Macular Research Recruitment

Page 1: Can you help with our research?

Our research relies on the good will of people with healthy eyes and those with eye problems. We are particularly interested in people with retinal conditions, such as age-related macular degeneration, diabetic macular oedema or retinitis pigmentosa.

How would you describe your vision?

Please select no more than 1 answer(s).

I have good vision in both eyes (with or without glasses)

I have poor vision in one eye even with glasses.

I have poor vision in both eyes even with glasses.

What can you tell us about your right eye? (tick all that apply)

My eye is healthy / I’ve not been told I have any eye condition.

My eye is healthy but I wear spectacles/contact lenses.

I have wet age-related macular degeneration.

I have had/am currently having eye injections.

I have dry age-related macular degeneration.

I have macular degeneration but unsure of the type.

I have diabetic retinopathy.

I have another eye condition (for example glaucoma).

I don’t know/unsure what eye condition I have.

Anything else you would like to tell us about your right eye?

What can you tell us about your left eye? (tick all that apply)

My eye is healthy / I’ve not been told I have any eye condition.

My eye is healthy but I wear spectacles/contact lenses.

I have wet age-related macular degeneration.

I have had/am currently having eye injections.

I have dry age-related macular degeneration.

I have macular degeneration but unsure of the type.

I have diabetic retinopathy.

I have another eye condition (for example glaucoma).

I don’t know/unsure what eye condition I have.

Anything else you would like to tell us about your left eye?

Date of Birth Required

Dates need to be in the format 'DD/MM/YYYY', for example 27/03/1980.

Please make sure the date is between 01/01/1922 and 31/01/2004.

(dd/mm/yyyy)