[p.179]
Section M5 - INTRAOCULAR LENS (IL) PAGE
Check item 12
Enter name and person number from Table MDI.
Person No. ____
These next questions are about your lens implant.
1. Do you now have a lens implant in your right eye, left eye, or both eyes?
2 [] Left eye
3 [] Both eyes
Check item 13
Enter each eye reported in a separate column, as well as name and person number in check item 12.
2 [] No (3)
b. How many times has the lens implant in your [right/left] eye been replaced?
c. Why did you have the lens implant in your [right/left] eye been replaced (the last time)?
If "glaucoma" ask: Did the glaucoma start after the implant?
Mark first three mentioned.
01 [] Injury
02 [] Glaucoma after implant
03 [] Irritation or inflammation
04 [] Trouble reading
05 [] Infection
06 [] Movement or displacement of the lens
07 [] Wrong lens power
08 [] Problem due to corneal transplant
88 [] Some other reason - Specify ____
Ask for each entry in 2c, except "Normal growth"
d. How long after that lens was implanted was this (entry in 2c) first noticed? Was it less than 30 days, 30 to 90 days, or more than 90 days?
2 [] 30-90 days
3 [] More than 90 days
2 [] 30-90 days
3 [] More than 90 days
2 [] 30-90 days
3 [] More than 90 days
2 [] 30-90 days
3 [] More than 90 days
2 [] 30-90 days
3 [] More than 90 days
2 [] 30-90 days
3 [] More than 90 days
2 [] 30-90 days
3 [] More than 90 days
2 [] 30-90 days
3 [] More than 90 days
2 [] 30-90 days
3 [] More than 90 days
e. How long did you have the lens implant in your [right/left] eye before it was replaced with the one you have NOW?
98 [] 6-11 months
Years ____
f. In what month and year did you get it?
Year 19____
0000 [] Before 1968
9898 [] 1968 or later
[p.180]
Section M5 - INTRAOCULAR LENS (IL) PAGE - Continued
3a. How long have you had the lens you NOW have in your [right/left] eye?
98 [] 6-11 months
Years ____
b. In what month and year did you get this one?
Year 19____
0000 [] Before 1968
9898 [] 1968 or later
4. Did your doctor tell you that the lens you NOW have in your [right/left] eye is an experimental lens?
2 [] No
9 [] DK
5. Does this lens have a substance in it that absorbs some types of light?
2 [] No
9 [] DK
6. Because of the lens implant in your [right/left] eye, did your doctor advise you to wear sunglasses when you are in bright light or sunlight?
2 [] No
9 [] DK
Please tell me if you have had any of the following problems or complications with or as a result of the lens you NOW have in your [right/left] eye?
7a. Have you had an infection?
2 [] No (7c)
9 [] DK (7c)
b. How long after your lens was implanted was the infection first noticed? Was it less than 30 days, 30 to 90 days, or more than 90 days?
2 [] 30-90 days
3 [] More than 90 days
c. Have you had any healing problems with the lens you NOW have in your [right/left] eye?
2 [] No (7e)
9 [] DK (7e)
d. How long had you had the lens when the healing problem was first noticed? Was it less than 30 days, 30 to 90 days, or more than 90 days?
2 [] 30-90 days
3 [] More than 90 days
e. Have you had pain, irritation, or inflammation of the inner eye since the [right/left] lens was implanted?
2 [] No (7g)
9 [] DK (7g)
f. How long had you had the lens when the pain, irritation, or inflammation was first noticed? Was it less than 30 days, 30 to 90 days, or more than 90 days?
2 [] 30-90 days
3 [] More than 90 days
g. Have you had glaucoma that started after this lens was implanted?
2 [] No (7i)
9 [] DK (7i)
h. How long had you had the lens when the glaucoma was first noticed? Was it less than 30 days, 30 to 90 days, or more than 90 days?
2 [] 30-90 days
3 [] More than 90 days
i. Have you had problems with clouding or blurred vision that started after this lens was implanted?
2 [] No (7k)
9 [] DK (7k)
j. How long had you had the lens when the clouding or blurred vision was first noticed? Was it less than 30 days, 30 to 90 days, or more than 90 days?
2 [] 30-90 days
3 [] More than 90 days
k. Have you had trouble reading newspaper print that started after this lens was implanted?
2 [] No (7m)
9 [] DK (7m)
l. How long had you had the lens when this trouble was first noticed? Was it less than 30 days, 30 to 90 days, or more than 90 days?
2 [] 30-90 days
3 [] More than 90 days
[p.181]
Section M5 - INTRAOCULAR LENS (IL) PAGE - Continued
7m. Have you had problems with glare or light streaks that started after this lens was implanted?
2 [] No (7o)
9 [] DK (7o)
n. How long had you had the lens when the glare or light streaks were first noticed? Was it less than 30 days, 30 to 90 days, or more than 90 days?
2 [] 30-90 days
3 [] More than 90 days
o. Have you had problems due to wrong lens power (with the lens you NOW have in your [right/left] eye)?
2 [] No (7q)
9 [] DK (7g)
p. How long had you had the lens when the wrong lens power was first noticed? Was it less than 30 days, 30 to 90 days, or more than 90 days?
2 [] 30-90 days
3 [] More than 90 days
q. Have you had any other problems or complications with or as a result of the lens you NOW have in your [right/left] eye?
2 [] No (8)
9 [] DK (8)
r. What were they?
Record first three mentioned.
02[] ____
03[] ____
Ask for each entry in 7r.
s. How long had you had the lens when the (entry in7r) was first noticed? Was it less than 30 days, 30 to 90 days, or more than 90 days?
[option for 3 entries in the original document -01 to 03- not presented here]
Comment: 01 -03
2 [] 30-90 days
3 [] More than 90 days
Mark 8a-c or ask:
8a. Have you had problems with your eyes feeling tired when you wake up?
2 [] No (9)
9 [] DK (9)
b. Did this problem start after the lens was implanted?
2 [] No (9)
9 [] DK (9)
c. How long had you had the lens when this trouble was first noticed? Was it less than 30 days, 30 to 90 days, or more than 90 days?
2 [] 30-90 days
3 [] More than 90 days
9. Why did you need to get a lens implant in your [right/left] eye in the first place?
Mark all mentioned.
2 [] Injury
8 [] Other - Specify ____
Check item 14
Mark appropriate respondent box and enter relationship to MDI person if proxy.
2 [] Self - telephone
3 [] Proxy - personal
Go to next column or next device.