History Taking

Just by taking the history of this patient, we have a good idea of what the diagnosis may be.

They are complaining of constant horizontal, binocular diplopia which is worse when looking to one side and in the distance. They have no ocular or family history. They have diabetes so are at risk of microvascular events. What could their diagnosis be?

Continue learning this week about what Orthoptists investigate. Return to this page discussion when you have figured it out!

Points to remember when taking a history:

• Introduce yourself and confirm patient identity
• What are their presenting complaints? Probe when necessary to help your diagnosis

For example: if the patient is complaining of double vision, When did it start? Was it associated with any trauma? Are the two images next to or on top of each other? Does the distance between the two images get further apart when they are looking at near or distant images, or when looking in a certain direction? Does the double vision go away when they cover either eye? Is the double always, mostly, sometimes or occasionally there? When they get the double vision, how long does it last for? Can they make it go away by blinking/moving their head? Are they bothered by it? Does it affect their livelihood? Are they driving at the moment? Do they have any other associated symptoms or concerns?

• Ocular History

It is important to know if a patient has any ocular history. This may show if a condition is longstanding or a result of other ocular diseases or treatment. Many eye conditions co-exist with others. It is also good to know what other care the patient is under for a holistic approach.

• Family History

A lot of eye conditions are hereditary or associated with genetics. If you are investigating a child who may have reduced vision, it is important to know if squints or glasses run in the family.

• Birth History

For younger children and babies, it may be important to know about their birth history. Some visual and ocular development problems are associated with prematurity. Squints can have a traumatic aetiology due to assisted delivery with forceps.

• General Health

It is important to ask patients if they are on any medication or have any allergies to avoid causing harm when giving treatment. Many eye problems are associated with systemic issues such as diabetes, hypertension, hyperthyroid or multiple sclerosis. Knowing what is going on elsewhere in the body can aid diagnosis and management. Often, the only way to treat an eye movement issue is to treat/manage the causing systemic disease.

Individuals with special educational needs are 28 times more likely to have eye problems, yet are more likely to go undetected. It is the role of an Orthoptist to adapt tests to suit the abilities of these patients and spot signs of visual development defects.