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Current practice guidelines in primary care - part 7

Ghi chú: 1. Bắt đầu đánh giá chỉ khi bệnh nhân phàn nàn về một vấn đề tầm nhìn hoặc làm suy giảm. Xác định làm suy giảm chức năng thị giác trong quá trình lịch sử thường xuyên và kiểm tra thể chất cấu thành hành nghề y, âm thanh | 126 DISEASE MANAGEMENT CATARACT IN ADULTS Notes 1. Begin evaluation only when patients complain of a vision problem or impairment. Identifying impairment in visual function during routine history and physical examination constitutes sound medical practice. 2. Essential elements of the comprehensive eye and vision examination Patient history Consider cataract if acute or gradual onset of vision loss vision problems under special conditions eg low contrast glare difficulties performing various visual tasks. Ask about refractive history previous ocular disease amblyopia eye surgery trauma general health history medications and allergies. It is critical to describe the actual impact of the cataract on the person s function and quality of life. There are several instruments available for assessing functional impairment related to cataract including VF-14 Activities of Daily Vision Scale and Visual Activities Questionnaire. Ocular examination including Snellen acuity and refraction measurement of intraocular pressure assessment of pupillary function external examination slit-lamp examination and dilated examination of fundus. Supplemental testing May be necessary to assess and document the extent of the functional disability and to determine whether other diseases may limit preoperative or postoperative vision. Most elderly patients presenting with visual problems do not have a cataract that causes functional impairment. Refractive error macular degeneration and glaucoma are common alternative etiologies for visual impairment. 3. Once cataract has been identified as the cause of visual disability patients should be counseled concerning the nature of the problem its natural history and the existence of both surgical and nonsurgical approaches to management. The principal factor that should guide decision making with regard to surgery is the extent to which the cataract impairs the ability to function in daily life. The findings of the physical examination should .