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DAOSD Activity Assessment Questionnaire
Name
(Required)
First
Last
Email
(Required)
Date
(Required)
Stage of Assessment
(Required)
BEFORE starting dupilumab treatment
At MONTH 3 after starting dupilumab treatment
At MONTH 6 after starting dupilumab treatment
In the past 7 days, have you experienced any of the following eye symptoms?
(Required)
Yes
No
Pain in one or both of your eyes
(Required)
0
1
2
3
4
5
6
7
8
9
Redness in one or both of your eyes
(Required)
0
1
2
3
4
5
6
7
8
9
Itchiness in one or both of your eyes
(Required)
0
1
2
3
Discharge from one or both of your eyes
(Required)
0
1
2
3
Change in vision (such as blurring or reduced vision) in one or both of your eyes
(Required)
0
1
2
3
Sensitivity to light in one or both of your eyes
(Required)
0
1
2
3
DAOSD Activity Assessment Score:
Δ