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SPEED II™ Questionnaire

SPEED II Questionnaire

  • Dry Eye Disease is the most frequent reason that patients visit eye doctors. Therefore, we ask that you take a few moments and thoughtfully complete the questionnaire below.

    Report the FREQUENCY of dry eye symptoms you are experiencing by checking Never, Sometimes, Often or Constant using the numbering system below:
  • Report the SEVERITY of your symptoms using the ratings list below:
    0 = No problems
    1 = Tolerable – not perfect but not uncomfortable
    2 = Uncomfortable – irritating but does not interfere with my day
    3 = Bothersome – irritating and interferes with my day
    4 = Intolerable – unable to perform my daily tasks
  • Please mark if you have experienced symptoms:
  • Have you ever been told that you have blepharitis or have you been treated for a stye?