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01/12/2011

History & Symptoms - Eye Examination

A general list of history and symptoms I like to use. You may omit and include each question at your own choice. 


Blog posts will follow which will break down the history and symptoms list into portions and will include follow questions for certain presenting symptoms.


R.F.V – Reason for visit. Establish if it is routine or if the px is having problems.
How is your DV (Distance vision) c(with) or s(without) spx (spectacles)?
How is your NV (Near vision) c or s spx?
How is your IV  (Intermediate vision) c or s spx.
What type of spx do you wear? NV/DV/BF/VF/ Occupational?
When was your last eye examination?

Do you wear contact lenses?
Type?
How often do you wear them?
When was your last aftercare?

Are you experiencing any:
 Headache?(H/As)?
Pain?
Burning?
Astenopia?
Flashes?
Floaters?

GH (General health):
How would you describe your GH?
When was your last medical examination (LME)?
Any: Diabetes (DM)?  Controlled? Are you under a diabetic retinal screening service (DRSS)?
when was your last DRSS appointment (appt)? When is your next DRSS appt?
High blood pressure? (BP),  is it under  control?
Cholesterol?  Is it under control?
Allergies? Hayfever?
Drug sensitivies?
Smoker?  Increases chances of microbial keratitis in CL wearers by x4/ Risk factor for ARMD.

Medicines:
Currently taking any medication? Note down name.
Over the counter medication (OTC)?  

Ocular Health:
Have you ever had surgery done to your eyes?
Treatment for any eye infections/allergies?
Amblyopia (Have you ever been told the vision in one eye is weaker than the other?)
Do you have a squint (Notice your eyes drift out occasionally)?
Did you ever wear spx as a child or have one of your eyes patched?
Have you ever needed to go to the eye hospital (HES)?

Family Medical History (FMH)?
DM? Which family member? Type 1 or 2?
BP? Which family member
Any other relevant health conditions within the family? 

Family Ocular History (FOH)?
Glaucoma? ARMD
Any other relevant ocular conditions within immediate family?

General Info: 
Occupation? –Identifies visual demands, establishes lens recommendations.
VDU?
Driver? – Does VA satisfy driving visual standards.
Hobbies/Sports?

17/11/2011

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