Towards Gaining the Best Information About Vision to Assist the Recovery of a Patient with Stroke

Abstract

Aim: The aim of this paper is to report on the development and evaluation of a tool, to be used by any healthcare practitioner, to screen for the presence of eye issues and problems in patients who have been diagnosed to have had a stroke. Practitioners caring for patients with stroke often detect stroke-related vision defects but miss pre-existing eye diseases, the need for glasses, and reduced acuity. In stroke units where orthoptists are employed the detection of eye conditions is high (83%) . The availability of orthoptists to work in stroke units is limited, so affected patients are likely to have undetected vision-based problems that may decrease the responsiveness to rehabilitation or prevent adaptations being made that can assist the patient with tasks.

Research design: A retrospective study using patient data collected from 100 patient case histories.

Methodology: The tool is a single page, tick-box checklist. It has 3 sections, each with actions to be implemented as required. The sections are:

a. questions about ocular history and symptoms

b. observation of ocular conditions (red eye, ptosis)

c. tests requiring responses that could be affected by vision defects (ability to fix and follow)

The tool was tested against 100 case histories of patients admitted to hospital following a stroke, comparing the ocular information noted by nonorthoptic healthcare practitioners and information from the orthoptic assessment.

Results: Of the 498 ocular conditions found by the orthoptic assessment, the tool identified 309 (62%). Nonorthoptic healthcare practitioners identified 85 (17%) ocular conditions.

Conclusion: In the absence of orthoptic services, the tool has the capacity to enable improved detection of vision conditions resulting in improved management as well as enhancing the response for rehabilitation.

The study has at all times followed the principles as outlined in the Declaration of Helsinki.

• Screening tool, stroke
• vision defects

Acknowledgments

The authors wish to acknowledge the support of Lyn Butler, Keren Edwards, Jan Steen, and the members of the Stroke Working Group.