Orthoptic stroke services in the UK and Ireland: how have they evolved?

TL;DR

This study examines how orthoptic stroke services in the UK and Ireland have changed over time, highlighting ongoing challenges in funding and service provision.

Contribution

The study provides updated data on orthoptic stroke services since 2017, revealing trends in funding and service provision.

Findings

Only 27.6% of orthoptic departments providing stroke vision services are funded.

Health inequality persists with areas lacking post-stroke vision services.

Vision screening in stroke units has increased, but many still use non-validated tools.

Abstract

There are ~100,000 new strokes in the UK each year, 60% experience a new stroke-related visual impairment. Orthoptic stroke services were surveyed as baseline and follow-up in 2007 and 2017. Three new guidelines relating to post-stroke vision were published 2023–2025 and added to a mandatory national audit programme. This study aimed to assess the current provision of stroke orthoptic services since the 2016 National Clinical Guideline update through to 2023 updates.

An online survey was circulated to registered orthoptists in the UK and Ireland.

A total of 206 responses representing 125 orthoptic departments (67% response rate) were received, from all five nations. Stroke vision services were reported to be provided by 66.1% of orthoptic departments in hospitals with a stroke unit, of which only 27.6% were funded. Services often rely on vision screening by the stroke team (84.2%) with referral to orthoptic services (65.8%), only half of which were reported to be using a validated screening tool. To cover a mean of 42.5 beds, a mean of 0.43 full-time equivalent orthoptic staffing dedicated to stroke care and 0.27 funded, with lower medians.

Since 2017, stroke unit vision screening provision has increased, however over the same period a reduction occurred in funded services. Health inequality persists in that there remain areas with no/poor provision of post-stroke vision services. This study provides a baseline by which to assess change following the publication/updates of national and international guidelines and national audit programmes strengthening recommendations for post-stroke vision care.

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