Table 6

 Indian vision function questionnaire (33 item)

In the first section, I am going to ask you how much your vision problem affects you in doing your daily activities. I will read out a choice of four answers and you will choose the one you feel describes you best. If you cannot do, or don’t do this activity because of vision, or other reasons, please tell me.
Question NumberGeneral functioning scalePlease tick √response box
Not at allA littleQuite a bitA lotCannot do this because of my sight
1Because of your vision how much problem do you have in climbing stairs?
2Because of your vision how much problem do you have in making out the bumps and holes in the road when walking?
3Because of your vision how much problem do you have in seeing if there are animals or vehicles when walking?
4Because of your vision how much problem do you have in finding your way in new places?
5Because of your vision how much problem do you have in going to social functions such as weddings?
6Because of your vision how much problem do you have in going out at night?
7Because of your vision how much problem do you have in finding your way indoors?
8Because of your vision how much problem do you have in seeing the steps of the bus when climbing in or out?
9Because of your vision how much problem do you have in recognising people from a distance?
10Because of your vision how much problem do you have in recognising the face of a person standing near you?
11Because of your vision how much problem do you have in locking or unlocking the door?
12Because of your vision how much problem do you have in doing your usual work either in the house or outside?
13Because of your vision how much problem do you have in doing your work up to your usual standard?
14Because of your vision how much problem do you have in searching for things at home?
15Because of your vision how much problem do you have in seeing outside in bright sunlight
16Because of your vision how much problem do you have in seeing when coming into the house after being in the sunlight?
17Because of your vision how much problem do you have in seeing differences in colours?
18Because of your vision how much problem do you have in making out differences in coins or notes?
19Because of your vision how much problem do you have in going to the toilet?
20Because of your vision how much problem do you have in seeing objects that may have fallen in the food?
21Because of your vision how much problem do you have in seeing the level in the container when pouring?
In the next section, I am going to ask you how you feel because of your eye problem, I will read out a choice of four answers and you will choose the one you feel describes you best.
Question NumberPsychosocial impact scalePlease tick √ response box
Not at allA littleQuite a bitA lot
22Because of your eye problem do you feel frightened to go out at night?
23Because of your eye problem do you enjoy social functions less?
24Because of your eye problem do you ashamed that you can’t see?
25Because of your eye problem do you feel you have become a burden on others?
26Because of your eye problem do you feel frightened that you may lose your remaining vision?
In the next section, I am going to ask you to what extent do you have the following eye problems. I will read out a choice of four answers and you will choose the one you feel describes you best.
Question NumberVisual symptoms scalePlease tick √ response box
Not at allA littleQuite a bitA lot
27Do you have reduced vision?
28Are you dazzled in bright light?
29Is your vision blurred in sunlight?
30Does bright light hurt your eyes?
31Do you close your eyes because of light from vehicles?
32Does light seem like stars?
33Do you have blurred vision?