Questions:

1. In the last 30 days, how much difficulty did [name of person] have in seeing and recognizing a person she knows across the road (that is, from a distance of about 20 meters)?
2. In the last 30 days, how much difficulty did [name of person] have in seeing and recognizing an object at arm’s length or in reading?

Response categories:

1. None
2. Mild
3. Moderate
4. Severe
5. Extreme

1. [Esi] only reads if the text is in very large print, such as 10 lines per page. Otherwise she does not read anything. Even when people are close to her, she sees them blurred.
   
   
2. [Adjoa] has no trouble falling asleep at night and does not wake up during the night, but every morning she finds it difficult to wake up. She uses an alarm clock but falls back asleep after the alarm goes off. She is late to work on four out of five days and feels tired in the mornings.
   
   
3. [Araba] can read words in newspaper articles (and can recognize faces on a postcard size photograph). She can recognize familiar people’s faces all the time and picks out most details in pictures from across 20 metres.
   
   
4. [Ekua] wakes up almost once every hour during the night. When she wakes up in the night, it takes around 15 minutes for her to go back to sleep. In the morning she does not feel well-rested and feels slow and tired all day.
   
   
5. [Aba] takes about two hours every night to fall asleep. She wakes up once or twice a night feeling panicked and takes more than one hour to fall asleep again. Three to four nights a week she wakes up in the middle of the night and cannot go back to sleep for the rest of the night. She is fatigued all day, every day and misses work several times a week. She cannot take part in sports or social activities.
   
   
6. [Efua] needs a magnifying glass to read small print and look at details on pictures. She also takes a while to recognize objects if they are too far from her.
   
   
7. [Fatima] can read words in newspaper articles (and can recognize faces on a postcard size photograph). She can recognize shapes and colours from across 20 metres but misses out the fine details.
   
   
8. [Mame] falls asleep easily at night, but two nights a week she wakes up in the middle of the night and cannot go back to sleep for the rest of the night. On these days she is exhausted at work and cannot concentrate on her job.
   
   
9. [Comfort] cannot detect any movement close to the eyes or even the presence of a light.
   
   
10. [Giftie] falls asleep every night within five minutes of going to bed. She sleeps soundly during the whole night and wakes up in the morning feeling well-rested and feels full of energy all day.