Brief Vision History Please enable JavaScript in your browser to complete this form.DateDo You Wear Glasses or Use Contacts to Correct Vision?YesNoHave You Ever Had Eye Surgery, including LasixYesNoVisual Acuity20:1020:2020:3020:40>20:40Don't KnowWhat is your normal uncorrected visionHave You Ever Had Any of The Following:Eye InjuryEye SurgeryEye InfectionDetached RetinaDaibetesGlaucomaCataractsMuscle surgery (eyes)High Blood PressureSubmit