This questionnaire aims to measure the community’s awareness about lazy eye disease (amblyopia). By filling out this questionnaire, you agree to use the information for scientific research purposes. All the information will be recorded anonymously. The data will be held only by the researches with strict confidentiality.
A : personal information : o The mother 1 This data has been filled in by o The father o Other: (relationship: …………………………) 2 The Mother's educational level Uneducated ☐ primary ☐ secondary☐ diploma /Institute ☐University ☐ 3 The Father's educational level Uneducated ☐ primary ☐ secondary☐ diploma /Institute ☐University ☐ 4 Mother's Work ...... Age : Nationality : 5 Father's Work ...... Age : Nationality :
B: Knowledge-related questions
Do you know anything about Yes 6 o amblyopia? o No o Decreased vision in one eye due to brain ignoring unclear image transmitted by the affected (lazy) eye, and favoring the healthy eye What is amblyopia? o A viral infection in the eye that causes progressive vision loss 7 o Eye deviation (inwards or outwards) due to eye muscles imbalance. (choose only 1 answer) o Droopy eyelid (eyes appear sleepy) o I do not know .
o Squint (strabismus) o Congenital cataract o Droopy Eyelid What are the causes of amblyopia? o Corneal opacity (premature babies)Premature birth 8 o (You can choose more than one o Myopia and farsightedness answer) o Astigmatism o Genetic factors o Eye injuries (trauma) o I do not know
o Poor vision in one eye What are the symptoms of o Eye deviation (misalignment) amblyopia? o Abnormal head postures (such as head tilt or head turn) 9 o Coming close to the television when watching, or bringing subjects close (You can choose more than one to the eye when looking at them answer) o Headache or eye strain o I do not know
o One of the parents has or had congenital cataract, droopy eyelids, strabismus, myopia, or hyperopia. What are the risk factors for a child st o Family history (1 degree relatives) of congenital cataract or 10 to develop amblyopia? strabismus
o (premature babies)Premature birth (You can choose more than one I do notknow answer) o
What are the complications of not o Permanent and irreversible vision loss in the affected eye. treating amblyopia? 11 o Loss of 3 dimensional (3D) perception. (You can choose more than one I do not know answer) o o Laser therapy o Surgery What are the methods for treating o Cover the healthy eye and treat the underlying cause amblyopia? o Cover the affected (lazy) eye, and treat the underlying cause 12 o Glasses only (You can choose more than one Drops only answer) o o No treatment o I do not know o Yes Does the child’s age affect the No 13 o response to treatment? o I don’t know
o Yes Does amblyopia require lifelong No 14 o treatment? o I don’t know
o Yes it is. If no family members have amblyopia, then my kids will Do you think amblyopia is a never get it. 15 hereditary disease? o No it is not. Any child can be affected by amblyopia.
o A doctor o Nurse o Medical Student A family member 16 Where do you get your information o Internet about amblyopia? o o newspapers and magazines o the television o I don’t have information o Others
C: Attitudes questions
o When the child complains (e.g blurry vision, double vision, eye pain) In your opinion, when is it necessary to When there is an abnormal sign (e.g strabismus or coming close 17 take your child for an ophthalmology o to TV) visit? o Periodic routine check-ups
o Yes Do you think amblyopia can be cured if No 18 o the child complies with the treatment o I don’t know
In your opinion, do parents have an o Yes 19 essential role in the treatment of o No amblyopia? o I don’t know
D: Yes Do you have a child previously o 20 No diagnosed with amblyopia? o