Macular Degeneration Questionnaire
What a macular degeneration questionnaire asks, with sample questions on eye history, treatment, and family history.
A macular degeneration questionnaire records the visit reason, eye history, past treatment, supplements, family history, and smoking before a retina visit. The questions on this page are built from retina practices' new patient forms and a macular degeneration treatment trial's visit form.
Macular degeneration questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a macular degeneration questionnaire in the patient's own language, strictly following the practice's instructions.
- Intake before the visit. Patients answer online before they arrive, or at a kiosk when they check in.
- Answers ready for the clinician. Clinicians see what the patient said before the visit starts.
- Less workload at the front desk. Staff spend less time handing out forms and entering answers by hand.
- Key details at a glance. The care team sees what matters up front and decides who needs attention first.
The form becomes a natural conversation: patients answer by talking, in their own words. AI Doctor is an information and patient-assistance interface. It collects answers for the care team to review. It doesn't diagnose, triage, or give treatment advice.
Sample macular degeneration questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What is the reason for your visit?Visit reason
- Which doctor referred you for this visit?Visit reason
- Has a doctor diagnosed macular degeneration before?Eye history
- Have you had eye surgery or laser treatment?Eye history
- Have you had treatment for macular degeneration before?Past treatment
- Which eye was treated, and when?Past treatment
- Which vitamins or eye supplements do you take?Medicines
- Which eye drops do you use now?Medicines
- Has a relative had macular degeneration?Family history
- Who in your family has had eye disease?Family history
- Do you smoke now, or did you smoke before?Lifestyle
- Do you still drive?Lifestyle
These are examples to read, not a form to fill in.
Macular degeneration questionnaire: FAQ
What does a macular degeneration questionnaire ask?
The sample questions here are based on retina practices' new patient forms and the Comparison of Age-related Macular Degeneration Treatments Trials (CATT) follow-up visit form. This page groups them into six areas: visit reason, eye history, past treatment, medicines, family history, and lifestyle.
Who fills in a macular degeneration questionnaire?
The patient, before a retina visit. One retina practice asks patients to update its medical history form every three years.
Does it ask about vitamins and supplements?
Yes. The CATT follow-up visit form asks whether the patient takes any vitamins, minerals, or dietary supplements, and whether medicines changed since the last visit.
Does it ask about family history?
Yes. The UC San Diego Student Health optometry history form and several retina practice forms ask whether a relative has had macular degeneration, and who.
Is there a template for this form?
The sample questions on this page show a typical set, taken from retina practices' history forms.
What happens after the macular degeneration questionnaire is completed?
The retina team reads the answers before the exam. AI Doctor records what the patient says and does not judge vision changes or suggest treatment.
Does AI Doctor give medical advice?
No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.
Can patient answers stay on our own servers?
Yes. RAVATAR offers on-prem deployment: the platform can run inside your own perimeter, so patient answers stay there. RAVATAR complies with GDPR and the EU AI Act.
Set up your AI Doctor in Genesis AI Avatar Studio
Genesis AI Avatar Studio is where you set up, test, and publish AI avatars for your website, mobile app, or Holobox. No coding or technical skills needed.
- 01Choose the AI Doctor avatar.
- 02Add your practice's FAQs and visit information.
- 03Talk to it, then publish it.
