Questionnaire for the potential buyers of DigiGlasses



Data about visual impairment
1. Extent of visual impairment:
Choose one of the following answers
2. Extent of visus (between 0.0-1.0):
3. Do you have visual field loss (shortfall, stricture)?
4. What kind of light is optimal for you?
Choose one of the following answers
5. How long have you been visually impaired?

Only numbers may be entered in this field

Help(please indicate the number of years)
6. What kind of eye disease(s) do you suffer from? 
Check any that apply
7. What kind of activities do you find difficult?
Check any that apply
Visual aids used at present
1. What kind of visual aids do you use? 
Check any that apply
2. In case you use glasses, what diopter do you need?
Help(please indicate value or range)
3. What kind of activities do you require visual aids with? 
Check any that apply
4. How many hours a day do you use visual aids?

Only numbers may be entered in this field

5. When did you start using visual aids?

Only numbers may be entered in this field

Help(please indicate year)
6. What kinds of activities do the visual aid(s) you currently use help you with? 
Check any that apply
7. Are you satisfied with the visual aid(s) you currently use?
Choose one of the following answers
8. What features of the visual aid(s) you currently use do you most appreciate?
Check any that apply
9. What features do you most lack about the visual aids you currently use?
Check any that apply
10. How much money have you spent on visual aids in the past 5 years?
Choose one of the following answers
Digital glasses
1. Would you be interested in a pair of 3 dimensional digital glasses (camera and projector built together) which would be of help in everyday life?
2. What visual impairment do you expect digital glasses to solve?
Check any that apply
3. What kind of reading functions do you expect from digital glasses?
Check any that apply
4. What kind of indoor activities do you think digital glasses could help with?
Check any that apply
5. What kind of activities do you think digital glasses could help you with?
Check any that apply
6. What aesthetic / practical aspects/features would you find important for the digital glasses to have?
Check any that apply
7. How much money would you spend on a pair of digital glasses?
Choose one of the following answers
8. Are you interested in testing such a product with the help of a rehabilitation expert?
Personal data
1. Please indicate the year of your birth:

Only numbers may be entered in this field

2. Please indicate your sex
3. Please indicate your highest level of education:
Choose one of the following answers
4. Please indicate your employment status:
Choose one of the following answers
5. Please indicate the county you live in:

6. Please indicate the type of settlement you live in:
Choose one of the following answers
7. Please indicate the per capita income of your family:
Choose one of the following answers