Gaining The Best Information About Vision To Assist The Recovery Of A Patient With Stroke

Neryla Jolly, Neryla Jolly, Ann Macfarlane & Kathryn Thompson

There has been concern that patients admitted to hospital following a stroke are not being fully assessed for the presence of vision problems because of a lack of staff with expertise in the area. Whilst stroke related vision defects may be detected, pre existing eye diseases, need for glasses, acuity standard and consequent ability to see is frequently not assessed. The undetected vision problems can impact on the patient's ability to respond to rehabilitation also ocular diseases left untreated can progress, resulting in vision impairment.

Results from a study of 150 patients, conducted in 2006-7 in three NSW Stroke Units (50 consecutive patients from each unit) revealed that:

• 126 (84%) of the patients had notable ocular defects, which were acquired or pre existing
• 80 patients (54%) had pre existing vision problems that impacted on performance
• 107 patients (68%) had stroke related conditions that were significant
• Significantly more vision problems were reported by orthoptists than staff with minimal expertise in vision
• Significantly more interventions, were implemented by orthoptists, to assist vision related problems

The study supports the value of detecting vision defects to support the patient. In the absence of constant access to an eye care practitioner a method of alerting health care workers to the presence of vision defects is therefore important to assist the referral pattern.

This paper will report on the impact of the above study outcomes on the development and trial of a screening tool. The tool is for use by all health care practitioners, to enable the detection and referral of a patient with a stroke who has a vision defect, both acquired or pre existing, to ensure appropriate specialized care.