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- What is Meibomian Gland Dysfunction? We Can Help
BlephEx for Blepharitis

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OPTICAL
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- Contact Lenses
INSURANCE

LOCATIONS
- Manhattan Beach
- Redondo Beach
ABOUT US
SERVICES
OPTICAL
- Eyeglasses
- Contact Lenses
INSURANCE

LOCATIONS
- Manhattan Beach
- Redondo Beach
ABOUT US
SERVICES
OPTICAL
- Eyeglasses
- Contact Lenses
INSURANCE

Home » Eye Care Services » Dry Eye » SPEED™ Questionnaire

SPEED™ Questionnaire

SPEED™ Questionnaire

For the Standardized Patient Evaluation of Eye Dryness (SPEED) Questionnaire, please answer the following questions by checking the box that best represents your answer. Select only one answer per question.

1. Report the type of SYMPTOMS you experience and when they occur:
Dryness, Grittiness or Scratchiness*
- At this time
- Not at this time
- Within past 72 hours
- Not within past 72 hours
- Within past 3 months
- Not within past 3 months
Soreness or Irritation*
- At this time
- Not at this time
- Within past 72 hours
- Not within past 72 hours
- Within past 3 months
- Not within past 3 months
Burning or Watering*
- At this time
- Not at this time
- Within past 72 hours
- Not within past 72 hours
- Within past 3 months
- Not within past 3 months
Eye Fatigue*
- At this time
- Not at this time
- Within past 72 hours
- Not within past 72 hours
- Within past 3 months
- Not within past 3 months
2. Report the FREQUENCY of your symptoms using the rating list below:

0 = Never
1 = Sometimes
2 = Often
3 = Constant
Dryness, Grittiness or Scratchiness*
- 0
- 1
- 2
- 3
Soreness or Irritation*
- 0
- 1
- 2
- 3
Burning or Watering*
- 0
- 1
- 2
- 3
Eye Fatigue*
- 0
- 1
- 2
- 3
3. Report the SEVERITY of your symptoms using the rating list below:

0 = No Problems
1 = Tolerable - not perfect, but not uncomfortable
2 = Uncomfortable - irritating, but does not interfere with my day
3 = Bothersome - irritating and interferes with my day
4 = Intolerable - unable to perform my daily tasks
Dryness, Grittiness or Scratchiness*
- 0
- 1
- 2
- 3
- 4
Soreness or Irritation*
- 0
- 1
- 2
- 3
- 4
Burning or Watering*
- 0
- 1
- 2
- 3
- 4
Eye Fatigue*
- 0
- 1
- 2
- 3
- 4
4. Do you use eye drops for lubrication?*
- Yes
- No
If yes, how often?
Add your name, phone number and email address to see your results:
Name
First Last
Phone
Email
New or returning patient?
- New
- Returning
Click “submit” to see your SPEED score results.

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Advanced Eyecare Center of Manhattan Beach

2101 Rosecrans Ave, Ste 1215
El Segundo, CA 90245

Phone: 310-321-6990
Fax: 310-321-6170
Email: info@advancedeyecarecenter.net
(Do not send personal health information by email.)

Monday: 8:00 AM - 5:00 PM
Tuesday: 9:00 AM - 6:00 PM
Wednesday: 10:00 AM - 7:00 PM
Thursday: 9:00 AM - 6:00 PM
Friday: 9:00 AM - 5:00 PM
Saturday: Closed
Sunday: Closed

Advanced Eyecare Center of Redondo Beach

310 Ave I
Redondo Beach, CA 90277

Phone: 310-373-3191
Fax: 310-373-3979
Email: frontdesk@advancedeyecarecenter.net
(Do not send personal health information by email.)

Monday: Closed
Tuesday: 9:00 AM - 5:30 PM
Wednesday: 9:00 AM - 5:30 PM
Thursday: 9:00 AM - 5:30 PM
Friday: 9:30 AM - 5:00 PM
Saturday: 8:00 AM - 4:30 PM
Sunday: Closed

Advanced Eyecare Center of
Manhattan Beach Optometry - Located at 2101 Rosecrans Ave, Suite 1215 El Segundo CA 90245 Phone: 310-321-6990 www.advancedeyecarecenter.net

Advanced Eyecare Center of
Redondo Beach Optometry - Located at 310 Ave I Redondo Beach CA 90277 Phone: 310-373-3191 www.advancedeyecarecenter.net

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