Eye On Vision Foundation

Please email Prof, Goadsby and Dr. Schankin at  This e-mail address is being protected from spambots. You need JavaScript enabled to view it with the following information. If you already sent a brief "I'm interested" email, please RESEND with this information. Thank you so much!

Name

Address

Date of Birth (Day/Month/Year)

Telephone number

Willingness to be contacted for research

Indicating they are allowing us to keep the contact details solely for communication for research? it?s a European data protection thing?

 

Brief description of symptoms ?

 

Short description of visual symptoms in own words:

 

Visual snow: what type (chose one):

-          black and white (i.e. only black dots on white background, white dots on black background)

-          clear (i.e. color of the background)

-          flashing (i.e. always white, brighter than background)

-          colored

-          all of these

Other symptoms (yes or no) I know it is difficult but for an email yes or no to the other symptoms

-          After images

-          Trailing of images in the vision

-          Blue field entoptic phenomenon (i.e. white squiggly lines moving pulsating on the blue sky)

-          Floaters in vision

-          Colored clouds or waves with eyes closed

-          Flashes of light

-          Impaired night vision

-          Sensitive to  light

-          Tinnitus