Patients receiving care and treatment from Stockport NHS Foundation Trust’s stroke service will soon receive additional screening and rehabilitation for visual conditions, thanks to a new project and funding.

Patients at the stroke unit based at Stepping Hill Hospital will receive full orthoptist assessment when admitted with a stroke, which will mean more successful outcomes in treating the eye conditions which often accompany a stroke. They will then receive orthoptic review and therapeutic support and rehabilitation within the community.

Visual impairment is a common consequence of stroke, reported in up to 72% of stroke survivors. Impairments can include low vision, visual field loss, eye movement deficits resulting in double vision and/or nystagmus and visual perception difficulties. Individuals with post stroke visual impairment report a reduction in overall quality of life.

Almost 40% of stroke survivors with new onset visual impairment do not or cannot report visual symptoms. This highlights the importance of vision screening to ensure stroke survivors receive appropriate diagnosis, referral, and treatment.

The National Clinical Guideline for Stroke (2023) recommended that people with stroke should be screened for visual changes by a professional with appropriate knowledge and skills, and that people with altered vision or eye defects should receive information, support, and advice from an orthoptist and/or an ophthalmologist.

Following these recommendations, the Greater Manchester Neurorehabilitation & Integrated Stroke Delivery Network helped co-ordinate a collaborative bid with the Stockport NHS Foundation Trust orthoptic team and inpatient and community stroke teams, the East Cheshire NHS Trust community stroke team and a local charity partner.

The Catalyst funding of £264,000 from NHS England Stroke Quality Improvement Rehabilitation (SQuIRe)was successfully secured for ‘Implementation of a visual impairment pathway in the Southern Sector of Greater Manchester’. The purpose of Catalyst funding is to support projects that make a difference to patient care, and the Stockport project is one of five new Catalyst projects in addition to the current 14 Catalyst projects across the North West.

The new orthoptist led service will be supervised by Head Orthoptist Fiona Bush, and will be initiated at the stroke unit based at Stepping Hill Hospital. There will also be additional staffing in community stroke teams to support patient rehabilitation and manage the expected extra workload of new diagnoses, with support from charity partners.

Stockport NHS Foundation Trust’s stroke service is one of only three specialist units in Greater Manchester, and also treats patients from Eastern Cheshire, Trafford, Tameside and North Derbyshire. It is consistently rated as one of the best units in the country by the independent Sentinel Stroke National Audit Programme (SSNAP).

Dr Shivakumar Krishnamoorthy, Network Hospital Clinical Director for Greater Manchester Neurorehabilitation & Integrated Stroke Delivery Network said “Patients who present with stroke are highly likely to experience visual impairments as well, and these can be a barrier to successful engagement with stroke rehabilitation, as they can result in loss of confidence, impaired mobility, reading difficulties, and increased accidents. Diagnosis from a specialist orthoptist service is an excellent way of recognising the problems early on, so that patients can receive the care and treatment they require. We are delighted to have received SQuIRe funding from NHS England to support this innovative service.”

Christine Hyde, Stockport NHS Foundation Trust Team Lead for the Community Neurorehabilitation Service and Greater Manchester Neurorehabilitation, and Integrated Stroke Delivery Network Community Lead for Neurorehabilitation said “Having a specialist orthoptist assess our patients early on after being admitted to identify visual impairments will have a huge impact on the care, treatment and support of our stroke patients. We are very pleased that we will be able to provide this additional care.”