Category: Stroke; Brain Injury; Technology (e.g. robotics, assistive technology, mHealth)
Determine if patients with signs and symptoms of strabismus (eye misalignment) can be diagnosed and treated with press-on prism using a tele-consult process. Strabismus occurs in 20% of stroke survivors, increases risk for fall by 2.2x's, and can be successfully and inexpensively treated with press-on prism in a reported 64% to 80%. Unfortunately care is often delayed due to a lack of access to vision rehabilitation specialists (OD).
Setting : Inpatient
Participants (or Animals, Specimens, Cadavers) :
Twenty-five patients for whom tele-consult was provided for signs or symptoms of strabismus
Strabismus measurement was obtained with an app which calculates asymmetry in the position of the flash reflections on the ocular surface. This method is used by other commercially available devices (Welch Allyn Spot, Volk Eyecheck), with a reported accuracy of ±1.25°(2.5Δ). We hypothesized that this level of accuracy would be sufficient for diagnosis and prism prescription. OTs onsite took the app pictures and sent to the offsite OD for review and recommendations. Where appropriate, OTs followed instructions to cut and apply press-on prisms.
Main Outcome Measure(s) :
Summary statistics were calculated from a 4-item likert-type scale (0 to 10) completed by the onsite OTs after treatment.
Ability to "provide diagnosis" was rated as (median, (IQR)) 9, (7 to 10); 2) "guide OT strategies or modifications for vision" 9, (8 to 10); 3) "alleviate double vision" 6.5, (5.25 to 8); 4) "Reduce patient concern" 8 (6.5 to 10). Two OTs reported liking the process, the other did not.
Tele-consult for signs and symptoms of strabismus was safe, feasible, well accepted by patients and most clinicians, and resulted in similar success rates as in-person treatment reported in prior studies.
Gang Luo– Associate Professor of Opthalmology, Harvard Medical School, Boston, Massachusetts
Matthew Keilty– OT, Spaulding Rehabilitation Hospital, Sandwich, Massachusetts
Kevin Houston– Assistant Professor of Ophthalmology, Harvard Medical School, Norwell, Massachusetts