Dry Eye Questionnaire

SPEED™ Questionnaire

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

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

	Never	Sometimes	Often	Constant
Dryness, Grittiness or Scratchiness
Soreness or Irritation
Burning or Watering
Eye Fatigue

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)