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Michelle Courtney-Harris, Neryla Jolly, Fiona J Rowe, Kathryn Ailsa Rose; Development of a screening tool to identify eye conditions in patients admitted to hospital for stroke.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5168.
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To address under-detection of eye conditions in patients with stroke, an eye screening protocol designed to be used by health practitioners without eye care experience for the detection of pre-existing and acquired stroke-related eye conditions was evaluated.
A bedside screening tool was designed in consultation with the Ophthalmology Service of the New South Wales Agency for Clinical Innovation. The tool had three sections questioning ocular history and symptoms, observations of facial and ocular appearance and assessment of eye movements and vision. Stroke units in two metropolitan Sydney public hospitals that had no direct access to eye care professionals were asked to identify patients admitted for ≥3 days and were able to consent and participate. Patients (n=100) were randomly allocated into two groups. All participants’ were assessed using the screening tool by a non-eye care practitioner. Additionally, the orthoptist performed a comprehensive ocular assessment in Group 1 and in Group 2 administered the screening tool only to assess limits of agreement on individual items. The tool’s sensitivity and specificity for detecting existing and newly acquired eye conditions and appropriate referral were assessed.
The tool demonstrated 100% sensitivity (95% CI 92.7-100) and specificity (95% CI 20.7 to 100) in detecting pre-existing eye conditions. It was less successful in identifying new conditions (sensitivity = 66.7%, 95% CI 41.7-84.8; specificity = 66.6%, 95% CI 49.6-82.3). This could in part be explained by 4 of the 19 tool items where agreement was <80% (range 65-78%) with question timing and ambiguity determined in 3 questions and uncertainty for one item differentiating age-related lid lag from ptosis. The sensitivity and specificity for recommended referral was 90% (95% CI 69.9-97.2) and 50% (95% CI 32.6-67.4) respectively. The Group 2 tool versus tool assessment showed 100% agreement for items related to pre-existing conditions, 85% for visual acuity assessment and 75% for items related to newly acquired conditions and eye movement assessment.
The eye screening tool is a valid instrument for identifying pre-existing conditions in patients with stroke. Identification of newly acquired eye conditions can be improved by minor modifications. The level of over-referral will be addressed by addition of a non-eye care practitioner ophthalmic education tool.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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