MYZE

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What’s your first name?We’ll use this to personalize your experience.

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1. Do your EYES FEEL IRRITATED, ITCHY OR GRITTY, like there’s something in there?

Never

Sometimes

Half of the time

All of the time

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2. Do your EYES FEEL LIKE THEY’RE BURNING, ACHY OR SORE?

Never

Sometimes

Half of the time

All of the time

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3. Are your EYES WATERY OR TEARY?

Never

Sometimes

Half of the time

All of the time

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4. Do your EYES FEEL TIRED OR FATIGUED?

Never

Sometimes

Half of the time

All of the time

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5. Do you have BLURRED VISION, even with glasses or contacts on?

Never

Sometimes

Half of the time

All of the time

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6. Are your EYES RED AND IRRITATED?

Never

Sometimes

Half of the time

All of the time

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7. When do your eyes feel and look their worst?

Morning (when you wake up)

Evening (at the end of your day)

Always

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8. Do your symptoms get in the way of…(select all that apply)

Enjoying a sunny or breezy day

Reading a good book

Using my computer for work or fun

Watching my favorite TV shows

Using my mobile device

Driving at night

None of the above

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So we can share your personalized daily routine with you, please let us know your email address?By inputting my email, I consent to receive communications from MYZE via email. I can always unsubscribe at any time. For further information, please review the MYZE Privacy Policy.

email@example.com

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Now let's understand what may be causing your symptoms

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8. How many hours per day are you watching your TV, looking at your phone, computer and/or tablet?

2-4 hours

4-7 hours

7-10 hours

10+ hours

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9. Do any of the following apply to you? (Select all that apply)(Select all that apply)

No

Use a CPAP machine at night

Sleep with a fan on

Sleep with eyes open or partially open

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11. Do you smoke?

YESNO

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10. Do you FEEL YOUR EYES more when wearing contact lenses?

I don’t wear contact lenses

Never

Sometimes

Half of the time

All of the time

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11. Would you characterize yourself as a competitive gamer?

Yes

No

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A few more details will help us personalize your care plan

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12. Have you had or will you have LASIK, PRK, ocular surgery or a cosmetic procedure near or around your eyes?(Select all that apply)

No

LASIK

PRK

Ocular Surgery

A cosmetic procedure

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13. Have you ever been treated for or diagnosed with Dry Eye Disease or other ocular disease or disorder?(Select all that apply)

Advanced Dry Eye Disease

Meibomian Gland Dysfunction (MGD)

Blepharitis

Floppy Eyelid Syndrome (FES)

Lagophthalmos

None

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14. What products / treatments have you used or taken for your dry eye?(Select all that apply)

Prescription drugs

LipiFlow

Ocular hygiene products

iLux

Artificial tears

Radio Frequency Treatment (RF)

Intense Pulse Light (IPL)

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15. Do you currently see any of the following health care professionals?(Select all that apply)

Primary care physician

Optometrist

Ophthalmologist

Dermatologist

Plastic Surgeon

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Your personalized routine is ready! Your eyes will thank you!

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20. What is your first and last name?

First Name

Last Name

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21. Which of the following age groups do you fall into?

18-34 years old

35-54 years old

55+

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22. What is your gender?

Female

Male

Non-binary

Would rather not say

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23. We want to stay connected. What is your preferred method of contact?

Email

Text

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SCORING

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For Q9 and Q13

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Q7, Q9, Q13