Vision care for stroke survivors

BACKGROUND

Visual impairment is a common consequence of stroke. National guidelines across the UK (Royal College of Physicians National Clinical Guidelines for Stroke 2012, Scottish Intercollegiate Guidelines Network Guidance 118, 2010) recommend specialist vision assessment for stroke survivors who are suspected of having a visual problem.

In spite of this, there is a problem with how we care for people with vision problems after stroke. Vision testing is not routinely performed for these people. There are many differences across the UK for getting access to eye care services for specialist testing and treatment.

AIM

The Stroke Association and Thomas Pocklington Trust identified a number of key questions relating to the care of people with visual problems after stroke. Dr Fiona Rowe led a team of researchers to investigate whether stroke survivors across the UK, who have visual conditions, still have visual problems that have not been addressed (unmet need).

The aims were to identify the vision care provided for stroke survivors with visual impairment and the extent to which they have needs that are not currently being met, specifically:

  • How much ‘unmet need’ (when a problem is not addressed or is not addressed sufficiently) is there in post-stroke vision services?
  • Is there a clear pathway for vision care in stroke survivors?
  • What are the variations in post-stroke vision care, and how might they be addressed?
  • What constitutes good practice in post-stroke vision care?

IMPACT

Across the UK there is inequality in care provision for stroke survivors with visual problems. Stroke survivors continue to have unmet needs with their visual problems.

A number of issues were suggested during our interviews that could cause vision services to fail. These included a lack of funding, lack of orthoptic cover, staff retraining, lack of stroke doctor support and incorrect information about visual problems.

From our interview results across the UK, we identified a number of recommendations to promote best practice across all stroke units. These included formal orthoptic care, flexible and timely appointments, formal stroke team training, full support from stroke doctors, lay summaries, open communication between eye care and stroke teams, visual information leaflets, use of approved referral forms and use of a vision care pathway.

The full report and lay summary of this work can be read here.