( ) During 2019
( ) During 2018
( ) During 2017
( ) Before 2017
( ) Never

( ) During 2018
( ) During 2017
( ) During 2016
( ) Before 2016
( ) Never

Which of the following year(s) did you have an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. MARK ALL THAT APPLY

() During 2017
() During 2016
() During 2015
() Before 2015
() Never

When was the last time you had an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. (CHECK ONE)

During 2001 .............................. () 1
During 2000 .............................. () 2
During 1999 .............................. () 3
Before 1999 .............................. () 4
Never ........................................ () 5

Which of the following year(s) did you have an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. MARK ALL THAT APPLY

During 2015 ......................................()
During 2014 ......................................()
During 2013 ......................................()
Before 2013 ......................................()
Never ................................................()

4. Which of the following year(s) did you have an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. MARK ALL THAT APPLY

During 2014 ......................................()
During 2013 ......................................()
During 2012 ......................................()
Before 2012 ......................................()
Never ................................................()

Which of the following year(s) did you have an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. MARK ALL THAT APPLY.

During 2013 ......................................()
During 2012 ......................................()
During 2011 ......................................()
Before 2011 ......................................()
Never ................................................()

Which of the following year(s) did you have an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. MARK ALL THAT APPLY.

During 2012 ......................................()
During 2011 ......................................()
During 2010 ......................................()
Before 2010 ......................................()
Never ................................................()

When was the last time you had an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. (CHECK ONE)

During 2001 .............................. () 1
During 2000 .............................. () 2
During 1999 .............................. () 3
Before 1999 .............................. () 4
Never ........................................ () 5

Which of the following year(s) did you have an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. (CHECK ALL THAT APPLY)

During 2010..........................................() 1
During 2009..........................................() 2
During 2008..........................................() 3
Before 2008 .........................................() 4
Never....................................................() 00

Which of the following year(s) did you have an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. (CHECK ALL THAT APPLY)

During 2009..........................................() 1
During 2008..........................................() 2
During 2007..........................................() 3
Before 2007 .........................................() 4
Never....................................................() 00

Which of the following year(s) did you have an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. (CHECK ALL THAT APPLY)

During 2008 .............................. () 1
During 2007 .............................. () 2
During 2006 .............................. () 3
Before 2006 .............................. () 4
Never......................................... () 00

Which of the following year(s) did you have an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. (CHECK ALL THAT APPLY)

During 2007 .............................. () 1
During 2006 .............................. () 2
During 2005 .............................. () 3
Before 2005 .............................. () 4
Never ........................................ () 00

Which of the following year(s) did you have an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. (CHECK ALL THAT APPLY)

During 2006 .............................. () 1
During 2005 .............................. () 2
During 2004 .............................. () 3
Before 2004 .............................. () 4
Never ........................................ () 00

Which of the following year(s) did you have an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. (CHECK ALL THAT APPLY)

During 2005 .............................. () 1
During 2004 .............................. () 2
During 2003 .............................. () 3
Before 2003 .............................. () 4
Never ........................................ () 00

Which of the following year(s) did you have an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. (CHECK ALL THAT APPLY)

During 2003 .............................. () 1
During 2002 .............................. () 2
During 2001 .............................. () 3
Before 2001 .............................. () 4
Never ........................................ () 00

When was the last time you had an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. (CHECK ONE)

During 2002 .............................. () 1
During 2001 .............................. () 2
During 2000 .............................. () 3
Before 2000 .............................. () 4
Never ........................................ () 5

When was the last time you had an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light. (CHECK ONE)

During 2001 .............................. () 1
During 2000 .............................. () 2
During 1999 .............................. () 3
Before 1999 .............................. () 4
Never ........................................ () 5