Welcome to the Standardized Patient Evaluation of Eye Dryness (SPEED) Questionnaire!

This short questionnaire allows us to determine the severity and frequency of your eye dryness and will provide a score once completed. Let's get started!

Have you experienced Dryness, Grittiness or Scratchiness within the past 3 months?(Required)

Yes

No

Press Enter

Have you experienced Dryness, Grittiness or Scratchiness within the past 72 hours?(Required)

Yes

No

Press Enter

Have you experienced Dryness, Grittiness or Scratchiness today?(Required)

Yes

No

Press Enter

Have you experienced Soreness or Irritation within the past 3 months?(Required)

Yes

No

Press Enter

Have you experienced Soreness or Irritation within the past 72 hours?(Required)

Yes

No

Press Enter

Have you experienced Soreness or Irritation today?(Required)

Yes

No

Press Enter

Have you experienced Burning or Watering within the past 3 months?(Required)

Yes

No

Press Enter

Have you experienced Burning or Watering within the past 72 hours?(Required)

Yes

No

Press Enter

Have you experienced Burning or Watering today?(Required)

Yes

No

Press Enter

Have you experienced Eye Fatigue within the past 3 months?(Required)

Yes

No

Press Enter

Have you experienced Eye Fatigue within the past 72 hours?(Required)

Yes

No

Press Enter

Have you experienced Eye Fatigue today?(Required)

Yes

No

Press Enter

Now, let's find out how frequently your symptoms are occurring:

Press Enter

How often do you experience DRYNESS, GRITTINESS, or SCRATCHINESS?(Required)

Never

Sometimes

Often

Constant

Press Enter

How often do you experience SORENESS or IRRITATION?(Required)

Never

Sometimes

Often

Constant

Press Enter

How often do you experience BURNING or WATERING?(Required)

Never

Sometimes

Often

Constant

Press Enter

How often do you experience EYE FATIGUE?(Required)

Never

Sometimes

Often

Constant

Press Enter

Thanks! Now, help us understand the severity of your symptoms:

Press Enter

How severe is the DRYNESS, GRITTINESS, or SCRATCHINESS?(Required)

No Problems

Tolerable - not perfect, but not uncomfortable

Uncomfortable - irritating, but does not interfere with my day

Bothersome - irritating and interferes with my day

Intolerable - unable to perform my daily tasks

Press Enter

How severe is the SORENESS or IRRITATION?(Required)

No Problems

Tolerable - not perfect, but not uncomfortable

Uncomfortable - irritating, but does not interfere with my day

Bothersome - irritating and interferes with my day

Intolerable - unable to perform my daily tasks

Press Enter

How severe is the BURNING or WATERING?(Required)

No Problems

Tolerable - not perfect, but not uncomfortable

Uncomfortable - irritating, but does not interfere with my day

Bothersome - irritating and interferes with my day

Intolerable - unable to perform my daily tasks

Press Enter

How severe is the EYE FATIGUE?(Required)

No Problems

Tolerable - not perfect, but not uncomfortable

Uncomfortable - irritating, but does not interfere with my day

Bothersome - irritating and interferes with my day

Intolerable - unable to perform my daily tasks

Press Enter

Do you use eye drops for lubrication?(Required)

Yes

No

Press Enter

How often do you use eye drops?(Required)

Press Enter

One last thing...

please provide us with your information so we can finish calculating your score:

Press Enter

Name

First Last

Press Enter

Sex

Press Enter

Date of Birth

MM slash DD slash YYYY

Press Enter

This field is hidden when viewing the form

Total Speed Score

Press Enter

Press Enter

Δ

0% Completed!

🎉 1st Ever Annual Trunk Show

One Day Only.
Big Savings on Frames.

Thursday, 12/11 • 12:00 PM – 6:00 PM

It’s our 1st ever annual trunk show and you’re invited!
Join us for an afternoon packed with style, savings, and surprises.

Event-exclusive frame discounts you won’t see again soon
Expanded inventory with styles brought in just for this event
Refreshments & treats while you browse
Plus a few fun surprises 👀

Limited-time event • Walk-ins welcome