Take the Vision Test

Learn if a vision dysfunction may be contributing to your symptoms.

Does your child’s vision contribute to learning challenges?

This vision and learning questionnaire helps determine if your child’s symptoms are attributed to a vision dysfunction.


Complete this test by selecting the option that best describes how often each symptom occurs. It is helpful to have your child participate by answering some of the questions on their own.

Blur when looking at near
Double vision, doubled or overlapping words on page
Headaches while or after doing near vision work
Words appear to run together when reading
Burning, itching or watery eyes
Falls asleep when reading
Seeing and visual work is worse at the end of the day
Skips or repeats lines while reading
Dizziness or nausea when doing near work
Head tilts or one eye is closed or covered while reading
Difficulty copying from the chalkboard
Avoids doing near vision work such as reading
Omits (drops out) small words while reading
Writes up or down hill
Misaligns digits or columns of numbers
Reading comprehension low, or declines as day wears on
Poor, inconsistent performance in sports
Holds books too close, leans too close to computer screen
Trouble keeping attention centered on reading
Difficulty completing assignments on time
First response is “I can’t” before trying
Avoids sports and games
Poor hand/eye coordination, such as poor handwriting
Does not judge distances accurately
Clumsy, accident prone, knocks things over
Does not use or plan his/her time well
Does not count or make change well
Loses belongings and things
Car or motion sickness
Forgetful, poor memory

Your total vision score: 0


Enter your email address to receive a summary of results.


According to the American Optometric Association, a score of 20 or more points* or the persistence of 1-2 symptoms indicates the need for a Functional Vision Exam. (*JAM Optom Assoc 2006; 77:116-123)

Even if the score is less than 20, and you have a concern with your child’s academic or overall performance, a Functional Vision Exam is a definitive way to rule out whether vision is contributing to those challenges.

Is your vision contributing to headaches, dizziness, or anxiety?

This Binocular Vision Dysfunction & Neuro-Optometry questionnaire helps determine if you might have a Binocular Vision Disorder. It will also help determine if your presenting symptoms are related to an eye misalignment, especially following a concussion or Traumatic-Brain Injury TBI.


Complete this test by selecting the option that best describes how often each symptom occurs. You will also be asked to rate the severity of symptoms.

Do you have headaches and/or facial pain?
Do you have pain in your eyes with eye movement?
Do you experience neck or shoulder discomfort?
Do you have dizziness and/or light headedness?
Do you experience dizziness, light headedness, or nausea while performing close-up activities
(computer work, reading, writing, etc.)?
Do you experience dizziness, light headedness or nausea while performing far-distance activities (driving,
television, movies, etc.)?
Do you experience dizziness, light headedness, or nausea when bending down and standing back up, or when
getting up quickly from a seated position?
Do you feel unsteady or drift to one side while walking?
Do you feel overwhelmed or anxious while walking in a large department store (Target, Wal-Mart, Costco, etc.)?
Do you feel overwhelmed or anxious when in a crowd?
Does riding in a car make you feel dizzy or uncomfortable?
Do you experience anxiety or nervousness because of your dizziness?
Do you ever find yourself with your head tilted to one side?
Do you experience poor depth perception or have difficulty estimating distances accurately?
Do you experience double/overlapping/shadowed vision at far distances?
Do you experience double/overlapping/shadowed vision at near distances?
Do you experience glare or have sensitivity to bright lights?
Do you close or cover one eye with near or far tasks?
Do you skip lines or lose your place when you are reading? Do you use your finger, ruler or other guides to
maintain your position on the page?
Do you tire easily with close-up tasks (computer work, reading, writing)?
Do you experience blurred vision with far-distance activities (driving, television, movies, chalkboard at
school, etc.)?
Do you experience blurred vision with close-up activities (computer work, reading, writing, etc.)?
Do you blink to ‘clear up’ distant objects after working at a desk or working with close-up activities
(computer work, reading, writing, etc.)?
Do you experience words running together while reading?
Do you experience difficulty with reading or reading comprehension?
Dizziness
10 is the worst it could be, and 0 means you have none of that symptom
Nausea
10 is the worst it could be, and 0 means you have none of that symptom
Anxiety
10 is the worst it could be, and 0 means you have none of that symptom
Headache
10 is the worst it could be, and 0 means you have none of that symptom
Neckache
10 is the worst it could be, and 0 means you have none of that symptom
Unsteady when walking
10 is the worst it could be, and 0 means you have none of that symptom
Sensitivity to light
10 is the worst it could be, and 0 means you have none of that symptom
Reading difficulty
10 is the worst it could be, and 0 means you have none of that symptom

Your total vision score: 0


Enter your email address to receive a summary of results.


A score of 15 or more points or the persistence of 1-2 symptoms indicates the need for a Neuro-Optometric Vision Exam.

Even if the score is less than 15, and you have a concern with the symptoms you are experiencing, a Neuro-Optometric Exam is a definitive way to rule out whether vision is contributing to your symptoms.

These surveys are not a substitute for consulting a physician and do not provide diagnoses.

Our doctors specialize in diagnosing and treating vision dysfunctions that impact school, work, sports and performance in daily activities. This includes reading, comprehension, sustaining attention, driving and many other activities as well as behaviors. Contact us if you have questions regarding your symptoms at 630-323-7300.

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