SPEED™ QUESTIONNAIRE - mobile version

For the Standardized Patient Evaluation of Eye Dryness (SPEED) Questionnaire, please answer the following questions by checking the box that best represents your answer. Select only one answer per question.

1. Report the type of SYMPTOMS you experience and when they occur:

Dryness, Grittiness or Scratchiness

At this visitWithin past 72 hoursWithin past 3 months

Soreness or Irritation

At this visitWithin past 72 hoursWithin past 3 months

Burning or Watering

At this visitWithin past 72 hoursWithin past 3 months

Eye Fatigue

At this visitWithin past 72 hoursWithin past 3 months

2. Report the FREQUENCY of your symptoms using the rating list below:

0 = Never 1 = Sometimes 2 = Often 3 = Constant

Dryness, Grittiness or Scratchiness

Soreness or Irritation

Burning or Watering

Eye Fatigue

FREQUENCY SCORE

3. Report the SEVERITY of your symptoms using the rating 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

Dryness, Grittiness or Scratchiness

Soreness or Irritation

Burning or Watering

Eye Fatigue

SEVERITY SCORE

Total SPEED score (Frequency + Severity) =

Number

Result Message