Cataract Self Survey | Capitol Eye Care

Take the Cataract Self Survey

To determine if cataract surgery is right for you, please fill out the form. If you have any questions, please do not hesitate to contact us.

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How interested are you in seeing at a distance, driving or playing golf without glasses after your cataract surgery?
My distance vision is
Are you interested in seeing well up close (reading) without glasses after your cataract surgery?
My close vision is
If you had to wear glasses after your vision treatment for one of the following activities, which one would you most be willing to wear glasses for?
Do you suffer from halos and glare while driving at night?
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?
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?
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