Introduction to The Primary Eye Care Examination 27
OH: Bifs, worn all time. Happy c them. 1st wore age 50, this Rx 2 years old. F&F OK, no other OH. Never worn CLs. LEE: 2 yr. D&As, Hull. No FOH.
GH NIDDM for 15 yrs, Metformin 500 mg b.i.d, well controlled; High BP for 15 yrs, Propranolol 100 mg b.i.d, well controlled, check-up every 6/12; High cholesterol, last 2 yrs, ‘Statins’ 40 mg o.d. now under control; Takes aspirin o.d, last 3 yrs to ‘thin blood’ & ‘help avoid heart attack’, check-up every 6/12; LME: 2/12, Dr Pesudovs, Second Place, Hull. No allergies, FMH: None. Hobbies: Walking, watching TV. No PC use. Doesn’t drive.
2.3.4 Interpretation
Once all verbal information is accurately collected the examiner should have a list of tentative diagnoses in mind for each of the identified problems. The remainder of the eye examination is based on testing to differentiate which of the tentative diagnoses is correct as well as gathering information so that each system (visual function, refractive and binocular systems and an ocular health assessment; Table 1.1) has been assessed.
2.3.5 Most common errors
■Not fully investigating the patient’s chief complaint.
■Not recording all information obtained from the patient.
■Failing to identify a drug name and dosage or identify possible side effects.
■Recording personal abbreviations that will not be universally understood.
■Not following through the case history in an organised manner.
■Forgetting that the case history taking can continue throughout the examination.
■Taking the confidential case history in public (e.g. waiting room).
■Assuming the same information is still current from the previous case history.
■Repeating questions.
■Leaving a record card on view to the public, such as on the reception desk.
2.4 BIBLIOGRAPHY AND
FURTHER READING
Amos, J.F. (1991) Patient history. In: Clinical procedures in optometry (eds J.B. Eskridge, J.F. Amos and J.D. Bartlett). Philadelphia: J.B. Lippincott.
Elliott, D.B. (1997) The problem-oriented examination’s case history. In: The ocular examination: measurements and findings (ed. K. Zadnik). Philadelphia: W.B. Saunders.
Ettinger, E.R. (1994) Professional communications in eye care. Boston: Butterworth-Heinemann.
2.5 REFERENCES
Amos, J.F. (1987) The problem-solving approach to patient care. In: Diagnosis and management in vision care (ed. J.F. Amos). Boston: Butterworths, pp. 1–8.
Blume, A.J. (1987) Reassurance therapy. In:
Diagnosis and management in vision care (ed. J.F. Amos). Boston: Butterworths, pp. 715–718.
Buckley, J.G. and Elliott, D.B. (2006) Ophthalmic interventions to help prevent falls. Geriatrics and Ageing 9, 276–280.
Claydon, B.E. and Efron, N. (1994) Noncompliance in contact lens wear. Ophthalmic and Physiological Optics 14, 356–364.
Dawn, A.G. and Lee, P.P. (2004) Patient expectations for medical and surgical care: a review of the literature and applications to ophthalmology. Survey of Ophthalmology 49: 513–524.
Dawn, A.G., Santiago-Turla, C., Lee, P.P. (2004) Patient expectations regarding eye care: focus group results. Archives of Ophthalmology 121, 762–768.
Edmunds, B., Francis, P.J. and Elkington, A.R. (1997) Communication and compliance in eye casualty. Eye 11, 345–348.
Elliott, D.B. (1998) The problem-oriented optometric examination. Ophthalmic and Physiological Optics (suppl. 18), S21–S29.
28 Clinical Procedures in Primary Eye Care
Ettinger, E.R. (1994) Professional communications in eye care. Boston: Butterworth-Heinemann.
Fylan, F. and Grunfeld, E.A. (2002) Information within optometric practice: comprehension, preferences and implications. Ophthalmic and Physiological Optics 22, 333–340.
Fylan, F. and Grunfeld, E.A. (2005) Visual illusions? Beliefs and behaviours of presbyope clients in optometric practice. Patient Education and Counseling 56, 291–295.
Hopper, S.V. and Fischbach, R.L. (1989) Patientphysician communication when blindness threatens. Patient Education and Counseling 14, 69–79.
Moss, S.E., Klein, R. and Klein, B.E.K. (1998) The 14-year incidence of visual loss in a diabetic population. Ophthalmology 105, 998–1003.
Pesudovs, K., Garamendi, E. and Elliott, D.B. (2004) The Quality of Life Impact of Refractive Correction (QIRC) Questionnaire: development and validation. Optometry and Vision Science 81, 769–777.
Pesudovs, K., Garamendi, E. and Elliott, D.B. (2006) A quality of life comparison of people
wearing spectacles or contact lenses or having undergone refractive surgery. Journal of Refractive Surgery 22, 19–27.
Shamoon, H., Duffy, H., Fleischer, N. et al. (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetesmellitus. The New England Journal of Medicine
329: 977–986.
Stearne, M.R., Palmer, S.L., Hammersley, M.S. et al. (1998) Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38.
British Medical Journal 317, 703–713.
Steele, C.F., Rubin, G. and Fraser, S. (2006) Error classification in community optometric practice – a pilot study. Ophthalmic and Physiological Optics
26, 106–110.
Weed, L.L. (1968) Medical records that guide and teach. The New England Journal of Medicine 278, 652–657.