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PEDIG Forms / Questionnaires

Amblyopia Treatment Index - a quality of life questionnaire to assess the impact of atropine or patching treatment on child and family

 

Nasolacrimal Duct Obstruction - a symptom survey and quality of life questionnaire for Nasolacrimal Duct Obstruction in Children

 

Intermittent Exotropia Questionnaire (IXTQ) - 3 questionnaires- one for the child, one for the parent about the child (proxy), and one for the parent about themselves.

  • Child < 5 years - (2 questionnaires- proxy and parent questionnaires, no child questionnaire)
  • Child 5-7 years - (3 questionnaires- child 5-7y questionnaire, proxy and parent questionnaires)
     
  • Child 8-17 years - (3 questionnaires- child 8-17y questionnaire, proxy and parent questionnaires)
 

Pediatric Eye Questionnaires (PedEyeQ)

Pediatric Eye Questionnaire for Children Ages 0-4 Years

 

Pediatric Eye Questionnaire for Children Ages 5-11 Years 

 

Pediatric Eye Questionnaire for Children Ages 12-17 Years