Improving Eye Care in Stroke Patients
Michelle Courtney-Harris’s work on a vision screening tool is set to vastly improve eye care in stroke, with the potential to help in other areas of visual assessment i.e. head injury patients. The vision screening tool is now mandatory in hospitals in NSW as part of the Acute Stroke Treatment Pathway.
The seeds of Michelle Courtney-Harris’s PhD were sown back in the early 2000s when a group of orthoptists became concerned that admitted stroke patients with visual problems were going unrecognised. They undertook a pilot study that looked at existing models of care for patients diagnosed with stroke in the hospital system and found that an incredible 80% of stroke patients had some sort of visual problem or visual impairment, many of which went unrecognised and/or unreferred.
“The education module is fun and interactive, and the idea is that it will help reduce that referral burden.”
Michelle Courtney-Harris, lecturer and PhD candidate, UTS Graduate School of Health
Out of that project came the idea to devise a vision screening tool to help non-eye care professionals more easily pick up existing and newly-acquired eye problems in their stroke patients. The original screening tool was developed by Neryla Jolly from Ryde Rehabilitation Hospital in conjunction with a team of orthoptists and other allied health professionals with a special interest in stroke in close consultation. The NSW Health Agency for Clinical Innovation (ACI) also supported the project. The tool was tested and modified by the group, then it needed validation.
“That’s where I came in,” says Graduate School of Health lecturer and PhD candidate Courtney-Harris who has extensive clinical experience as an orthoptist. “I found that while the tool was simple enough that busy health professionals such as registrars, occupational therapists, physiotherapists or nurses could easily incorporate it into a routine examination of the patient, some of the questions could be a little ambiguous. I made a series of minor changes and recommendations to improve it,” she says.
Courtney-Harris found that even through the majority of health professionals were using the tool correctly, and knew roughly what a cataract or macular degeneration were, for example, they often didn’t understand the functionality implications of that on their patient. They also often couldn’t distinguish between what was an old issue, and what was a result of the stroke.
“This resulted in a lot of patients being referred for eye care assessment that probably didn’t need them, which can be a problem especially in rural and regional areas where there is an overburden due to the limitation of ophthalmological services available,” she continues.
One of the most important recommendations Courtney-Harris made was to develop an education module that could be used in conjunction with the vision screening tool. It’s designed to make the user more aware of pre-existing ocular pathology that can cause functional loss in their patients, as well as some newly-acquired ones that can result from a stroke. “The education module is fun and interactive, and the idea is that it will help reduce that over-referral burden,” says Courtney-Harris.
As of September 2017, the screening tool and education module went live on the NSW health Continuing Education platform and is now mandatory as part of the Acute Stroke Treatment Pathway. Courtney-Harris continues to work in partnership with the NSW ACI on the validation of the tool and the design and validation of the education module. “It’s great that the tool is now being used in NSW and I think it will be a big help for both stroke patients, and the healthcare professionals looking after them,” she says.