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Myopia Management Quiz

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This quiz is not designed to constitute advice as to your visual health or, more particularly, to provide a diagnosis. An accurate diagnosis for vision problems and conditions can only be made by an eye practitioner following a complete eye examination.
Myopia (nearsightedness) can cause serious eye conditions, especially later in life. If your child has myopia, fill in the quiz below and your eye doctor will contact you to discuss their risk of myopia progression and how it can be prevented.
Age when your child was first diagnosed with myopia
What is the child’s ethnic background?
Which family members have myopia?
On average, how many hours per day does your child spend outdoors?
On average, how many hours per day does your child spend reading from a book, or looking at a computer, tablet, or cell phone screen?
When using a tablet or cell phone, or while reading a book does your child hold it less than 30 cms from their face?
Do you consider your child a bookworm?
Does your child experience eyestrain when working on the computer?
If your child wears glasses, does he or she leave them on when reading?
Even with no signs of progressive myopia, it's important to visit , who will monitor and ensure that your child's vision stays healthy. However, we encourage you to discuss ways to keep myopia from progressing at your child's next routine eye exam.
If your child has been experiencing minor diopter changes, but engages in habits that may increase their refractive error, we can help. Our myopia management program not only treats myopia, but will also guide your child in developing better habits and vision strategies to slow or stop myopia progression in its tracks.
If your child shows consistent and recent signs of progressive myopia, it is critical that you schedule a myopia management consultation with our office as soon as possible. At , we have the technology and expertise to evaluate your child's myopia and offer various treatment options.

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Parent's or Guardians Name *
Child's Name *
Date of Birth *