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798 Nicholson St
Fitzroy North, Victoria 3068
Brain
Brain Injury

Brain Injury Vision Symptom Survey (BIVSS)

    • 0 = Never
    • 1 = Seldom
    • 2 = Occasionally
    • 3 = Frequently
    • 4 = Always

    A.Eyesight clarity
    Distance vision blurred and not clear - even with lenses

    Near vision blurred and not clear - even with lenses

    B. Please rate each behaviour

    How often does each behaviour occure? (circle a number)

    Clarity of vision changes or fluctualte during the day

    Poor night vision / can't see well to drive at night

    C. Visual Comfort
    Eye discomfort / sore eyes / eystrain

    Headaches or dizziness after using eyes

    Eye fatigue / very tired after using eyes all day

    Feel "pulling" around the eyes

    D. Doubling
    Double vision - espicially when tired

    Have to close or eye to see clearly

    Print moves in and out of focus when reading

    E. Light Sensitivity
    Normal indoor lighting is uncomfortable - too much glare

    Outdoor light too bright - have to use sunglasses

    Indoor fluorescent lighting is bothersome or annoying

    F. Dry Eyes
    Eyes feel "dry" and sting

    "Stare" into space without blinking

    Have to rub eyes a lot

    G. Depth Percecption
    Clumsiness / misjudge where objects really are

    Lack of confidence walking / missing steps / stumbling

    Poor handwriting (spacing, size, legibility)

    H. Peripheral Vision
    Side vision distorted / objects move or change position

    What looks straight ahead - isn't always straight ahead

    Avoid crowds / can't tolerate "visually-busy" places

    I. Reading
    Short attention span / easily distracted when reading

    Difficulty / slowness with reading and writing

    Poor reading comprehension / can't remember what was read

    Confusion of words / skip words during reading

    Lose place / have to use finger not to lost place when reading

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