Accurate Diagnosis: Key to Sustainable Interventions - Essay Sample

Introduction

Primary medical examinations and record keeping are critical steps in the achievement of accurate diagnoses. In return, accurate diagnoses provide the yardstick for sustainable interventions for various diseases and health conditions (Taylor 2019). Various diseases afflicting different body organs, and systems usually prevent typical symptoms which overlap across an array of diseases. Because of this overlap of symptoms across more than one disease or condition, medical practitioners rely on both subjective and objective reporting of symptoms and disease effects to formulate an accurately targeted intervention. Subjective medical information is derived from the physical and mental or emotional manifestations of disease as reported by the patient to the medical practitioner. Subjective medical data include general symptoms like nausea, headache, dizziness, fever, and fatigue (Taylor 2019). On the other hand, medical practitioners use physical and chemical examinations to obtain objective medical data. Such examinations include blood tests, urinalysis, blood pressure checks, and x-ray analysis, among other techniques. Other critical patient information, such as pre-existing medical conditions and personal or family disease history, can also be used as a source of objective medical data.

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Eyecare is a crucial medical practice that requires accurate and appropriate data recording to execute. Medical record keeping serves the purpose of guaranteeing continuity of care for the patient (Tan et al. 2019). Therefore, proper medical records for eye care should vividly capture the patient’s past symptoms, diagnoses, and management as well as the current management regimens to facilitate medical decision making. Comprehensive medical records ensure that a patient continues to receive quality care even in the absence of the practitioner(s) who handled their case in the past. Therefore, medical records are essential as a component of standard hospital procedures and for legal compliance (Taylor 2019). In ophthalmology, the accuracy of records is paramount, beginning with the patient’s details such as name, age, gender, contacts, and residence (Tan et al. 2019). The data presented in this ophthalmological excerpt indicates the personal details of the patient. The personal details enable easy tracking of the patient in case of any follow-ups.

History and Symptoms

The patient in question has a family history of cataracts in the mother. Family history is an essential objective pointer that the patient’s eye problem could be the early stage of cataract development. Cataracts development can be hereditary. The complications reported by the patient include discomfort in bright sunlight and difficulty driving at night. These are typical complications associated with the early stages of both glaucoma and cataracts (Bourne et al. 2017). Therefore, the primary aim of the differential diagnosis is to determine which of the two conditions, cataracts and glaucoma, the patient is experiencing. A family history of cataracts, combined with sensitivity to bright light, suggests that the patient suffers from cataracts. However, the patient also suffers from dryness of the eyes. Dry eyes have a reverse relationship with both glaucoma and cataracts (Shah, Law and Ahmed, 2016). Various treatments for glaucoma may cause dry eyes. Patients who are recovering from cataracts(especially after correctional surgeries) may also experience dry eyes (Flaxman et al. 2017). Since the patient has no personal history of glaucoma or cataracts, the dry eyes must be isolated and considered as a separate problem.

Besides, some health conditions do not directly arise from personal or family medical history affecting the particular organ under scrutiny. The presentation of the patient and family history in these records only consider ocular health. This incomprehensive reporting can be limiting since ophthalmological conditions may arise as secondary conditions to non-ocular diseases. For example, congenital galactosemia may lead to the development of cataracts (Townsend 2016). Despite being non-comprehensive, the ocular history records provided enable proper targeted examination and intervention for the patient’s eye condition.

Examinations and Features

The basic diagnostic procedures for glaucoma entail the monitoring of intraocular pressure and refraction tests. These tests reveal normal values for glaucoma. The funduscopic exam is also an essential diagnostic technique for glaucoma (Wiggs and Pasquale, 2017). The most indicative measure for glaucoma in funduscopy is the cup-to-disc(CD) ratio. A CD ratio of more than 0.5 is a likely indicator of glaucoma (Wiggs and Pasquale 2017). The patient records indicate a CD ratio of 0.3 and 0.35 for the left and right eyes, respectively. The cumulative results of IOP and CD measurements differentially point out to cataracts as the most probable cause of the patient's vision problems (Ferguson et al. 2018). The follow-up procedures for this patient include visual acuity tests, slit-lamp tests, contrast sensitivity, and pupil dilation tests.

Time is a critical factor in understanding disease. The patient records show the timeframe during which the patient’s eye condition has existed. Furthermore, the records indicate the light conditions under which the reported symptoms manifest the most. This is essential data since the optimal functioning of the human eye depends on the quality and duration of light. Light determines the relative activation of the cones and rods to enable vision in high and low light intensities, respectively (Saikumar et al. 2019). Specificity is also integral in medical record keeping. The data indicates that the patient uses eye drops for dry eyes, with no history of ocular injuries or infections. The records do not specify the type of eye drops used by the patient. By specifying the eye drops used, it is possible to predict possible ophthalmological conditions basing on the active components of the eye drops.

Differential Diagnosis

Differential diagnosis entails the set of medical procedures used to distinguish and treat or manage a particular health condition from a set of possible conditions with similar symptoms. Differential diagnosis is based on the specific symptoms as presented by the patient, the patient’s personal or family medical history, physical examinations, and laboratory results. From these indicators, a medical professional conducts further medical investigations to confirm a medical suspicion. Differential diagnosis is a crucial procedure as it limits the possibilities of misdiagnosis, which may cause more health complications to the patient.

Differential diagnosis is particularly important in the identification, treatment, and management of ocular diseases. Cataracts lead to opacification of the lens of the eyes. The opacification of the lens obscures the light from reaching the retina (Saikumar et al. 2019). As a result, cataracts lead to light sensitivity, which may progressively lead to loss of vision. Cataracts affect individuals of all ages. However, the condition is more prevalent among older adults. Depending on the stage of diagnosis, cataracts can be corrected by the use of refractive lenses or surgical removal. The differential diagnosis of cataracts must first rule out the possibility of glaucoma, dry eyes, and refractive error. These three conditions have similar symptoms with cataracts, such as impaired vision at night and sensitivity to light and glare (Townsend 2016). Visual field tests, intraocular pressure tests, and cup-to-disc ratio on funduscopy are conducted to rule out glaucoma during differential diagnosis of cataracts. Normal peripheral vision from these tests rules out glaucoma.

Once the symptomatically related conditions are ruled out, specific eye examinations are conducted to determine any impairment in visual acuity as well as abnormalities in the back(retina) and front(iris and cornea) of the eye. The procedures include visual acuity tests, slit-lamp tests, and the pupillary dilation test. Visual acuity tests measure the eye’s ability to see and contrast images at various distances (Townsend 2016). The test uses a chart to measures the patient’s ability to read progressively smaller letters. The eyes are first tested individually, then together. While one eye is tested, the other eye remains covered. The visual acuity test is the primary examination for cataracts.

References

Bourne, R.R., Flaxman, S.R., Braithwaite, T., Cicinelli, M.V., Das, A., Jonas, J.B., Keeffe, J., Kempen, J.H., Leasher, J., Limburg, H. and Naidoo, K., 2017. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. The Lancet Global Health, 5(9), pp.e888-e897. https://www.sciencedirect.com/science/article/pii/S2214109X17302930

Ferguson, T., Swan, R., Ibach, M., Schweitzer, J., Sudhagoni, R. and Berdahl, J.P., 2018. Evaluation of a trabecular micro bypass stent with cataract extraction in severe primary open-angle glaucoma. Journal of glaucoma, 27(1), pp.71-76.

Flaxman, S.R., Bourne, R.R., Resnikoff, S., Ackland, P., Braithwaite, T., Cicinelli, M.V., Das, A., Jonas, J.B., Keeffe, J., Kempen, J.H. and Leasher, J., 2017. Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. The Lancet Global Health, 5(12), pp.e1221-e1234. https://www.sciencedirect.com/science/article/pii/S2214109X17303935

Saikumar, S.J., Anup, M., Nair, A. and Mathew, N.R., 2019. Coexistent cataract and glaucoma–Causes and management. TNOA Journal of Ophthalmic Science and Research, 57(2), p.132.

Shah, M., Law, G. and Ahmed, I.I.K., 2016. Glaucoma and cataract surgery: two roads merging into one. Current opinion in ophthalmology, 27(1), pp.51-57.

Tan, J.C., Ferdi, A.C., Gillies, M.C. and Watson, S.L., 2019. Clinical registries in ophthalmology. Ophthalmology, 126(5), pp.655-662.

Taylor, K., 2019. The importance of keeping good medical records. Practice Management, 29(1), pp.16-20.

Townsend, W.M., 2016. Cataracts: Clinical presentations, diagnosis and management. Equine Veterinary Education, 28(12), pp.705-711.

Wiggs, J.L. and Pasquale, L.R., 2017. Genetics of glaucoma. Human molecular genetics, 26(R1), pp.R21-R27.