History and Examination Should Precede Tests

To the Editor.— Dr Kolder,¹in his discussion of a patient who suffered loss of vision following cataract surgery, correctly indicates the unlikelihood of the proffered diagnosis of multiple evanescent white dot syndrome. He also briefly lists a potpourri of entities that may have resulted in visual loss following a surgical procedure. If Dr Kolder had been less kind, he might have pointed out that a markedly restricted peripheral vision in,an eye with permanent loss of central vision is not compatible with the physical findings as given, specifically, a normal optic disc and a "dissipated" swollen retina. He also might have pointed out that a brain scan, electroretinogram, and fluorescein angiogram would have little likelihood of showing an abnormality that was not suspected on the basis of a careful ophthalmologic examination. It seems to me that this problem is another illustration of how readily physicians discard the use