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One of the first rules we learned!

One of the first things we learned in optometry school was the importance of taking a thorough history. This is not only important from a medico-legal standpoint, but more relevant is that a good history can clue in the astute clinician to determine a diagnosis even before setting the patient up in the slit lamp, or uploading an OCT. 

For instance, the 40 year old type A accountant presenting on April 16th with a 1 week history of painless distorted vision OS presents an almost slam dunk diagnosis; and similarly the 22 year old college student who sleeps in her lenses and reports light sensitivity and pain in one eye since that morning does not present an overly challenging differential diagnosis. 

Specific questions are important when talking low vision history.

Low vision history taking is a little different though. Certainly, you still need to ask the usual questions about family and medical history, but the standard chief complaint question “what brings you in today,” needs to be modified for these patients.  

In our office, we focus (pun intended) our questionnaire on patient goals, and ask them to be as specific as possible. For most of our patients, we understand that if they are referred for low vision, they generally would like to see better at all distances.

What are the patient’s goals?

But, we want to know what a patient wants to read…because if they just want to read their mail, that is a different task and may require a different solution than reading the New York Times every day or being able to read their large print bible. Similarly, for distance tasks, a goal of being able to see the television more easily is different and requires a different solution than being able to navigate in unfamiliar areas more easily. 

A task specific low vision history/questionnaire will help the streamline the low vision evaluation itself and increase the likelihood that the patient’s low vision goals will be met, thus creating a positive patient-doctor experience at the conclusion of the visit, and in the future. 

With the myriad of low vision devices available, having a goal-oriented low vision history ensures that the practitioner can demonstrate the devices that are most appropriate for the patients stated needs and desires. 

Jonathan Fishbein
Dr. Jonathan Fishbein has extensive experience in working with the visually impaired. He graduated from University of Toronto in 1993, and New England College of Optometry in 1997. He completed a residency in low vision at the Feinbloom Vision Rehabilitation Center in Philadelphia PA, where he later worked as a clinical instructor. He has worked at the Low Vision Center of Central New Jersey since 2001.

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