Stroke is the third most common cause of death and the leading cause of disability in adults in Australia. To date, rehabilitation and treatment have largely been focused on mobility and speech.
However, a number of ocular conditions can result from stroke, as the brain and eyes are interconnected. In addition, non-eye care health practitioners are not always able to distinguish between pre-existing and newly acquired eye conditions. This can result in misinterpretation and over-referrals to already stretched ophthalmology services, especially in regional areas.
To improve detection and recognition of visual and ocular changes in patients diagnosed with stroke, Orthoptist and UTS PhD candidate Michelle Courtney-Harris has completed validation processes which lead to refinement of a vision screening tool developed by Neryla Jolly from Ryde Rehabilitation Hospital in conjunction with the NSW Health Agency for Clinical Innovation (ACI). An education package allowing clinicians to easily adopt the tool when assessing stroke patients, is now under development.
Courtney-Harris says the elderly are more likely to have on-going eye conditions. As such, health practitioners need to be able to decipher between a stroke-related or pre-existing eye condition.
“One of the main problems is that many of the patients who experience stroke are elderly, even though it can affect any age group.
“Older people generally have other age-related ocular problems that often get forgotten, all of which can lead to poor visual function, affecting their rehabilitation process.”
“If there are disturbances along the visual pathway, or the cranial nerve pathways, there can be ocular implications and patients can suffer from things like double vision, visual neglect, and visual field loss. This will impact rehabilitation and possibly their ability to drive and have normal mobility in the long term.”
The screening tool’s main objective is to help non-eye care health professionals identify both pre-existing and newly acquired eye conditions in patients diagnosed with stroke.
“The tool has the ability to identify an existing visual problem as well as new ones. If the visual problem is significant then health practitioners can adapt their rehabilitative processes more appropriately.”
“It is simple enough that busy health professionals such as registrars, occupational therapists, physiotherapists or nurses can easily incorporate it in to a routine examination of the patient.”
At the recent ‘Stroke 2016’ conference in Canberra, Courtney-Harris and her supervisor Professor Kathryn Rose Head of Discipline (Orthoptics) at UTS led a workshop for health practitioners specialising in stroke to gain feedback on specific areas of eye health that should be included in the education package. This will be developed for further improvement of the vision screening tool outcomes.
“If we can improve non-eye care health practitioners’ ability to assess and understand eye function through the screening tool and education package, then their over-referral rate will come down.
“This will make a real difference to the outcomes and speed of treatment in regional NSW, as currently there is an overburden due to the limitation of ophthalmological services available.”
The validated vision screening tool will be introduced into NSW hospitals in 2017 as part of the acute stroke pathway. Courtney-Harris works in partnership with NSW ACI on the validation of the tool and the design of the education package.