Orthoptic stroke services in the UK and Ireland: how have they evolved?

Why eye care after stroke matters

Stroke is best known for causing weakness or speech problems, but it also often harms sight. In the UK alone, tens of thousands of people each year are left with new vision difficulties after a stroke, affecting reading, balance, driving, and everyday independence. This study looks at how well hospitals across the UK and Ireland are set up to find and treat these vision problems, focusing on the role of orthoptists—specialist eye-care professionals who assess and manage eye movement and related vision issues.

Checking in on hospital eye services

The authors repeated a survey of hospital eye departments first carried out in 2007 and again in 2017. They asked orthoptists across the UK and Ireland whether their hospitals had stroke units, whether those units routinely checked stroke survivors’ vision, who led that work, how it was organised and funded, and what the main obstacles were. The timing was important: national stroke guidelines were strengthened in 2016 and again in 2023, and a national stroke audit has recently begun tracking whether and when stroke patients receive vision checks and specialist assessment.

More screening, but still uneven care

Out of 186 possible departments, 125 responded, giving a solid picture of practice. Most worked in hospitals with a stroke unit, and around two-thirds of those units reported some kind of on-ward vision service. In many places, orthoptists lead this work, but there is heavy reliance on the wider stroke team—such as nurses or therapists—to perform quick screening checks and then refer on to orthoptics. Only about half of these teams use a standard, tested screening tool; the rest use local or informal methods. Very few hospitals provide automatic, specialist vision screening for every stroke patient, as current guidelines advise.

Too little time and money for eye specialists

Where vision services do exist on stroke units, they are often running on goodwill rather than secure funding. Only about a quarter of departments reported that their stroke-unit vision service was formally funded. On average, less than half of a full-time orthoptist post is actually devoted to stroke patients, and even less of that time is properly funded. Many services therefore depend on ad hoc visits or seeing stroke survivors later in busy eye clinics, rather than building vision care into routine early stroke treatment. Lack of funding and lack of orthoptic capacity were the most commonly reported barriers, and some respondents still felt that key decision-makers did not see stroke-related vision care as a priority.

Health gaps and missed chances

The survey shows that improvements over the last two decades have not erased major gaps. Some hospitals still have no specialist orthoptic input for stroke, and many rely mainly on basic screening that may miss important vision problems, especially more subtle issues with eye movements, visual attention, or how people use vision in daily life. This leads to health inequalities: depending on where a person has their stroke, they may or may not receive timely, expert help with their sight. The authors highlight evidence that early specialist assessment can be more accurate, faster, and potentially cheaper overall than a two-step process where general staff screen and then refer on, especially when one factors in the costs of falls, accidents, and delayed rehabilitation linked to poor vision.

What this means for people after stroke

For someone recovering from a stroke, seeing clearly and comfortably is crucial for walking safely, reading, recognising people, and taking part in rehabilitation. This study finds that while more stroke units now pay attention to vision, specialist services remain under-resourced and unevenly available. The results provide a new starting point to judge whether recent guideline updates and national audits will finally close these gaps. In plain terms, the authors conclude that every stroke survivor should quickly have their vision checked, ideally by an orthoptist, and that health systems need to match this priority with proper staffing, funding, and consistent practice across all regions.

Citation: Hepworth, L.R., Rowe, F.J. Orthoptic stroke services in the UK and Ireland: how have they evolved?. Eye 40, 654–660 (2026). https://doi.org/10.1038/s41433-026-04243-4

Keywords: stroke vision, orthoptics, stroke rehabilitation, health inequalities, hospital eye services