The Eye Health Summit™ with graphic of a blue eye

Please fill out this brief survey.

Once you complete, you'll receive instant access to Dr Rani’s 3-Step Morning Routine For Vibrant Eyes

Pre-Summit Survey

Thank you for taking the time to fill out this survey! It should take less than 5 minutes.

Your responses will help us ensure that The Eye Summit™ 2026 meets your needs and provides you with the most relevant information to keep your eyes healthy.

As a special thank you, once you complete and submit the survey, you'll receive a complimentary copy of Dr Rani’s 3 Step Morning Routine For Vibrant Eyes

Click "NEXT" to begin.

Q1. Please select your age range: *

Under 18

18-30

31-40

41-50

51-60

61-70

70+

Q2. Gender: *

Male

Female

Prefer not to say

Q3. Country *

Country

State

Q4. Which best describes you? *

Patient/General Public

Eye Care Provider (MD/OD)

Non-Eye Care Provider (MD/DO/NP/PA/DC/LAc)

Nutritionist / Health Coach

Student/Trainee

Q5. Which eye or vision concerns are most relevant to you? (Select all that apply) *

Dry Eye/Blepharitis/MGD

Digital Eye Strain

Macular Degeneration

Cataract

Glaucoma

Diabetes

Optic Nerve Condition

Migraine/Visual Aura/Light Sensitivity

Visual Snow

Brain/neurologic vision issues

Other

If "Other," please specify:

Q6. Which of the following do you believe impact eye health? (Select all that apply)

Genetics

Nutrition

Supplements

Sleep

Exercise/Movement

Stress

Screen use

Not sure

Other

If "Other," please specify:

Q7. How would you rate your current knowledge of eye health and prevention? *

Very low

Low

Average

High

Very High

Q8. Which sources do you trust most for eye health information? (Select top 2)

Eye Doctor

Primary Care Provider

Family/Friends

Scientific Articles

Podcasts

Social Media

Other

If "Other," please specify:

Q9. How often do you actively take steps to protect your eye health? *

Daily

Weekly

Occasionally

Rarely

Never

Q10. Have you ever purchased eye health products or services as listed below?

Glasses/Contacts

Supplements

Procedures/Devices

None

Q11-15 For Patients/Public Track ONLY: Q11. Have you ever been diagnosed with an eye condition?

Yes

No

Not sure

If "Yes," please specify below:

Q12. Which statement best reflects your current approach?

I focus on prevention

I react only when symptoms occur

I rely primarily on doctors to tell me what to do

I feel overwhelmed / unsure what to do

Q13. How confident are you that you are making the necessary diet and lifestyle choices to protect your vision?

Not very confident

Confident

Highly confident

Q14. What has stopped you from improving your eye health? (Select all that may apply)

Lack of knowledge

Insufficient access to care

Cost

Time

Conflicting information

No symptoms/eye issues yet

Don’t believe anything can help

Q15. Are you interested in structured programs or guidance for improving eye health?

Yes, definitely

Maybe

No, I'm OK for now

Q16-Q19. For PRACTITIONER Track ONLY: Q16. How often do you counsel patients on nutrition and lifestyle for eye health?

Routinely (> 75% of visits)

Often (50–75%)

Sometimes (25–50%)

Rarely (<25%)

Never

Q16-Q19. For PRACTITIONER Track ONLY: Q17. Which areas do you feel LEAST trained in? (Select all that apply)

Dry eye root-cause treatment

Diet & Lifestyle counseling

Eye supplements (AREDS2, carotenoids, omega-3s)

Neuro-ophthalmology

Functional/integrative medicine

None

Other

If "Other," please specify below:

Q16-Q19. For PRACTITIONER Track ONLY: Q18. What would most improve your ability to help patients? (Select ALL that apply)

Clinical protocols

Evidence-Based Guidelines

Patient Education Tools

Product Guidance

Certification/training

Other

If "Other," please specify below: (copy)

Q16-Q19. For PRACTITIONER Track ONLY: Q19. Do you currently recommend or sell eye health products/supplements in your office?

Yes, frequently

Occasionally

Rarely

Never

Q20. What are your top goals for attending The Eye Summit™ 2026?

Goal 1 *

Goal 2

Goal 3

Final thoughts

Q21. Is there anything specific you hope to learn or any questions you have about your eye health that you'd like us to address during the summit?

Skip to next if not

Thank you!

Enter your name and email, then click "SUBMIT" to receive your complimentary copy of Dr Rani’s 3-Step Morning Routine For Vibrant Eyes

Full Name

Email *

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The Eye Summit™ 2026 Is Sponsored By:

Ageless Eyes

Bauch + Lomb

Defocus Media

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1049 Fifth Avenue Suite 2C New York, NY 10028

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