Welcome to question of the day #128

Eyetools question of the day #128

Some of my patients tell me so much during history and symptom taking that I find it hard to identify the important information. What can I do?

Some patients are very concise in their responses to questions during history and symptoms taking and this is helpful. Others give information that is not related to eye health. It is likely they don’t know what aspects of their health are relevant to eyes and/or that they are worried about not relaying something that is important to their eye health so they are cautious and tell us everything about their health. I have had patients tell me about their cystitis and others that they have recently had a vasectomy. We should never blame patients for the excessive delivery of information during the history and symptom taking. It is up to us to distill the important from the immaterial.

Having a good structure to history and symptom taking is a good place to start:

  • Symptoms, description and duration.
  • History of ocular and general health.
  • Current general health.
  • Medication.
  • Family history of ocular and general health.
  • Visual needs in terms of occupation, recreation or general activities.
  • Whether the patient drives, with or without prescription, and;
  • previous optical prescription and date of last eye examination or sight test- approximate, if the exact date is not known.

My own questioning takes this form:

  • How are things with your eyes?
  • Are you happy with your distance vision?
  • Are you happy with your close vision?
  • Have you ever had any eye problems that required treatment by an optometrist, general practitioner or hospital based specialist?
  • Have you ever had any problems with your general health?
  • How is you general health now? [Some patients will say that their general health is fine but when you ask whether the are taking any medications they give you a list. This is because in their minds the medicines make their general health fine. This is why it is important to ask about current general health and about medicines].
  • Are you taking any medicines?
  • Some eye and health problems can be transferred through the family. Is there any one in your family that has or has had glaucoma, cataracts, diabetes or any other eye or other health problem?
  • What is your employment?
  • What hobbies do you have?
  • What sports do you do?
  • When was you last eye examination?
  • Do you have your current glasses?

It is easy to check for ocular side effects of all the medicines a patient reports through the web. Bear in mind that even antibiotics can have ocular side effects. While having a vasectomy is very unlikely to have any bearing on eye health of function, taking antibiotics for cystitis may have some bearing on eye health and function.

Some of my patients tell me things that happened to them or a member of their wide family 40-60 years ago. These are very unlikely to have any bearing on current eye health and function.

Occasionally a patient will tell me ‘that the bottom half of the vision in one eye is fuzzy & black in part’. This is very relevant and will drive me to perform visual field analysis and a retinal examination through a dilated pupil. The same techniques would be mandatory when a patient tells me that there is a black curtain slowly descending in the vision of one eye.

Using structured questioning, listening and drilling down further on the responses to some of your questions will help you separate the wheat from the chaff.