HISTORY TAKING IN CLINICAL OPHTHALMOLOGY VISAUL ACUITY MEASUREMENT

1. By/Mohamed Ahmed El –Shafie
Assistant Lecturer in ophthalmology department KafrELShiekh University

2. History
‫العيان‬ ‫اسمع‬

3.  A good history commonly leads to a diagnosis
 Helps you focus your examination
 Indicates when/what investigations are needed

4. Introduce yourself.
• Note – never forget patient names
•Respect patient privacy.
General Approach
Try to see things from patient point of view. Understand
patient mental status, anxiety, irritation or depression.
Listening
Questioning: simple/clear/avoid medical terms/leading,
interrupting, direct questions and summarizing.

5. History
 Personal history
 History of presenting complaint
 Past history
 Family history
 Social history

6. PERSONAL HISTORY
 Name: To be familiar with your patient
 Age:
Buphthalmos in infants
Keratoconus in teenage
Senile cataract in old age
 Sex:
Males as Retinitis pigmentosa
Females as Autoimmune Diseases
 Address: to know socioeconomic state
 Telephone no: to keep contact with your patients
 Special habits: Sports and smoking
 Occupations: metal workers

7. COMPLAINTS
Patient Own Words
‫بالعربى‬ ‫لو‬ ‫حتى‬

8. Chief Complaint
• The main reason push the pt. to seek for visiting a ophthalmic
consultation.
• Usually a single symptoms, occasionally more than one complaints
e.g. blurred vision, swelling, pain, trauma, inflammation etc.
• The patient describe the problem in their own words.
• It should be recorded in his/her own words.
• What brings your here? How can I help you? What seems to be the
problem?

9.  How long?
 Involving one or both eyes?
 Any associated symptoms?
 Any similar problems before?
Analysis of complaints

10. COMPLAINTS
*Diplopia: uniocular or binocular
*Flashes of lights: RD
*Floaters as Musca volitans
*Metamorphopsia as in macular diseases
*Field defects: glaucoma
 Visual :
*Diminution of vision:
 Gradual: Cataract or errors of refraction
 Sudden: CRAO

11. COMPLAINTS
 Non Visual:
 Eyelid Oedema
 Redness
 Lacrimation
 Discharge
 Itching
 Burning
 FB sensation
 Pain
 Phtophopia

12. CAUSE OF CONJUNCTIVAL CONGESTION
Allergic conjunctivitis & other form of conjunctivitis
Chemical conjunctivitis because of drugs,
Carotid-cavernous fistula
Malignant lymphoma
CAUSE OF CILIARY CONGESTION
Keratitis
Acute & chronic iridocyclitis
Acute congestive glucoma

13. PAST HISTORY
 Past Ocular History:
 Medical
Topical medications or same illness before
 Past Medical History:
DM
Hypertension
Allergy- Eczema
Drug co-morbidity
 Surgical: any eye operation done before

14. FAMILY HISTORY
 Certain diseases run in families as :
Retinitis Pigmentosa
Progressive Myopia
Glaucoma
 irrlevant

15. SOCIAL HISTORY
 Smoking
 Alcohol
 Occupation
 Home circumstances

16. EXAMINATION
 General Appearance as:
Lid retraction
Madarosis
Ptosis
Exophthalmos

17. EXAMINATION
Visual Acuity
(VA)

18. NORMAL VISUAL RESPONSE
Age Visual response
Newborn Light perception
4-7 weeks Eye contact with mother
4-12 weeks Fixates and follows interesting bright
coloured objects
3 months Change expression smiles and cries
3-4 months Reach objects using vision
6-9 months Crawling and later walking avoiding
objects
Gwiazda et al 1980

19. FIXATION TARGETS (fix and follow) :
 If appropriate targets are used, this reflex can be demonstrated
by about 6 wk of age.
Binocular fixation preference :

20. OPTICOKINETIC NYSTAGMUS :
 Evaluation of the presence or absence of
opticokinetic nystagmus was the first “technologic”
approach to acuity measurement in preverbal
children.

21. VISUAL ACUITY
Rules
 It is a test for central vision only
 Discuss gratings with your patient
 Start with one eye (uniocular)
 Good illuminated chart with higher contrast

23. VISUAL ACUITY
Pin Hole test
To differentiate refractive errors
from organic diseases by
blocking peripheral rayes

24. VEDIO

25. VISUAL ACUITY
Interpretation
UCVA
BCVA
6/6
20/20
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