eyeglass

[p.44]

Item 0 must be asked for all persons 3 years old or over. If under 3 years mark the "under 3" circle Item 0: these next questions are about eyeglasses and contact lenses.
Does -- have eyeglasses or contact lenses? (mark for each person)

Fill one eyeglass page (question 1-6) for each person with "yes" marked in item 0 for eyeglasses or contact lenses

1. Person number

2. Which does -- have: eyeglasses, contact lenses, or both?

Question 3 refers to all eyeglasses and contact lenses which a person has.
3a. Are any of -- eyeglasses (or contact lenses) prescribed for reading and close work?

b. Are any of -- eyeglasses (or contact lenses) prescribed for seeing distant objects better?

If "No" to both 3a and 3b ,ask 3c:
c. What are his eyeglasses (or contact lenses) prescribed for?

If "Yes" in 3a only, ask 4a:
4a. How often does -- use his eyeglasses (and contact lenses) while reading or doing close work: all of the time, most of the time, hardly ever or never?

If "Yes" in 3b only, ask 4b:
b. How often does -- was his eyeglasses (and contact lenses) for seeing distant objects: all the time, most of the time, hardly ever, or never?

For any other combination of entries in 3c and 3b, ask 4c.
c. How often does -- use his eyeglasses (and contact lenses): All of the time, most of the time, hardly ever, or never?

Question 5 refers to the first visual and (eye glasses or contact lenses) that the person got.
5. About how old was -- when he got his first pair of eyeglasses (or contact lenses)?

Question 6 refers to the last visual aid (eye glasses or contact lenses) that the person got.
6a. Did -- obtain his last pair of eyeglasses (or contact lenses) during the last 2 years or before that time?

Ask 6b, c, and d for all persons examined for eyeglasses during past 2 years.
b. Who examined --for those eyeglasses (or contact lenses)?

c. Where was he examined?

d. Is the doctor (person) who examined- an ophthalmologist or an optometrist?

Fill After completing interview
If person was examined by a doctor or other person not connected with a commercial company, check telephone directory and mark appropriate circle based on the telephone listing.
Item V
Not verifiable because:

Verified and listed as-