“I can’t see!”
“I have terrible vision!”
These are things that I have heard time and time again, and you will too as you see patients on the wards or in clinics. This will even happen at the local restaurant or family gatherings. They are the words that are often a patient’s first volley into their hope for a fix. Those phrases, however, need to be fleshed out, parsed and hunted through. They mainly give you a sense that of visual unhappiness. Keep reading if you’d like to see some of the history points and questions you may ask to begin your hunt for an answer, or at least to know how worried you should be about the patient before you.
Go open ended right out of the box
I usually strike an engaged posture and ask them what they mean by terrible vision. The conversation will go in a whole array of directions with that, but those directions are good, great even. After they have begun to explain their symptoms you can then cone down with more focused questions.
The following things are crucial to sort out as you listen and engage them.
- Does having their glasses on make any difference?
- Is the trouble with their near vision or far vision?
- Is it there all of the time or just some time?
- Does blinking make a difference?
- Is it blurry like “looking through a shower curtain,” or dim “like someone turned the lights down”?
- Both eyes or just one?
- Is part of the vision missing? as in the top or bottom part? Left or right part?
It is not as crucial for the primary care provider to determine etiologies or to quantitate the visual level as in Snellen Acuity. It is more important that they are able to come to a conclusion on the urgency of a given situation. Does their care need moved to a specialist now or can it reasonably be delayed? That is part of this question. Also do they need to see an ophthalmologist or a neurologist? That is, are the symptoms consistent with an eye issue or a brain issue? [Read more…] about Terrible vision? What’s that mean to you?