History Taking

Question 1

State the importance of history-taking

Answer 1

puts you in the position of detective: there are often problems to
discover and you must observe, listen to what patients say and how they
say it, and questioning to identify their problems as much as possible

Question 2

what are the 5 objectives of case history? REBTD

Answer 2

1. To elicit reasons for visit
2. To ascertain patient’s expectations
3. To acquire relevant background information
4. To determine the specific tests or procedures that should be performed
   during the examination
5. To form a tentative diagnosis

Question 3

what is do you ask about in the demographics section? what does the demographics section tell us?

Answer 3

Age/ Gender/ Race/ Occupation

• The demographics provides a risk profile of eye conditions and supports
clinical management of the patients.

Question 4

what is do you ask about in the chief complaints section?

Answer 4

Determine the chief complaint by
asking open-ended question:
“What is the reason for your visit?”
“What brings you to the optometry
centre today?

Question 5

what is do you ask about in the symptoms section (9 things)? what technique should we use to inquire about a positive symptom? what follow up questions should we ask

Answer 5

1. Blurred vision
2. Red eyes
3. Eye pain
4. Floaters
5. Flashes of light
6. Headache
7. Double Vision
8. Itchiness
9. Dryness

DR FALOPPE

Question 6

what does DR FALOPPE stand for?

Answer 6

D = Duration
R = Relief factor(s)
F = Frequency
A = Associating factor(s)
L = Laterality / Location
O = Onset
P = Prescription
P = Pain
E = Exacerbating factor(s)

TAKE NOTE:
• The DR FALOPPE utilises a “ONE SIZE FITS ALL” approach on
follow-up questions – which means some of the these follow-up
questions MAY NOT be applicable on certain symptoms
• At THIS POINT, you will follow-up any (+) chief complaint +
symptoms using DR FALOPPE
• HOWEVER, you will soon realise that DR FALOPPE is not
necessary for every symptoms – however, you will need a good
knowledge of ocular disease before reaching this point.

Question 7

what is do you ask about in the Refractive and Optical Appliances Hx section?

Answer 7

Spectacles
What types of lenses? e.g., SVD/ SVN/ PAL/ BF

When was it made?

Was it through optical shop or purchase online?

Are you satisfied with the current spectacles? If not, why?

Question 8

what VA assessment should we take as priority in the interest of time?

Answer 8

aided only

unaided can be taken if there is time as it is a good starting point for ret

Question 9

what should we always ask myopic paediatrics?

Answer 9

If the child is myopic, check if the child went through any myopia
intervention programme (e.g., myopia control lenses, atropine eye
drops, etc.)

Question 10

what do you ask about in the CL section?

Answer 10

SCL/ RGP
• What is the brand? Monthly/ Weekly / Daily?

• How many hours/day? How many days per week?

• Do you sleep / shower / swim with you lenses?

• Where do you get your lenses from? (e.g., online / optical shop)

• When was the last time you had your aftercare? (i.e., anterior eye health check)

• Are you satisfied with the current lens so far? If not, why?

• What lens care solutions are you using?*

• Do you rub and rinse your lens?*

• How often do you change your lens case?*

*These questions are NOT applicable to daily disposable lenses

Question 11

what do you ask about in the POH section?

Answer 11

Last eye exam (LEE)

• When?
• Where? Typically, this would be an optical shop. If patient
reported hospital, then you will need to find out the
reason for seeing the ophthalmologist.

• Any injury/ surgery?

Question 12

what should you ask kids and elderly in particular about in the POH section?

Answer 12

• Paediatrics: Any strabismus (eye turn)/ lazy eyes/ colour
vision defects?

• Elderly: Any cataract/ age-related macular degeneration/
glaucoma?

Question 13

what do you ask about in the PMH section?

Answer 13

Last medical examination (LME)

• when?

• any concerns from the last medical check up?

• If applicable, any follow up visits? when?

Question 14

what medical conditions do you ask about in the PMH section?

Answer 14

• Diabetes Mellitus(DM)?
which type? 1 or 2
• Duration? (LONGER duration of DM - INCREASED risk for Diabetic
Retinopathy (DR))
• HbA1c ? (Normal <6-7%)
• on meds? next med check? on follow-up for posterior eye health check?

• Hypertension/ High blood pressure (HTN/ HBP)?
• blood pressure? (Normal: <120/80 mmHg)
• on meds?

• Hyperlipidaemia/ High Cholesterol?

• Ischaemic Heart Disease (IHD)

Question 15

what eye conditions do you ask about in the FOH section?

Answer 15

Important for inherited conditions such as:
• Glaucoma?
• AMD?
• Keratoconus?
• vision loss/ blindness due to?

Question 16

what eye conditions do you ask about in the FOH section for kid?

Answer 16

Particularly for Paediatrics (<16 years):
• colour vision defects?
• strabismus/ eye turn?
• lazy eyes?
• myopic parents?

Question 17

what conditions do you ask about in the FGH section?

Answer 17

Diabetes (DM)
• Hypertension/ High blood pressure (HTN/ HBP)?
• Hyperlipidemia/ High cholesterol?

Here, you are ONLY looking out for any possibly inherited conditions. It
is NOT necessary to know about the medications/ treatment/ management for
their family immediate members.

Question 18

what do you ask about in the meds and allergies section?

Answer 18

Check whether they are on regular medications for any conditions (e.g.,
oral meds for diabetes or eye drops for glaucoma, etc.)

• Some medications have ocular side effects (more to cover in Ocular
Pharmacology)

• Check whether there is any allergy history (e.g., a patient with allergic
rhinitis or asthma may have more issues with contact lenses)

Question 19

what do you ask about in the visual tasks section?

Answer 19

Hobbies (e.g., water sports, boxing, divers, golf, etc.)

Occupation (e.g., auditor → deals with small numbers, welder → exposed to
flying particles/ photochemical burns, etc.)

• ? Driving → IMPORTANT to know if patient fulfil the driving standards

• Near work → on average hours/day usage on phones/ tablets/ laptops

• Any visual breaks?

Question 20

what do you ask kids parents in particular about in the visual tasks section? what does this provide us with?

Answer 20

“Does John actively engage in outdoor
activities? How many hours?”

• “What is the average duration for near
work tasks before any visual breaks?”

• “What is the approximate near task
distance?”
this provides us with Myopia Risk Profile

Question 21

what do you ask about in the others section?

Answer 21

do you smoke
any abnormal head posture
any mobility issues (elderly)
red eyes?