Eye Exam Part 1: The Case History

Eye Exam Part 1: The Case History

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How does the average person know . . . I mean, really know . . . that they are getting a good eye exam? Well, I'm embarking on a series of blogs to give the lucky few who read this an insider's point of view . . . THE ABRIDGED VERSION. I can go on and on and on, and THE LONG VERSION would allow you to pass an Optometry national board exam. So I won't go there.
We're going to break it down, boys and girls. This time, we'll address . . . THE CASE HISTORY.

As a clinician, I take seriously the trust my patients bestow in me to provide the highest standard of care and ensure their wellness within the capacity of my profession. I always strive to keep up with technological advances that allow me to do so. Both of my practices, Optometry by the Bay and Daly City Optometry, are equipped with diagnostic instruments that garner ewws and ahhs from the patient gallery. After years of practice, however, it is the less technological aspects of the eye exam that continue to impress me for their diagnostic powers.

Take, for instance, the case history. It's the case history that drives the rest of the exam. There should be conversation about the main reason for the visit, aka the chief complaint, and follow up questions that dissect your problem into pieces like onset, duration, aggravating factors, is it getting better or worse, and previous episodes. You should be asked about your visual demands, overall health condition, medications, family history, and who your primary care provider is (as well as secondary providers) in case further communication or consultation is needed.

Not only are we gathering facts, but a good clinician, consciously or subconsciously, is also making gross observations about things like the patient's overall state. True story: In early November, 2007, a 49 year-old Asian male, J.G., walked sluggishly into Optometry by the Bay. It was close to noon. He had recently noticed some blurred vision, was having some headaches and generally felt weak. It turns out that he was also a martial arts instructor in generally good health.

Something about him just did not make sense to me. Most martial arts guys I knew - especially instructors - were usually full of energy and enthusiasm ala Jackie Chan movie bloopers, but J.G. was the complete opposite that morning.
Among other findings, his vision was not correctable to 20/20, and his pupils were not quite reacting the way they should. After taking a close look at his swollen optic nerves, I took digital images of them, carefully explained to him what I was seeing, and sent him straight to an ER. Two days later, he had a golf-ball sized tumor removed from the right side of his brain. Two weeks after that, J.G. walked into my office - aided by his son. . . . big smiles on both faces. His head was shaven and a bandage covered the staples in his scalp. He and his family "just had the best Thanksgiving - ever." I've been lucky enough to see J.G. every six months, and I'm happy to say he's got his swagger back and is doing very well.

About the Author:
If you looking for an Optometrist in Hercules or an Optometrist in Pinole don't hesitate to Optometry By The Bay!



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