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Westmead Eyes Optometrists

Optometrist Westmead Sydney

BIVSS Pre-Assessment Questionnaire

Westmead Eyes Optometrists

Brain Injury Vision Symptom Survey (BIVSS)

Complete this separate symptom survey on your phone before or during your appointment. Your score appears immediately, and you can then send the full result to Westmead Eyes.

Quick phone option: you do not need to enter personal details to calculate the score. Details are requested only if you choose to send the completed result to the clinic.
Progress0 of 28 answered
Response scale: 0 Never, 1 Seldom, 2 Occasionally, 3 Frequently, 4 Always.

Eyesight clarity

1Distance vision blurred and not clear - even with lenses
2Near vision blurred and not clear - even with lenses
3Clarity of vision changes or fluctuates during the day
4Poor night vision / cannot see well to drive at night

Visual comfort

5Eye discomfort / sore eyes / eyestrain
6Headaches or dizziness after using eyes
7Eye fatigue / very tired after using eyes all day
8Feel pulling around the eyes

Doubling

9Double vision - especially when tired
10Have to close or cover one eye to see clearly
11Print moves in and out of focus when reading

Light sensitivity

12Normal indoor lighting is uncomfortable - too much glare
13Outdoor light is too bright - have to use sunglasses
14Indoor fluorescent lighting is bothersome or annoying

Dry eyes

15Eyes feel dry and sting
16Stare into space without blinking
17Have to rub the eyes a lot

Depth perception

18Clumsiness / misjudge where objects really are
19Lack of confidence walking / missing steps / stumbling
20Poor handwriting (spacing, size, legibility)

Peripheral vision

21Side vision distorted / objects move or change position
22What looks straight ahead is not always straight ahead
23Avoid crowds / cannot tolerate visually busy places

Reading

24Short attention span / easily distracted when reading
25Difficulty / slowness with reading and writing
26Poor reading comprehension / cannot remember what was read
27Confusion of words / skip words during reading
28Lose place / have to use finger not to lose place when reading
BIVSS source: Laukkanen H, Scheiman M, Hayes JR. Brain Injury Vision Symptom Survey Questionnaire. Optom Vis Sci. 2017;94(1):43-50. The BIVSS was developed for adults with mild-to-moderate brain injury. When used for patients without a known brain injury, the total is used as a descriptive symptom profile rather than a validated diagnostic result.
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