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Year of birth
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1925
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1920
Current City, State, and Country
City
State / Province / Region
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
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Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Diagnosis
Dry (Atrophic) Age-related Macular Degeneration
Geographic Atrophy (Advanced Dry AMD)
Wet (Neovascular) Age-related Macular Degeneration
Myopic Degeneration
Stargardt Disease
Other
Eye/s Affected
Left only
Right only
Both
Age when diagnosed
Under 50
50-54
55-60
61-65
66-70
71-75
76-80
81-85
86-90
91-95
96+
Prefer Not to Answer
Acuity in better eye
20/20 (normal)
20/30
20/40
20/50
20/60
20/70 (visually impaired)
20/80
20/90
20/100
20/100-20/200
Over 20/200 (legally blind)
Count fingers
Little or no light perception (blind)
Treatment (eye medications, supplements, etc.)
Prognosis or current state of vision
Family history of vision
Impact on my life
Past or present employment
More about me (hobbies, interests, etc.)
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