IPL Trial Post Treatment Questionnaire

IPL Trial Post Treatment Questionnaire
- Intense Pulsed Light (IPL) Infomation
- IPL Trial Post Treatment Questionnaire

Thank you for participating in our IPL trial. Below are a few further questions for you to complete.

Questions 1-3 are the same questions you have answered prior to commencing the treatment. Please answer these questions again, keeping in mind your symptoms post IPL treatment.

Full Name

Phone Number

Q1a: During a typical day in the past month how often did your eyes feel discomfort?

0: Never 1: Rarely 2: Sometimes 3: Frequently 4: Constantly

Q1b: When your eyes feel discomfort, how intense is this feeling of discomfort at the end of the day, within two hours of going to bed?

0: Never have it 1: Not intense at all 2: Minimally intense 3: Mildly intense 4: Moderately intense 5: Very intense

Q2a: During a typical day in the past month, how often did your eyes feel dry?

0: Never 1: Rarely 2: Sometimes 3: Frequently 4: Constantly

Q2b: When your eyes felt dry, how intense was this feeling of dryness at the end of the day, within two hours of going to bed?

0: Never have it 1: Not intense at all 2: Minimally intense 3: Mildly intense 4: Moderately intense 5: Very intense

Q3: During a typical day in the past month, how often did your eyes look or feel excessively watery?

0: Never 1: Rarely 2: Sometimes 3: Frequently 4: Constantly

Q4a: How did you find the experience during the procedure itself?

Q4b: How did you find the experience of scheduling appointments?

Q5: Have you noticed an overall improvement in your dry eye since undergoing IPL treatment?

1: No improvement 2: Moderate improvement 3: Significant improvement

Q6: Would you like to be notified when you will be due for a maintenance treatment (typically one treatment every 6 months)?

Yes No

Q7: Would you recommend IPL treatment to someone else who has dry eye symptoms?

Yes No

Thank you for being a part of our IPL trial, we really value your insights so if you have any further comments please leave them below.

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Acknowledgement of Country

Canterbury Eyecare acknowledges the traditional Aboriginal custodians of the many lands that we live and work on, and their continuing connection to Country and culture.