Table 1.
Phone Triage Questions.
| Category | Question Asked | Answer Choices |
|---|---|---|
| Age | How old are you? | - Patient states age at time of call |
| Sex | Are you male or female? | - Male - Female |
| Established versus New Patient | Have you been seen at Kellogg Eye Center before? If so, have you been seen in retina or comprehensive clinics? | - No (new patient) - Yes (retina or comprehensive based on patient answer and electronic medical record) |
| Affected Eye | Which eye has symptoms? | - Left eye - Right eye - Both eyes |
| Symptom Onset | When did your symptoms start? | - Within 24 hours - Within 72 hours - 3-7 days ago - 1-2 weeks ago - More than 2 weeks ago |
| Evolution of Vision Change | Has your vision change remained stable, improved, or worsened? | - Stable - Improved - Worsened |
| Floater Presence | Have you noted new floaters in your vision? If so, how many? | - None - Less than 5 - More than 5 but less than 10 - More than 10 but less than 100 - More than 100 |
| Floater Characterization | What do your floaters look like? | - Cobweb - Tiny dots - Big blobs - Swirls - Other |
| Flashes Presence | Have you noted new flashes in your vision? If so, how many? | - None - Less than 5 per day - More than 5 per day |
| Blurred Vision Presence | Ignoring your floater(s), have you experienced blurred vision? If so, how would you characterize it? | - None - Intermittent - Constant |
| Symptoms of Curtain/Veil/Shadow | Have you experienced a non-moving curtain or veil or shadow in the side of your vision? | - Yes - No |
| Pain Presence and Characterization | Do you have pain in the affected eye? If so, how would you characterize it? | - No - Dull/Achy - Throbbing - Sharp - Pressure Sensation - Scratchy/Sandy/Foreign Body Sensation |
| Prior Glasses Use | When you were a young adult (before any procedures to your affected eye), did you need glasses to see to drive? | - Yes - No |
| Prior Retinal Tear or Retinal Detachment | Did you have a prior retinal tear or detachment in the affected eye? The unaffected eye? |
- Yes - No - Yes - No |
| Prior Retinal Tear or Retinal Detachment Characterization | Are your current symptoms similar to past tears/detachments? | - Yes - No - Not applicable (if patient did not have retinal tear or retinal detachment) |
| Diabetes Status | Are you a diabetic? | - Yes - No |
| Uveitis Status | Do you have uveitis? | - Yes - No |
| Trauma Status | Have you had a significant trauma to your head or affected eye? If yes, when? | - No - Within the past 2 months - More than 2 months ago |
| Retinal Surgery Status | Have you ever gone to the operating room for retinal surgery in either eye? | - No - Within the past 2 months - More than 2 months ago |
| Cataract Surgery Status | Have you ever gone to the operating room for cataract surgery in the affected eye? | - No - Within the past 2 months - More than 2 months ago |
| Intravitreal Injection Status | Have you had an intravitreal injection in the affected eye within the past 12 hours? | - Yes - No |
| Primary Care Provider | When was the last time you saw your primary care provider? | - Never - Within the past month - Within the past 3 months - Within the past 6 months - Within the past year - Within the past 2 years - More than 2 years ago |