Value of medical history in ophthalmology: A study of diagnostic accuracy

Abstract

PurposeThis study aimed to demonstrate the value of the chief compliant and patient history to accurately diagnose patient pathology without requiring ocular examination or imaging in an outpatient neuro-ophthalmology clinic.MethodsWe prospectively evaluated 115 consecutive patients at our institution from January to April 2009. The attending neuro-ophthalmologist committed to a single most likely diagnosis while solely being exposed to patient demographic information (age, gender, race) and chief complaint, but was otherwise blinded to ocular examination or imaging. The validity of the initial diagnosis was assessed by further acquiring subjective and objective findings and the percentage of correct diagnoses was determined.ResultsPatient cases were categorized based on the neuro-ophthalmologic localization of the final diagnoses: afferent nervous system, central nervous system (CNS), efferent nervous system, orbital system, and pupillary system. Correct diagnoses by chief complaint and patient history were 84%, 100%, 86%, 80%, 50% and 100% for afferent, central, efferent, orbit, pupil, and other neuro-ophthalmic diseases, respectively. Over half the cases were correctly diagnosed by chief complaint alone, which improved to 88% when combined with the patient history.ConclusionsA simple combination of patient history and chief complaint predicts an overall diagnostic accuracy in approximately 90% of cases. Our study demonstrates the remarkable diagnostic value of patient history in neuro-ophthalmologic clinic practice.

Ophthalmology practice during the COVID-19 pandemic

“…For example, a recent study demonstrated that an experienced neuro-ophthalmologist could correctly diagnose 88% of new cases based on the history alone. 40 Beyond the patient's history, many aspects of the physical examination can be performed through simple photographs and video that patients can obtain using their smartphones. Anisocoria can be assessed by asking the patient to photograph their eyes in dim and bright light.…”

Mucus fishing syndrome

“…It has been shown that 82.5% of initial patient diagnoses can be attained purely based on patient history while the final diagnosis can be made through patient history in 76% of cases 3 4. A more recent study showed an overall diagnostic accuracy of 88% was attained based on the chief presenting report and history alone in a neuro-ophthalmological clinical practice 5. A detailed patient history is able to provide invaluable first-hand information about the patient, supplementing clues which may prove essential in reaching an accurate diagnosis for the patient.…”

Diagnostic Error in Neuro-ophthalmology: Avenues to Improve

“…A recent prospective study [ 43 ] highlighted the power of gathering a history. An attending neuro-ophthalmologist was able to identify the correct diagnosis in 88% of 115 consecutive patients presenting to an outpatient neuro-ophthalmology clinic based on history and chief complaint alone.…”