The College of Optometrists

1. Is there any need to ask questions about FOH and FMH any point of asking questions about glaucoma. 2. Any point of asking questions of Flashes and Floaters...

if theses questions are asked in the routine CL H&S is there any justification for the questions.

3. Should you use fluorscein in new CL fit and if you don't where is the justification for it?

thanks

Hi, What a bril question! Chears for asking it. Sorry for not answering earlier - I was away.

1) FOH - many people carry enhanced risk to things like AMD, glaucoma, myopia, colour defects, binocular problems, squint and amblyopia etc. So there is good point to ask about this. You will note each problem above, has a different care plan = and without knowing the FOH you can't offer the care plan.

2) FMH - a positive FH of pathology will increase risk of the person having a related problem.

The point is - you need as much info as possible to guide you to beable to give a professional opinion. Just looking at the eye does not give enough information to give such an opinion. You have to rule out pathology as best as you can, without asking about family history deprives you of much valuable clues -which will stop you giving a professional care plan, which will allow the patient to have prompt treatement, which would have reduced the risk of progression.

3) As you imply, not everyone with retinal detatchment will have flashes or/ and floaters. But equally, unless you use a contact lens gonioscope or use indentation and a head band - you can't be sure you have not missed a retinal weakness. So asking about these important symptoms - is jolly worth asking.

4) Yes, you can justify asking all these questions during every contact lens aftercare. The justification is (1) research shows most people give faulty information to the practitioner - so regularly going over the ground may reveal more detail. (2) - things can change in them and in their close relatives.

5) You need flourescene at every contact lens exam to beable to check corneal integrity, tear film and lens rubbing. It is a fundemental test - like taking a VA -and not to do it is wild!

So without asking the questions and also doing the flourescen tests - you are making assumptions which deprives you of offering a professional opinion and care plan. This would make the opinion difficult to justify medico-legally.

On another level, the eye exam is a conversation between you and your patient about their eyes and vision. To encourage this conversation - you would need to show interest in their family history and think about things they may have forgotton to tell you. The justification - is that you may save their vision by catching the eye problem early.

steve

Absolute yes on the usage of flourescein in both pre-fitting, fitting and aftercare of contact lenns patients. I'd also add you should also evert the lids at all these visits for baseline assessment and monitoring.

Questioning strategy in H&S is slightly more tricky, if you have recently done a full eye examination it may be unecessary to repeat questions on FOH etc. in your contact lens assessment. However if you have not conducted a full eye exam recently it would be sensible to ask these questions.