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Home » Eye Care Services » Myopia Management » Myopia Management Quiz

Myopia Management Quiz

Myopia Risk Assessment - New

*DISCLAIMER: 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
- Never diagnosed
- Younger than 5
- 5-10
- 10-15
- 16 and older
What is the child’s ethnic background?
- Asian/Pacific Islander
- Caucasian
- African American
- Hispanic
Which family members have myopia?
- Father
- Mother
- Brother
- Sister
On average, how many hours per day does your child spend outdoors?
- Less than 30 minutes
- 30 to 60 minutes
- 1-2 hours
- More than 2 hours
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?
- Less than 30 minutes
- 30 to 60 minutes
- 1 to 2 hours
- More than 2 hours
When using a tablet or cell phone, or while reading a book does your child hold it less than 30 cms from their face?
- Yes
- No
Do you consider your child a bookworm?
- Yes
- No
Does your child experience eyestrain when working on the computer?
- Yes
- No
If your child wears glasses, does he or she leave them on when reading?
- Yes
- No
Total risk score
high risk
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 Urban Eyes, we have the technology and expertise to evaluate your child's myopia and offer various treatment options.
moderate risk
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 Dr. Dana Kindberg will also guide your child in developing better habits and vision strategies to slow or stop myopia progression in its tracks.
low risk
Even with no signs of progressive myopia, it's important to visit
Want to discuss your score? Leave us your info!
Our team will contact you to discuss your results within 24-48 business hours. You can also call the office and ask them to check up your results as well.
Parent’s or Guardian’s Name*
First Last
Phone*
Email*
Child’s First Name
Age

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Urban Eyes

400 Urban Plaza, E-110
Kirkland, WA 98033

Phone: 425-403-2020

Monday: 10:00 AM - 7:00 PM
Tuesday: 10:00 AM - 7:00 PM
Wednesday: 10:00 AM - 7:00 PM
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Saturday: 10:00 AM - 7:00 PM
Sunday: 11:00 AM - 5:00 PM

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Urban Eyes
400 Urban Plaza, E-110
Kirkland, WA 98033
Phone: 425-403-2020
https://www.myurbaneyes.com

Fax: 425-490-5448

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