case history & preliminary measurements

what is the purpose of taking a case history for contact lenses

• influences a practitioner's diagnosis and treatment decisions

• helps determine if the patient is a suitable for contact lenses

• a need’s analysis to determine what will work best for this specific patient: type and design of contact lenses

• To begin the process of differential diagnosis.

• To begin the process of patient education

• To establish a caring relationship with the patient, showing compassion, empathy, and respect

how should the questions be asked: ettiquete of case history taking

◦Open’ questions rather than ‘closed’ ones should be used to encourage each patient to provide as much information as possible.

◦Patients should be encouraged to be honest

◦Questions do not always have to follow a specific order, it is best that your patient feel heard, so let them speak

in order to establish suitability of lenses we need to know the reasons for CL wear - give some examples of why patients may need CLs (7)

•Inconvenience of spectacles

•Cosmesis

•Improved Vision

•Sports/Recreation

•Occupation

•Vision therapy - (children undergoing amblyopia treatment)

-Colour Vision Defects

explain what a motivation and needs analysis is (5)

•Establish visual needs: At near, intermediate and distance

•Consider the environment

•The time spent (intended use) - if for all day wear or only during sports activities - how many hours? 

•Support network required - young and elderly patients who may struggle to put lenses in independently and keep up to date with appointments etc. 

•Health and hygiene levels required for intended use - patients are able to look after them appropriately 

explain what LOFTSEA is 

•Location

•Onset

•Frequency

•Type and Severity of concern

•Self-treatment

•Effect (life in general and vision)

•Associated issues

• use to further probe patients to understand their concern fully

give an outline of a basic CL history questions - questions you would ask

• reason for visit / cheif complaint

• motivation for wearing CLs

• their CL history

• new/existing patient

• present CL? satisfied or any complaints

• any previous failures with CLs? why?

• general ocular health and systemic 

• medications 

• allergies

• surgeries/trauma/hospital 

• family ocular and health history 

• occupation and hobbies

• visual and professional requirements 

• risks

• for new wearers: reason for wearing

• when/where and how long will they plan on wearing

• existing CL wearers:

• Are you currently wearing CL, or have previously tried

  •What type of lenses are they

  How old are the current lenses?

  •How often do you clean them, and what solution do you use

  •How many days a week do you wear them

  •What time do you put them in and take them out, on a daily basis?

  •How would you rate the comfort out of 10, and would you say you have any comfort  

  •How would you rate the vision out of 10?

• these questions help us predict future success 

why is it important to ask questions about medication in relation to CLs and give some specific examples

• medicine may have ocular side effects - affecting contact lens wear

for example:

•Females using or ingesting contraception would cause dry eyes

•Roaccutane is a drug given to reduce severe acne.  This causes severe dry eyes.  CL wear is not recommended when this drug is being taken.

•Eyedrops with preservatives can leave deposits in CL.