Post Stroke Visual Impairment: Interdisciplinary Collaborative Program – Canadian Perspective

ABSTRACT

Post-stroke visual impairment (PSVI) affects more than 60% of the people who have a stroke but visual function is not routinely assessed in most stroke units. Recent high-quality research in this field has produced evidence-based assessment and management practices for PSVI. Orthoptists have integrated into the stroke care team in the United Kingdom (UK) to provide this valuable service. This paper outlines the development and implementation of the first known orthoptic PSVI service in North America. A pilot program was developed between the Ophthalmology, Neurology, and Physical Medicine and Rehabilitation Departments in Saskatoon, Saskatchewan, Canada. A new referral pathway was established to refer stroke patients with PSVI directly to an orthoptist with specialization in PSVI. Clinical findings from the first year of operation are reported. One hundred and seven visual deficits were suspected by the referring service. Visual field deficits were the most commonly reported PSVI. Diplopia was the most commonly reported oculomotor deficit in this cohort, and visual neglect/inattention was the most common visual perceptual deficit reported. Reading issues were the most commonly reported functional issues. Following assessment by an orthoptist, 45 additional visual deficits were identified and addressed. Stroke patients require assessment and treatment for PSVI. Orthoptists are perfectly suited to PSVI assessment and management. There is an opportunity to increase orthoptists’ scope of practice in North America to ensure stroke patients receive specialized vision assessment and treatment.

KEYWORDS:

• Post-stroke visual impairment
• orthoptics
• post-stroke management
• post-stroke assessment
• visual rehabilitation

Acknowledgments

• Dr. Paul Murphy, supervising Ophthalmologist

• Dr. Frozan Qasemi, supervising Ophthalmologist

• Dr. Gabriela Campos-Baniak, supervising Ophthalmologist

• Dr. Jing Shi, Medical Director, Saskatoon City Hospital Stroke Rehabilitation, Physical Medicine and Rehabilitation Unit

• Michael Walby, Orthoptist, who performed the visual field screenings

• Lindsay Schreiner, RN, who performed the NEI VFQ-25 post-assessment questionnaires – funding of this position was provided by the Royal University Hospital (RUH) Foundation

• Saskatoon City Hospital Foundation Board Members, who personally donated to the pilot program

• Royal University Hospital Acute Stroke Unit and Saskatoon City Hospital Physical Medicine and Rehabilitation Unit

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors contribution

Joel Hyndman co-developed the pilot program, performed all PSVI assessments, researched, and wrote the manuscript. Dr. Brett Graham and Ruth Whelan co-developed the pilot program.

Additional information

Funding

The work was supported by the Saskatoon City Hospital Foundation and the Royal University Hospital Foundation.