History and Symptoms

Question 1

Why do history and symptoms?

Answer 1

• know nothing about person in the room
• need to identify problems
• ascertain baseline
• need to ensure appropriate tests included
• establishes a good rapport
• litigation

Question 2

Open questions and closed questions

Answer 2

open = how are you today 
closed = yes/no or limited choices

Question 3

Funnel questioning

Answer 3

• start with open question
• narrow question down
• response

Question 4

what to ask in h&s?

Answer 4

-reasons for visiting
-current ocular and optical status
-symptoms
-prev ocular history
-family ocular history
general medical history (family)
-general health
-medication
-allergies
-lifestyle and occupation

Question 5

3 categories of symptoms

Answer 5

• what the px sees
• what px sees in mirros
• what px feels

Question 6

typical patient complaints

Answer 6

• visual
• pain, ache
• redness, congestion and inflammation
• crustiness, flakes on lids
• lumps, mass, swelling
• eyelid problems
• squint, nystagmus
• visual defects

Question 7

symptoms in order of frequency

Answer 7

• blurred vision at near
• non specific ocular discomfort/ fatigue
• burning/ tearing of eyes
• blurred vision at distance
• no complain - routing
• no complaint - broken/lost glasses
• headache no ocular association
• headache with ocular dissociation
• conj, bleph
• lid twitching
• photophobia
• ocular pain

Question 8

difference between symptom and sign

Answer 8

symptom = what the patient reports 
sign = what the optom sees

Question 9

what to ask about last eye exam?

Answer 9

• changes that may have ocurred
• myopia, astigmatism, hyperopia
• iop
• cataract
• presbyopia
• rx out of date
• able to determine if change is normal

Question 10

vision related questions

Answer 10

• any problems with dv (with or without rx) eg driving, tv
• any problems with iv eg computer, music
• dispensing considerations - bifocals, varis, sv
• any problems with nv

Question 11

probing questions

Answer 11

• any problems with flashers/floaters - asked because of ret detachement, and asscociated with high myopia
• any problesmw ith double vision/ headaches - asked because of BV probs, tumour, vascular problems

Question 12

floaters

Answer 12

• may have to describe to px
• best seen against a bright background
• small numbers normal
• looking for changers in shape, size or freq

Question 13

FLOADS

Answer 13

-follow up questions 
frequency
location 
onset 
association 
duration 
severity

Question 14

diplopia

Answer 14

• vertical or horizontal?
• monocular/ binocular
• sudden onset?
• in any position of gaze?
• constant or intermittent?

Question 15

prev ocular history

Answer 15

any history of?

• squint (strabismus)
• lazy eye (amblyopia)
• hes
• ever worn glasses/CLs
• last a/c

Question 16

family ocular history

Answer 16

any history of?

• glaucoma
• diabetes
• htn
• amd
• any other eye disease

Question 17

general health

Answer 17

-poor gen health associated with ocualr manifestations eg ankylosing spondylitis

Question 18

medication

Answer 18

• all meds have side effects
• often pxs dont know what meds are called so record what used for
• need to ask as some affect the eye

Question 19

allergies

Answer 19

-some assoiated with certain eye conditions eg hayfever

Question 20

driver

Answer 20

• type of vehicle
• do they wear glasses to drive - should they?
• a letter 79mm high at a distance of 20mm AND VA must be at least 6/12 binocularly

Question 21

VDT

Answer 21

• how many hours/day, days/week, viewing distance

with use, the blink rate is reduced, eyes tend to get dry, reduced eyelid coverage

Question 22

asthenopia

Answer 22

eye strain

• sore, tired eyes
• eyes pull
• visual discomfort

Question 23

always finish with

Answer 23

is there anything else need to know about your eyes?

• cover against litigation
• if you forget to ask something