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

BACKGROUND: 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. METHODS: An online survey was circulated to registered orthoptists in the UK and Ireland. RESULTS: 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. CONCLUSIONS: 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.