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Dry Eye Disease Study Now enrolling adults with ongoing dry eye symptoms.

Oculus Research Garner, North Carolina

See if you qualify

Dry Eye Pre-Screening Questionnaire

Are you 18 years of age or older?(Required)

Yes

No

Date of Birth(Required)

Have you been diagnosed by a doctor with Dry Eye?(Required)

Yes

No

Not sure

How would you rate your symptoms related to Dry Eye Disease? (0=none, 10=most severe)(Required)

None (0)

Mild (1-4)

Moderate (5-7)

Severe (8-10)

Have you used any over-the-counter treatments related to Dry Eye Disease within the last 30 days?(Required)

Yes

No

Please Specify(Required)

Have you used any nasal, inhaled, systemic (including injections), or topical corticosteroids within 30 days? (Example: Flonase, fluticasone, etc.)(Required)

Yes

No

Please Specify(Required)

Have you used any products or therapies within the timeframes listed below, including the following? Contact lenses (within the last 14 days) Ocular prescription medications (within the last 30 days) Mechanical dry eye treatments (within the last 30 days) (e.g., LipiFlow®, BlephEx®, intense pulsed light (IPL), or similar in-office procedures)(Required)

Yes

No

Not Sure

Please Specify item(s) and date(s) of last use:(Required)

Please Specify(Required)

Have you had any eye procedures, surgeries, or injections within the last 6 to 12 months? (Including, but not limited to: LASIK, refractive surgery, cataract surgery, etc.)(Required)

Yes

No

Please Specify When(Required)

Have all medications (both over-the counter and prescription) been stable for at least 30 days?(Required)

Yes

No

Please Specify(Required)

Do you have any significant or uncontrolled medical conditions that could affect study participation or safety?(Required)

Yes

No

Not sure

Please Specify(Required)

Please Specify(Required)

Your Name(Required)

First Last

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

CAPTCHA

958 Vandora Springs Rd.
Garner, NC 27529
(919) 346-6945
info@oculusresearch.com

9650 Brier Creek Pkwy Suite 103
Raleigh, NC 27617
(919) 346-6945
info@oculusresearch.com

940 SE Cary Pkwy Suite 100
Cary, NC 27518
(919) 346-6945
info@oculusresearch.com

Mon - Fri: 8:00 AM - 6:00 PM
Sat & Sun: Closed

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