Abstract
Background
This healthcare evaluation focussed on the effectiveness of an orthoptic-led inpatient vision screening service at Nottingham University Hospitals for older adults admitted with a fragility hip fracture. The service was developed in response to national guidance, which recommended a multifactorial assessment, including a vision assessment for older adults presenting following a fall.
Method
Vision screening was carried out by orthoptists on eligible patients ≥65 years of age admitted to the Trauma and Orthopaedic wards with a hip fracture. Retrospective data for patients screened between 2015-2019 were analysed, including: patient demographics, screening eligibility and outcome, ophthalmology referrals made, ophthalmology appointment attendance and outcome.
Results
Of 3321 patients admitted with hip fracture between 2015-2019, 2033 (61%) were eligible for vision screening and 1532 (75%) of these were screened. 784 (51%) patients screened had an ocular abnormality requiring ophthalmology referral via their GP, or a sight test at an optician. Only 144/383 (38%) requiring ophthalmology referral were successfully referred and only 107/186 (58%) patients given appointments attended. 98/107 had pathology and cataracts was the most common finding (51%). 61/98 (62%) patients had treatable vision impairment.
Conclusions
We found a large proportion of hip fracture patients who had impaired vision; much of which was easily treatable and could be detected effectively with orthoptic-led bedside screening. The most common eye problem in those referred to ophthalmology was cataracts. An internal referral pathway to ophthalmology is proposed. There is a need to investigate reasons for disengagement with eye care services in this population.