Protocol - Long COVID - Symptoms Due to COVID-19 - Ocular (Long Form)

Eye and Vision Symptoms

1. Did you experience these symptoms, and when did you experience them?

[ ] None of the below eye and vision symptoms apply to me

Eye and Vision Symptoms

All Other Symptoms - Checkbox

2. Have you experienced any of these symptoms since the start of your COVID-19 illness? (Please choose all options that apply)

[ ] Vision symptoms - Blurred vision

[ ] Vision symptoms - Double vision

[ ] Vision symptoms - Sensitivity to light

[ ] Vision symptoms - Tunnel vision

[ ] Vision symptoms - Total loss of vision

[ ] Eye pressure or pain

[ ] Pink eye (conjunctivitis)

[ ] Bloodshot eyes

[ ] Dry eyes

[ ] Redness on the outside of eyes

[ ] Floaters

[ ] Seeing things in your peripheral vision

[ ] Other eye issues: ________

[ ] None of the above

Symptom Course

3. How severe were/are your symptoms over the course of the weeks/months?

If you experienced multiple severities for symptoms within the time period, select the most severe within that time period.

4. Which of these descriptions appropriately describes your experience with relapses, and your symptom course overall? Please select all that apply:

[ ] My relapses happen in a regular pattern (monthly, daily, or weekly).

[ ] My relapses happen in an irregular pattern (randomly).

[ ] My relapses happen in response to a trigger (stress, alcohol, exercise/exertion, etc).

[ ] My relapses are getting shorter/easier over time.

[ ] My relapses are getting longer/harder over time.

[ ] My relapse severity has stayed about the same over time.

[ ] Overall, my symptoms have slowly gotten better over time.

[ ] Overall, my symptoms have stayed about the same over time.

[ ] Overall, my symptoms have slowly worsened over time.

[ ] I got worse rapidly.

[ ] I got better rapidly.

[ ] Other ___________

7. Which of these trigger a relapse or worsening of symptoms? Please select all that apply:

[ ] Stress

[ ] Alcohol

[ ] Caffeine

[ ] Heat

[ ] Period/menstruation

[ ] Week before period/menstruation

[ ] Exercise

[ ] Physical activity

[ ] Mental activity

[ ] Other ___________