Testing a vision assessment and referral model (VA-RIS) for people in rehabilitation after stroke or fracture at the University of Canberra Hospital

The intervention is the Vision Assessment Referral, Investigation and Support (VA-RIS) pathway, a structured optometry-led assessment designed for patients admitted to the University of Canberra Hospital (UCH) for rehabilitation following stroke or falls-related fractures. Within the first 1–3 weeks of admission, participants randomised to the intervention group first complete a set of quality-of-life questionnaires including the EuroQOL-5D-3L (EQ-5D), Impact of Vision Impairment (IVI), and the National Eye Institute Visual Function Questionnaire (NEI VFQ-25), which are administered in a separate session by a research assistant. The questionnaire session is expected to take approximately 30 minutes, depending on the participant’s pace and support needs. At a separate session within the same 1–3 week timeframe, participants undergo a comprehensive vision assessment conducted face-to-face by final-year optometry students from the University of Canberra, under the supervision of ACT Health-credentialed optometrists. The assessment is consistent with standard of care routinely delivered in optometry clinics. The specific tests administered are determined by clinical judgement, taking into account each patient’s history, presentation, and physical or cognitive capacity. Where feasible, the assessment aims to include at minimum: habitual distance and near visual acuity testing (unaided and/or with current spectacles), confrontation visual fields, Amsler grid testing, contrast sensitivity (e.g. Pelli Robson Chart), and objective refraction. However, as with routine optometric care, the actual tests may vary depending on the patient’s condition and tolerance. Additional tests, such as ocular motility, saccades and pursuits, near point of convergence (NPC), near point of accommodation (NPA), cover testing, pupil reactions, binocular vision assessment (e.g. stereopsis, heterophoria), colour vision testing (e.g. Ishihara or UNSW SOVS Suite), intraocular pressure (e.g. Perkins tonometry), and ocular health evaluation (e.g. slit lamp examination, fundoscopy, or portable OCT), may be included where clinically appropriate. Bedside assessments and simplified materials may be used for patients with mobility or cognitive limitations. Where appropriate, the assessment also captures patient-reported or observed functional difficulties, such as reading, face recognition, and mobility-related visual challenges. The vision assessment is expected to be conducted within a 60-minute timeframe, during which as many relevant components as feasible will be completed based on the patient’s condition and tolerance. Findings are recorded using a standardised clinical form and entered into the hospital’s Digital Health Record (DHR). A written report summarising clinical findings and recommendations (e.g. environmental modifications, low vision aids, or onward referrals) is provided to the treating rehabilitation team, along with an in-system notification. The clinical recommendations are intended to inform patient care during the inpatient rehabilitation stay at UCH and may also remain relevant post-discharge. However, their application is determined by the treating rehabilitation team, who integrate this information with other clinical findings to make holistic decisions. The vision assessment contributes to multidisciplinary care planning, but the research team does not control how the recommendations are used in practice. Within 14 days of discharge, participants complete a follow-up assessment that includes the same set of quality-of-life questionnaires, again administered by a research assistant. Within 6–8 weeks post-discharge, a second follow-up is conducted at UCH. This includes repeated administration of the same quality-of-life measures by the research assistant, and a brief reassessment of visual function (e.g. visual acuity, visual fields, and ocular health), where feasible, conducted by final-year optometry students from the University of Canberra under the supervision of ACT Health-credentialed optometrists. These follow-ups contribute to the evaluation of patient outcomes and the sustained impact of the intervention. The anticipated duration of this follow-up assessment is approximately 60 minutes.

The intervention is the Vision Assessment Referral, Investigation and Support (VA-RIS) pathway, a structured optometry-led assessment designed for patients admitted to the University of Canberra Hospital (UCH) for rehabilitation following stroke or falls-related fractures. Within the first 1–3 weeks of admission, participants randomised to the intervention group undergo a structured vision assessment conducted face-to-face by final-year optometry students from the University of Canberra under the supervision of registered optometrists. The assessment is consistent with standard optometric care, defined for the purposes of this study as non-invasive, routinely performed clinical vision tests commonly used in optometry practice. These procedures are low risk and part of usual clinical care rather than experimental testing. The assessment follows a structured framework but is adapted based on each patient’s clinical condition, tolerance, and rehabilitation context. While the assessment is individualised, it includes a minimum core set of components where feasible: habitual distance and near visual acuity, confrontation visual fields, contrast sensitivity, and refractive evaluation. Additional tests (e.g., ocular motility, binocular vision assessment, colour vision testing, computerised visual field testing, intraocular pressure measurement, and ocular health evaluation) may be performed based on clinical judgement, taking into account each patient’s history, presentation, and physical or cognitive capacity. Bedside assessments and simplified materials may be used for patients with mobility or cognitive limitations, and functional visual difficulties relevant to rehabilitation may also be documented. The assessment is conducted once during the inpatient rehabilitation admission, typically within 1–3 weeks of admission, and takes approximately 60 minutes to complete depending on patient tolerance and clinical complexity. No repeated intervention assessments are required as part of the intervention. Follow-up assessments at discharge and post-discharge are conducted for outcome measurement only and are not part of the intervention. The total duration of the intervention is limited to this single assessment session, with subsequent clinical management occurring as part of routine care. Findings are recorded using a standardised clinical form and entered into the hospital’s Digital Health Record (DHR). A written report summarising clinical findings and management recommendations (e.g., environmental modifications, optical correction, low vision strategies, or onward referrals) is provided to the treating rehabilitation team via routine clinical systems. The clinical recommendations are intended to inform multidisciplinary rehabilitation care during the inpatient stay; however, implementation of recommendations remains at the discretion of the treating clinical team. The VA-RIS pathway aims to facilitate systematic identification, documentation, communication, and management of vision impairment within rehabilitation practice.