1.1.1 Flashcards
In what order do you do a history and symptoms?
1.Confirm name/age
2. RFV (what brings you in today?) (what is your reason for visit?)
3. When was your last eye test? What was the outcome of that test? Did you get a new prescription/glasses? How old are your current glasses?
4. How is your distance/close up/ arms length away vision with and without rx?
5. Have u had any trauma/surgery to your eyes?
6. Have you ever been to the hospital for your eyes?
7. Have you ever had any patching on your eyes?
Also Inc do u wear contact lenses/ last A/C
8. FOH: is there any history of any eye conditions in your family?
Inc glaucoma and cataracts
9. Do you have any general health conditions/ are you under the doctor for any type of care? Inc HBP and diabetes
10. Are you on any medications? Dosage? How often do u take them?
11. Do you have any allergies?
12. Is there any history of any health conditions in your family? Inc Diabetes and HBP
13. Do you get any flashes/floaters/headaches (any out of the normal) /double vision?
14. Are you working at the moment? What do you work as?
15. Do you drive? Do you wear your glasses when driving? What do they drive? (Based off legal driving standards)
16. How many hours do you look at a screen per day?
17. Do you have any hobbies or interests?
18. Is there anything else you would like to tell me before we start the eye examination?
19. SUMMARISE
Why does LOFTSEA stand for?
L- Location
O- Onset
F- Frequency
T- Type/ Severity
S- Self treatment/ Effectiveness
E- Effect on life
A- Associated symptoms
What does WORT stand for?
W- What
O- Onset
R- Review
T- Treatment
Reduced/blurred vision questions to ask px
Location: does this affect one or both of your eyes?
Onset: sudden or gradual onset? Did this start recently, few days/weeks ago or have you had this a long time?
Frequency: is it constant or occur in episodes lasting a few seconds/hours?
Associated/secondary symptoms: is the vision affected in the centre, periphery or both?
Do you have any pain in or around the eyes?
Do you have headaches? Do you have eye strain (asthenopia)?
Have new floaters suddenly started to appear in your vision?
Do you see flashes of light (photopsia) in your vision?
Do you experience distorted vision (metamorphopsia)?
Do you have a tender scalp, jaw ache when chewing, ear or neck pain, weight loss, fatigue?
Do you ever have vertigo, limb weakness or numbness?
Asthenopia
Ask patient do you get eye strain?
Symptoms can help differentiate visual causes from pathology
Visual causes include: ametropia (more often hyperopia), accommodative dysfunction, presbyopia, binocular anomaly, poor illumination
Pathological causes: ocular inflammation, retinal disease
Are symptoms relived/ caused by spectacles?
Does it get worse? as the day goes on?
Is it worse after near/ distance work?
Investigate Rx and BV status
Patient may complain of tearing, burning, itching, glare, pressure (ie headaches)
Distorted or dazzled vision- eye ache and headache
Can be due to refractive error (high/low)
Potential ocular motor imbalance
Are the optic discs swollen? Might have to look for diplopia/ visual fields for tumours
Headaches
Location: where is the headache located (frontal, temples, around the eyes, top of head, back of head)?
Onset: when did it start?
Frequency: how often do you get headaches? How long do they last?
Type/severity: how would u describe the pain (dull ache/sharp pain/ throbbing)
How bad is the scale on 1-10?
Self treatment: do you take anything for the headaches? Does it help? Have u been to the GP?
Associated symptoms: do you have reduced or blurred vision ?
Worse in morning or afternoon?
Do headaches come with an aura?
Any nausea?
Any scalp/temporal head tenderness?
Jaw claudication?
Do you ever have vertigo, limb weakness or numbness?
Check sinuses
Ask about dental history
Temporal artery sticking out?
Do you get any pain or burning?
If yes commonly a type of ‘dry eye’
Due to tear anomalies
May be side effect of medication for hypertension (eg contraceptive pill)
May be associated with arthritis
Patient may complain that eyes feel watery, pseudoepiphora, reflex tearing caused by dry eye
May be due to other ocular inflammatory conditions
Red eye
Location: does it affect one or both eyes?
Onset: did this start recently, few days/weeks ago or have u had this for a long time?
Frequency: is this the first time or recurrent?
Associated/ secondary symptoms:
Do you have reduced or blurred vision?
Do you have any soreness/irritation?
Do you have any pain in or around your eye?
Is the pain mild moderate or severe?
Are you sensitive to bright lights? (Photophobia)
Are you eyes itchy?
Are your eyes gritty?
Does it feel like there is something in your eye?
Can you see haloes around lights? (Enquire about headaches and nausea too)
Ocular history:
Do you wear CLs?
Any recent trauma to your head/eyes?
Have you had any eye surgery?
Have you had anything like this before?
Medical history:
Recent cold?
HBP or blood thinners?
Inflammatory bowel disease
Rheumatoid arthritis
Asthma, hay fever or eczema?
Diplopia
Do you have double vision such that you see two of one thing?
Has it started suddenly?
Does the double vision stop when one eye is covered, monoc/binoc?
Monocular diplopia= cataract or irregular astigmatism
Are the doubled images side by side on top of each other or both/diagonal?
Pathological/ traumatic diplopia often vertical
Is the double vision always present or does it come and go?
Is the double vision more noticeable when looking at a certain direction?
Is the double vision worse when you’re tired?
Flashes and/or floaters
Floaters are common and arise due to normal age related changes to the vitreous (it liquifies)
Flashes (photopsia) are more serious and occur when liquefaction causes posterior vitreous detachment (PVD) leading to a risk of retinal detachment; a risk that increases in high myopia
Location: which eye are the flashes and floaters are in? (R/L/BE)
What is the location of the flashes?
Onset: when did the floaters start? (Differentiate between long and outstanding)
When did the flashing start?
Frequency/occurence: are the floaters constant or intermittent?
Are the flashes constant/intermittent?
When does the flashing occur?
How long does the flashing last? (Differentiate migraine aura)
Type/severity:
Is there single or multiple floaters?
Size of floaters ?
Describe the flashes (colour and shape)
Are the floaters increasing/ decreasing in number or staying the same/stopped?
Associated symptoms:
Is there any visual change (disturbance) or drop in vision?
Ask about flashes in cases where patient only mentions floaters and vice versa
Is there a shadow/curtain in your vision?
Any headaches?
Any recent trauma or surgery to the eye?
Ocular history (OH)
Have you ever been to the GP or hospital regarding any eye related problems?
Have you had any eye infections, injuries or surgeries?
If an adult, ask about any treatment as a child eg vision training/patching
For any positive answer: question on
When did it occur?
Where were they seen?
Any treatment?
Any upcoming follow up appointment or discharged? If discharged when?
Any permanent effect on vision?
Ask if they are a contact lens wearer and if yes, ask:
When was your last contact lens aftercare?
What lenses they are currently wearing?any problems with the contact lenses?
General health (GH)
How is your general health?
Make it a habit to ask about the following:
Asthma/hayfever/allergies
Diabetes/hypertension/high cholesterol
If diabetic ask:
If it’s type 1/2?
When were they diagnosed?
If it is controlled or uncontrolled, and whether it is with medication or diet?
When their last blood check was? Do they check at home?
If they are enrolled on the diabetic retinal screening programme? If yes ask about their last screening, how often they are seen, whether they have received any treatment and when their next screening is
If hypertensive or hyperlipidemic:
If it is controlled or uncontrolled and whether it is medicated?
When their last blood check was? Do they monitor at home?
For children birth information can also be useful
Birth weight
Full term or premature
Oxygen given at birth
Delivery methods
Forceps used?
Medications
Name of medication?
Dosage?
How often is it taken?
Patients may not mention hayfever tablets, eye drops and contraceptive pills as medication or important so make sure to ask
May be easier to ask patients who are on many medications if they have a written order prescription
Family ocular/general health (FOH/FGH)
Make it a habit to ask about the following:
Glaucoma/ macular degeneration
Diabetes/ hypertension/ high cholesterol
Follow up any responses with: who? Type? Age of diagnosis? Any treatment? If GH lead to them having any eye conditions
For children the following could be asked regarding family history:
Glasses/prescription- myopia/ hyperopia/astigmatism/ anisometropia
Strabismus
Amblyopia
Colour vision deficiencies
Occupation, hobbies, driving
Driving - wears rx/ what vehicle do they drive
VDU use- hours/ how far away from them
Occupation
Hobbies
Smoking
