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O.T. Visual Screening Tool




Occupational Therapy Visual Screening Tool
Belfast City Hospital – Stroke Unit

Lorraine Coll
Specialist Occupational Therapist




         www.COT.org.uk
O.T. Visual Screening Tool


Presentation Structure

  • History
     • Screening Tool Overview
        • Audit Results
           • Benefits to Patients/O.T Profession
              • Future Developments
O.T. Visual Screening Tool


History



 2006      Original Screen used    2008     Amendments   2009     Pilot used   2010      Audit     2011




                   Meeting held to
                                                                Pilot
                   discuss potential
                                                                Completion
                   improvements



 Original NI OT Visual                 Updated screening                        Commencement of
 Screening Tool                        tool piloted in BCH                      OT Stroke
 Developed                             Stroke Unit                              Assessment Pathway
O.T. Visual Screening Tool


Screening Tool Overview                              Key Objectives



  •   Assess visual problems
  •   Guide assessment of cognition and perception
  •   Identify intervention requirements
  •   Guide onward referral to Optometry, Orthoptics and
      Sensory support services
O.T. Visual Screening Tool


Screening Tool Overview                                 Equipment



  •   Patients own glasses
  •   A red object/marker pen
  •   Pen torch
  •   Stopwatch or clock with second hand
  •   6m direct ‘Snellen’ chart
O.T. Visual Screening Tool


Screening Tool Overview                                     Contents



  1. Visual History
  •Glasses
  •Pre CVA visual problems
  •Post CVA visual problems (subjective report)
O.T. Visual Screening Tool


Screening Tool Overview                             Content



  2. Visual Acuity
  •Distant vision (Snellen Chart)
  •Near vision (reading task)
O.T. Visual Screening Tool


Screening Tool Overview                                 Content



  3. Oculomotor Ability
  •Horizontal & Vertical eye movement
  •Nystagmus
  •Diplopia (subjective report)
  •Primary position
O.T. Visual Screening Tool


Screening Tool Overview                              Content



  4. Visual Fields
  •Single or two person method
  •Monocular and binocular testing
O.T. Visual Screening Tool


Screening Tool Overview                                          Content



  5. Visual Attention
  •Visual Extinction
  •Severity of inattention (‘dot-to-dot test’)

  6. Observed functional problems
O.T. Visual Screening Tool


Audit Results              Nr of patients admitted to the stroke unit




                      49


                                               Patients Screened
                                               Patients unscreened


                122
O.T. Visual Screening Tool


Audit Results                     Types of CVA / Other Diagnosis Screened




                         12.70%


                36.40%            10.60%                     PACS
                                                             TACS
                                   6.30%                     LACS
                                                             POCS
                                                             Other

                         34%
O.T. Visual Screening Tool


Audit Results                                                           Referral Pathway Overview
   Visual Problem


                           Visual Field                          Visual Acuity
       Ptosis
       Ptosis                                       Diplopia                           Nystagmus
                             Deficit                               Problem




              Unilateral                Bilateral




                           Optometry
                                                                    Sensory
                            Optometry               Orthoptics
                                                                    Support

                           Onward Referral
O.T. Visual Screening Tool


Audit Results                                                 Referral Pathway Overview
   Visual Problem


                    Visual Field                       Visual Acuity
       Ptosis                            Diplopia                            Nystagmus
                      Deficit                            Problem




                                      Advise patient
                                        on ADLs




                                                       Sensory
                     Optometry
                                                       Support
                                                          Sensory
                     Optometry           Orthoptics
                                                          Support

                    Onward Referral
O.T. Visual Screening Tool


Audit Results                                                  Referral Pathway Overview
   Visual Problem


                    Visual Field                       Visual Acuity
       Ptosis                         Diplopia
                                      Diplopia                                  Nystagmus
                      Deficit                            Problem




                                                                       • Nausea
                                             Application               • Which eye?
                                             of Eye Patch              • Gauge patient reaction




                                                            Sensory
                                      Orthoptics
                                                            Support
                                                            Sensory
                     Optometry        Orthoptics
                                                            Support

                    Onward Referral
O.T. Visual Screening Tool


Audit Results                                                 Referral Pathway Overview
   Visual Problem


                    Visual Field                       Visual Acuity
       Ptosis                          Diplopia                              Nystagmus
                      Deficit                            Problem




                                        Impeding
                                      Rehabilitation




                                                          Sensory
                      Optometry                                                  Optician
                                                          Support
                                                          Sensory
                     Optometry         Orthoptics
                                                          Support

                    Onward Referral
O.T. Visual Screening Tool


Audit Results                                                   Referral Pathway Overview
   Visual Problem


                    Visual Field                       Visual Acuity
       Ptosis                         Diplopia                                 Nystagmus
                                                                            Nystagmus
                      Deficit                            Problem




                                               Oscillopsia
                                             (wavy images)




                                                        Sensory
                                      Orthoptics
                                                        Support
                                                          Sensory
                     Optometry        Orthoptics
                                                             Support

                    Onward Referral
O.T. Visual Screening Tool


Audit Results                                                  Onward Referral

  45.0%
  40.0%
  35.0%
  30.0%
  25.0%
  20.0%                                         42.5%

  15.0%                                                          29.7%
  10.0%
   5.0%     12.7%       12.7%       12.7%

   0.0%
          Orthoptics   Optometry   Sensory    Community       No Referral
                                   Support   Stroke Rehab
O.T. Visual Screening Tool


Benefits to Patients/O.T Profession

• Change of practice (bypass need for medical referral)
• Timely screening for patients
• Increased knowledge and understanding of visual
  problems
• Immediate intervention on ward
• Increased volume of referrals
O.T. Visual Screening Tool


Future Developments

  •   Re-audit
  •   Education, training and roll-out
  •   O.T. Stroke Assessment Pathway
  •   Feedback workshop (Belfast Trust)
  •   Potential multi-trust roll-out
O.T. Visual Screening Tool




Thank you for listening




www.COT.org.uk

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Occupational Therapy Visual Screening Tool

  • 1. O.T. Visual Screening Tool Occupational Therapy Visual Screening Tool Belfast City Hospital – Stroke Unit Lorraine Coll Specialist Occupational Therapist www.COT.org.uk
  • 2. O.T. Visual Screening Tool Presentation Structure • History • Screening Tool Overview • Audit Results • Benefits to Patients/O.T Profession • Future Developments
  • 3. O.T. Visual Screening Tool History 2006 Original Screen used 2008 Amendments 2009 Pilot used 2010 Audit 2011 Meeting held to Pilot discuss potential Completion improvements Original NI OT Visual Updated screening Commencement of Screening Tool tool piloted in BCH OT Stroke Developed Stroke Unit Assessment Pathway
  • 4. O.T. Visual Screening Tool Screening Tool Overview Key Objectives • Assess visual problems • Guide assessment of cognition and perception • Identify intervention requirements • Guide onward referral to Optometry, Orthoptics and Sensory support services
  • 5. O.T. Visual Screening Tool Screening Tool Overview Equipment • Patients own glasses • A red object/marker pen • Pen torch • Stopwatch or clock with second hand • 6m direct ‘Snellen’ chart
  • 6. O.T. Visual Screening Tool Screening Tool Overview Contents 1. Visual History •Glasses •Pre CVA visual problems •Post CVA visual problems (subjective report)
  • 7. O.T. Visual Screening Tool Screening Tool Overview Content 2. Visual Acuity •Distant vision (Snellen Chart) •Near vision (reading task)
  • 8. O.T. Visual Screening Tool Screening Tool Overview Content 3. Oculomotor Ability •Horizontal & Vertical eye movement •Nystagmus •Diplopia (subjective report) •Primary position
  • 9. O.T. Visual Screening Tool Screening Tool Overview Content 4. Visual Fields •Single or two person method •Monocular and binocular testing
  • 10. O.T. Visual Screening Tool Screening Tool Overview Content 5. Visual Attention •Visual Extinction •Severity of inattention (‘dot-to-dot test’) 6. Observed functional problems
  • 11. O.T. Visual Screening Tool Audit Results Nr of patients admitted to the stroke unit 49 Patients Screened Patients unscreened 122
  • 12. O.T. Visual Screening Tool Audit Results Types of CVA / Other Diagnosis Screened 12.70% 36.40% 10.60% PACS TACS 6.30% LACS POCS Other 34%
  • 13. O.T. Visual Screening Tool Audit Results Referral Pathway Overview Visual Problem Visual Field Visual Acuity Ptosis Ptosis Diplopia Nystagmus Deficit Problem Unilateral Bilateral Optometry Sensory Optometry Orthoptics Support Onward Referral
  • 14. O.T. Visual Screening Tool Audit Results Referral Pathway Overview Visual Problem Visual Field Visual Acuity Ptosis Diplopia Nystagmus Deficit Problem Advise patient on ADLs Sensory Optometry Support Sensory Optometry Orthoptics Support Onward Referral
  • 15. O.T. Visual Screening Tool Audit Results Referral Pathway Overview Visual Problem Visual Field Visual Acuity Ptosis Diplopia Diplopia Nystagmus Deficit Problem • Nausea Application • Which eye? of Eye Patch • Gauge patient reaction Sensory Orthoptics Support Sensory Optometry Orthoptics Support Onward Referral
  • 16. O.T. Visual Screening Tool Audit Results Referral Pathway Overview Visual Problem Visual Field Visual Acuity Ptosis Diplopia Nystagmus Deficit Problem Impeding Rehabilitation Sensory Optometry Optician Support Sensory Optometry Orthoptics Support Onward Referral
  • 17. O.T. Visual Screening Tool Audit Results Referral Pathway Overview Visual Problem Visual Field Visual Acuity Ptosis Diplopia Nystagmus Nystagmus Deficit Problem Oscillopsia (wavy images) Sensory Orthoptics Support Sensory Optometry Orthoptics Support Onward Referral
  • 18. O.T. Visual Screening Tool Audit Results Onward Referral 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 42.5% 15.0% 29.7% 10.0% 5.0% 12.7% 12.7% 12.7% 0.0% Orthoptics Optometry Sensory Community No Referral Support Stroke Rehab
  • 19. O.T. Visual Screening Tool Benefits to Patients/O.T Profession • Change of practice (bypass need for medical referral) • Timely screening for patients • Increased knowledge and understanding of visual problems • Immediate intervention on ward • Increased volume of referrals
  • 20. O.T. Visual Screening Tool Future Developments • Re-audit • Education, training and roll-out • O.T. Stroke Assessment Pathway • Feedback workshop (Belfast Trust) • Potential multi-trust roll-out
  • 21. O.T. Visual Screening Tool Thank you for listening www.COT.org.uk

Editor's Notes

  1. History Timeline with milestones and progress in between each Screening Tool Overview Run through screen content with illustrations and potentially screen shots of screening document Audit Results Overview of result categories to demonstrate the stats that can be obtained Example results from a recent audit (potentially from 3 sections) Future recommendations Belfast Trust OT Stroke Assessment Pathway Further Training Roll out to Belfast Trust
  2. 2006-The initial ‘N.I Visual Screening Tool’ was devised by the O.T subgroup of NIMAST (now disbanded)in consultation with Orthoptists and Optometrists
  3. To help identify visual problems that impact on functional activities To guide assessment of cognition and perception To identify intervention needed and guide onward referral to Optometry, Orthoptics and Sensory support services