I thought I’d start this blog with a success story.  This happened a while ago and it really changed the way I do history and symptoms.

Anyway, I tended to see Hx & Sx as a tick box exercise.  Are you having any problems with your vision or is this a routine visit? Do you currently wear glasses? For driving or reading or both? How are you finding your current glasses? Have you ever had to go to the doctor or the hospital for any problems with your eyes? Do you ever see flashing lights? And on, and on.

At uni, we were encouraged to have a conversation rather than go through our mental checklist but, in practice, especially at the start of my pre-reg, I was so worried about missing something that I relied heavily on my checklist.  Also, we’ve all had patients who go so far off course, you end up with 15 minutes to do a full eye test because Hx & Sx took 30.  Striking a balance is difficult.

One day I was testing a lady who was a little long-sighted.  She had managed to get by without reading glasses until a couple of years ago.  I asked how her vision was with her current reading glasses and she said that it was fine.  Did she have her glasses with her? “No.” At this point, on my checklist, I would usually move on but this time, I didn’t.

“Why don’t you have your glasses with you?” I asked.

Px: “I don’t tend to use them that often.”

Me: “But you can see well with them?”

Px: “Yes, they really help. I can barely read without them.” (She had a + 1.50 Add)

Me: “Is it the style of them you don’t like?”

Px: “No, they’re nice, designer ones.  I just don’t like wearing them.  They make me feel old.”

At this point, my patient seemed to relax noticeably: the cat was out of the bag.

I’m shortsighted so I’ve always had to wear glasses. My mother and gran and everyone else in my family are the same so I had never really thought about how presbyopia affected long-sighted people or emmetropes.  When I’m in my 40s, I will just switch from single vision to varis and not really bat an eyelid so I hadn’t really thought about reading glasses and, well, vanity.

This patient, a stylish, middle aged woman, didn’t like wearing her reading specs because she didn’t feel as if she should need them. In her mind, she associated reading glasses with being old and since she didn’t feel old, she hadn’t come to accept the glasses, although she (rather grudgingly) had to wear them at work.

Me: “Has anyone ever spoken to you about contact lenses?”

Px: “No, surely it would be a lot of bother putting them in when I wanted to read and then taking them out again. No, I wouldn’t want that.” (Just a side note, but I’ve heard so many patients say this!)

So I explained monovision to her and asked if it was something she would like to try.  It was a resounding “Yes!”

It worked out that I didn’t have another patient for 15 minutes after her eye test so when I finished the refraction, ocular examination and tested ocular dominance, I popped an Air Optix MRP lens in her left eye.  I then asked her to go for a wander around the store, just to try the lens and let it settle.

I don’t know if you all have experienced a patient who is trying monovision or multifocal contacts for the first time.  Some of them wander around with a look of wonder, just randomly picking things up to look at them then looking off into the distance and then back at what they are holding.  It’s magical to watch.  This patient must’ve read every price tag and inspected every item within 20 feet of the opticians as well as reading all the banners and promotional posters.

When she came back in, I tested her vision: 6/4.5 and N5. I then looked at the fit of the lens.  Everything looked good so I asked one of the optical consultants to do an I&R and the patient went away with her lens that day.

A week later, at her aftercare, she brought a big box of chocolates for me.  After chatting about how she was getting on with monovision, I found out she was going into hospital for a few days and that she didn’t think she would be able to take the lens out and clean it at night.  I fitted her with a daily disposable lens and gave her a trial pack of 5, just to use in the hospital.

This was one of my first real successes and it stemmed from the fact that, instead of just running through my list, I stopped and asked, “Why?”

No-one had mentioned monovision to this lady before so she had assumed that contact lenses weren’t an option for her when they were the ideal solution.

So, that’s the first little story I wanted to share.  The next one is about depression and how two different ladies with depression have had an impact on the way I communicate with patients.

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