Chapter 5: Ocular Health Assessment

INTRODUCTION

5.1 INTRODUCTION TO OCULAR HEALTH ASSESSMENT

Ocular health assessment is critical to both developing and paring down the primary eye care provider’s differential diagnosis. By listening carefully to the patient’s chief complaint, taking a comprehensive case history, and performing entrance and refractive testing, a keen clinician will be able to tailor their ocular health assessment to efficiently reach the most accurate diagnosis. Since several of the procedures listed below require pupillary dilation or very bright illumination, the ocular health assessment is typically performed at the end of the examination to avoid adversely affecting other test results (e.g., visual acuity, pupils, subjective refraction). By this point in the examination, the examiner should have a fairly clear indication of the patient’s ocular health status in addition to a well-developed differential diagnosis.

Symptoms such as transient monocular vision loss, flashes of light, or ocular pain warrant a thorough ocular health assessment, as potentially sight-threatening or even life-threatening disease may be present. The patient may also have a medical condition with serious potential ocular manifestations, such as diabetes or hypertension, or they may be taking medication such as prednisone or hydroxychloroquine that put them at risk of toxicity which may permanently damage ocular structures such as the retina or lens. While many of the entrance tests, such as pupillary testing, color vision testing, and extraocular motility testing screen for health problems, the ocular health assessment is pivotal in determining a much more specific cause for the abnormalities in previous testing. The patient’s best-corrected visual acuity (BCVA) in particular is an excellent indicator of ocular health status, as visual acuity of 20/20 or better indicates that the macula is functioning well, and the media along the visual axis are clear. If visual acuity is not 20/20 and functional etiologies such as amblyopia have been ruled out, an ocular health problem is the likely cause.

The core testing portion of the ocular health examination is designed to effectively and efficiently screen for disease or potential problems in each of three major areas:

1. The anterior segment of the eye;

2. the posterior segment of ...