Comprehensive Eyewear Performance & Maintenance Evaluation for Daily Spectacle Wearers

Full name

Age

Primary vision correction type

Please specify your combination of vision conditions:

Total years wearing prescription eyeglasses

Average daily wearing hours

Wearing pattern

For which activities do you primarily wear glasses? (select all that apply)

Primary daily activities while wearing glasses (select all that apply)

How many functional eyeglass pairs do you currently own?

Eyewear Inventory & Performance Tracking

Do you rotate between multiple pairs regularly?

Describe your rotation pattern and decision criteria for each pair:

Which single pair do you wear most often and why?

Age of your newest eyeglass pair (in months)

Age of your oldest eyeglass pair (in months)

Overall satisfaction with current lens clarity (1 = very dissatisfied, 5 = completely satisfied)

Do you experience increased glare or halos around lights at night?

Rate the severity of night vision issues for each condition

Have you noticed persistent smudging that returns quickly after cleaning?

Describe the smudging pattern: location on lens, frequency, activities when it occurs, and cleaning attempts:

Do you see micro-scratches or fine lines in your field of view?

Rate the impact of micro-scratches on visual tasks

Does your vision feel 'hazy' or less crisp compared to when the glasses were new?

When did you first notice the haziness?

Have you observed any coating peeling, flaking, or bubbling?

Select all visible coating damage types

Is the damage worse on one lens than the other?

Which lens shows more damage and where?

Estimated percentage of lens surface affected by coating damage

Rate your expectation for coating durability (1 star = should last 6 months, 5 stars = should last 3+ years)

Did the coating damage appear within the warranty period?

Describe your warranty claim experience and outcome:

Why did you not pursue warranty coverage?

How frequently do you clean your lenses?

Describe what constitutes 'visibly dirty' for you:

Which cleaning materials do you regularly use? (select all that apply)

Do you rinse lenses with water before wiping?

Why do you skip rinsing? (e.g., convenience, unaware of recommendation)

Have you ever washed your microfiber cloths with fabric softener or dryer sheets?

Describe your cloth washing routine: frequency, detergent type, drying method:

Describe your proper cloth washing routine for our records:

Date of your most recent microfiber cloth wash

Do you store glasses in a protective case when not wearing them?

Where do you typically place unprotected glasses?

Primary work environment

Are you regularly exposed to high humidity or rapid temperature changes?

Select applicable exposure scenarios

Do you work with chemicals, solvents, or aerosols while wearing glasses?

Specify chemical types and frequency of exposure (e.g., cleaning solvents, hair spray, paint fumes):

Do you spend significant time in direct sunlight while wearing non-sunglasses?

Average daily hours of direct sun exposure

Which activities do you regularly perform while wearing glasses? (select all that apply)

Date of your last comprehensive eye examination

Date of your most recent eyeglass purchase

Where did you purchase your primary eyeglass pair?

Did you purchase premium anti-reflective or coating packages?

Additional cost paid for premium coatings

Have you returned to the retailer for adjustments or complaints?

Describe the issues reported and solutions provided:

Have you had professional ultrasonic cleaning performed?

Frequency of professional cleaning per year

Rate how lens clarity issues impact these daily activities (1 = no impact, 5 = completely prevents activity)

Have you experienced headaches or eye strain you attribute to lens issues?

Describe headache frequency, location, and correlation with specific glasses or activities:

Have lens clarity issues caused you to avoid certain activities?

Which activities have you reduced or avoided?

Describe your most frustrating visual distraction and its impact on your daily routine:

How likely are you to replace your current glasses due to clarity issues alone? (1 = not likely, 5 = already shopping)

Rank these features by priority for your next eyewear purchase (drag to order: most important to least important)

Which lens enhancements would you consider for future purchases? (select all that apply)

Would you pay extra for a coating durability warranty?

Maximum additional amount you would pay for 2-year coating warranty

What would make a coating warranty valuable to you?

Preferred replacement cycle for primary eyeglasses

Share any additional insights about lens clarity, coating performance, or maintenance challenges that would help improve future eyewear:

I consent to sharing this anonymized data for eyewear research and product development purposes