Clinical Evaluation: History

Importance of Patient History

 Demographics
1. Age
2. Race and ethnicity
3. Family history of glaucoma
 Symptoms
 Usually asymptomatic until relatively late stages.
 Anatomically narrow angles and intermittent angle closure  headaches, halos.
 Pigment dispersion syndrome  blurred vision, pain, halos.
 Ocular history
 Refractive error
 Trauma
 Ocular surgery
 Systemic disorders
 Affect both diagnosis and the choice of medications.
 Asthma, chronic obstructive pulmonary disease (COPD)  β-blockers may be contraindicated.
 History of migraine or vasospasm  glaucoma occurring at relatively low IOP.
 Medication use
 Topical, inhaled, systemic corticosterioids  risk factor for increased IOP.
 Systemic β-blockers topical β-blockers diminished IOP lowering efficacy.
 Inquire history of reaction or allergy to sulfonamide medications.
 Topiramate  risk angle-closure glaucoma.
 Anticholinergic  risk angle-closure in person with anatomically narrow anterior chamber
angles.
 Review of records
 Past IOP levels.
 Status of the optic nerve.
 Visual field.
 Quality of Life
 Effects of the disease on their quality of life.
 Progressive decline  require more aggressive interventions, evaluation by a low vision
specialist.
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