Why taking patient history never ends

Publication
Article
Optometry Times JournalOptometry Times October 2019
Volume 11
Issue 10

pediatric patient
Ben Casella

I don’t like to read. I never did, and, still today, I’m more of a “wait until the movie comes out” kind of guy. I’m very fortunate in that our kids take after their mother in this regard (among others). 

I am a moderate myope, and I’m pretty sure that my contact lenses are a little stronger than they should be. This would account for my low degree of accommodative esophoria which becomes more manifest later in the day.  

You are thinking, “Cycloplege yourself and find out your true degree of myopia!” 

No. I’m not doing that, and you can’t make me. I’m not bothered by my vision. I just plain don’t like to read.

With this in mind, I saw a new patient the other day who reminded me why the patient history “never ends.” A seven-year-old presented with his mother and three siblings as new patients. The other three siblings checked out fine. The seven-year-old had no overt complaints. I asked him and his mother if there were problems with the board at school or with reading or concerns from the teacher. No one had any bad news to offer.

Previously by Dr. Casella: Make sure patients know follow-up visits may be covered 

Then his mother added, “Well, he doesn’t like reading, anyway.” I asked the child why not, and he said he just didn’t like reading.

You can tell where this is headed. As it turned out, the child was a mild latent hyperope of around 1.50 D OU. Best corrected visual acuity was 20/20 OU, and I wasn’t able to elicit frank phoria. Ocular health was unremarkable, and I released him with a prescription for as-needed wear at near. 

I asked the child’s mother to call me about a week after the glasses were dispensed, and she reported that she had noticed no changes in behavior but that he seemed to enjoy wearing them. That is one of those non-verbal cues that I pay attention to because it means I likely did something right. 

I hope I have helped create a bookworm out of this child-or that he at least doesn’t continue an aversion to reading. Had his mother not casually mentioned that little factoid about reading, I may well have accepted the report of no concerns at near and moved on. Looking back, however, I see the reality implied within that response: How can there be concerns with reading if one doesn’t read to begin with?

How do you pry for such lurking variables within a patient’s (especially a younger patient’s) visual well-being? I’m eager to know; drop me a line. In the meantime, I’ll be waiting for the movie to come out.

Read more editorials here 

Recent Videos
Danica Marrelli, OD, FAAO, at Glaucoma 360 discussing visual field testing for patients with glaucoma
Walline, OD, PhD, FAAO, states that the best way to learn the benefits of artificial intelligence for your practice is to stay on top of continuing education attendance.
Jeffrey Walline, OD, PhD, FAAO, gives an overview of the AAO's 2024 and what to expect in 2025 and beyond.
Dr Jamie Kuzniar discusses higher order aberrations and premium scleral lenses
Abby Gillogly Harsch, OD, FAAO, FSLS, shares a specific complex case of scleral lens fitting that she presented on at this year's GSLS.
Sherrol Reynolds, OD, FAAO, values the ophthalmic-optometric collaboration on display at the summit, running from February 14-17, 2025 in San Juan, Puerto Rico.
Katie Rachon, OD, FAAO, Dipl ABO, shares her excitement for the upcoming conference and what it means for an optometrist's toolbox.
EnVision Summit Cochair Cecelia Koetting, OD, FAAO, Dipl ABO, says that attendees should get ready for more discussion-based panels at this year's conference.
© 2025 MJH Life Sciences

All rights reserved.