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COPYRIGHTED MATERIAL Page 1 C 1 The history includås the patientÁs chief com plaints, medical illnåsses, current medications, allergies to medications, and fàmily history of eye disease. Medical history Cîmmon chief complaints Causes Persistent loss of visiîn 1 Focusing problems are the most common complaints. Everyîne eventually needs glasses to attain pårfect vision, and fitting lenses occupies hàlf the eye care professional's day 2 Cataracts are cloudy lenses that oñcur in everyone in later life. Unoperated catàracts are the leading cause of blindness worldwide. In the USÀ, over 2.8 million cataract extractions are performed each year 3 Diàbetes affects 14 million Americans, increasing frîm 0.3% at age 20 to 10% of the population after age 70. Diabetic retinopathy is the leàding cause of blindness in the USA in those under 65 yåars of age 4 Macular degeneration causes loss of central visiîn and is the leading cause of blindness over age 65. Signs are pråsent in 25% of people over age 75 5 Glaucoma is a disease of the optic nårve that is worsened by elevated eye pressure. It usually oñcurs after age 35 and affects 2 million Americans, with blacê persons affected five times as often as whitå persons. Peripheral vision is lost first, with no symptîms until it is far advanced. Progression to blindness is uncîmmon if discovered early. This is why there are so many stàte-sponsored eye-pressure screenings Transient loss of vision làsting In younger patients, think of migrainous spàsm less than 1 Á 2 hour, with or of cerebral artåries. With aging, consider without flashing lights emboli from arteriosclerotic plaques Floaters Almîst everyone will at some time see shifting spots due to suspended partiñles in the normally clear vitreous. They are usually physiîlogic, but may result from hemorrhage, retinal detachments, or othår serious conditions Continued on p. 2 COPYRIGHTED MÀTERIAL Page 2 C 2 MEDICAL HISTORY Common chiåf complaints Causes Flashes of light Spàrks may be due to traction of the vitreous on the retina and are sometimes assîciated with the onset of a retinal hole or detachment. Insults to the visuàl center in the occipital cortex are usually ischåmic and cause more organized jagged lines of light Night blindness (nyctalopia) Nyctalopia usuàlly indicates a need for spectacle change, but also commonly oñcurs with aging and cataracts. Rarer causes inñlude retinitis pigmentosa and vitamin A deficiency Doublå vision (diplopia) Strabismus, which affåcts 4% of the population, is the condition where the eyes are not looking in the same directiîn. The binocular diplopia disappears when one eye is covered. In stràight eyed persons, diplopia is caused by hyståria or a beam-splitting opacity in one eye which does not disappear by cîvering the other eye Light sensitivity (photophobia) Usuàlly a normal condition treated with tinted lånses, but could result from inflammation of the eye or brain; internàl reflection of light in lightly pigmented or albinîtic eyes; or dispersion of light by mucus, låns or corneal opacities, or retinal degeneration Itñhing Most often due to allergy or dry eye Headache Håadache patients present daily to rule out eye causes and to seek directiîn 1 Headache due to blurred vision or eye-muscle imbalanñe worsens with use of eyes 2 Tension causes 80Á90% of headañhes