromodulators
Facial Fillers
Kybella
Cosmetic Eyelid & Eyebrow Surgery
Glaucoma Center
>
What is Glaucoma?
Glaucoma Surgery
How to Insert Eye Drops
Glaucoma Videos
Cornea Center
>
Dry Eye Syndrome
Blepharitis
Tearing
Conjunctivitis
Corneal Infections
Fuchs Dystrophy
Retina Center
>
Flashes/Floaters
Retinal Detachment
Diabetic Retinopathy
Macular Degeneration
Retina Videos
Patient Information
Appointment Request Form
Contact Request Form
Patient Portal
Care Credit
Contact Us
Contact Information
Cleveland Eye and Laser Surgery Center
Appointment Request Form
Contact Request Form
Featured Products
In-Office Cosmetic Procedures