Vision-related quality of life in first stroke patients with homonymous visual field defects

Abstract

BackgroundTo evaluate vision-related and health-related quality of life (VRQoL, HRQoL) in first stroke patients with homonymous visual field defects (VFD) with respect to the extent of the lesion. Since VFD occur in approximately 10% of stroke patients the main purpose of the study was to investigate the additional impact of VFD in stroke patients hypothesizing that VFD causes diminished VRQoL.MethodsIn 177 first stroke patients with persisting VFD 2.5 years after posterior-parietal lesions VRQoL was assessed by the National-Eye-Institute-Visual-Functioning-Questionnaire (NEI-VFQ) and HRQoL by the Medical-Outcome-Study Short-Form-36 Health-Survey (SF-36). Questionnaire results of VFD-patients were compared with age- and sex-matched healthy controls and with general non-selected stroke samples as published elsewhere. VFD-type and visual acuity were partially correlated with questionnaire results.ResultsCompared to healthy controls VFD-patients had lower NEI-VFQ scores except ocular pain (Z-range -11.34 to -3.35) and lower SF-36 scores except emotional role limitations (Z-range -7.21 to -3.34). VFD-patients were less impaired in SF-36 scores than general stroke patients one month post lesion (6/8 subscales) but had lower SF-36 scores compared to stroke patients six months post lesion (5/8 subscales). Visual acuity significantly correlated with NEI-VFQ scores (r-range 0.27 to 0.48) and VFD-type with SF-36 mental subscales (r-range -0.26 to -0.36).ConclusionsVFD-patients showed substantial reductions of VRQoL and HRQoL compared to healthy normals, but better HRQoL compared to stroke patients one month post lesion. VFD-patients (although their lesion age was four times higher) had significantly lower HRQoL than a general stroke population at six months post-stroke. This indicates that the stroke-related subjective level of HRQoL impairment is significantly exacerbated by VFD. While VRQoL was primarily influenced by visual acuity, mental components of HRQoL were influenced by VFD-type with larger VFD being associated with more distress.

Remaining Visual Field and Preserved Subjective Visual Functioning Prevent Mental Distress in Patients with Visual Field Defects

“…Designed for the assessment of ophthalmologic diseases (Mangione et al, 2001) the NEI-VFQ is a valid and reliable instrument which was frequently used in studies focusing on the impact of visual field defects on subjective vrQoL after central visual pathway lesions (Cole et al, 2000; Beck et al, 2004; Raphael et al, 2006; Papageorgiou et al, 2007; Gall et al, 2009, 2010; Wagenbreth et al, 2011; Galetta et al, 2012; Walter et al, 2012; Jasse et al, 2013). It was demonstrated that diminished vrQoL was significantly related to the size of the visual field defect (e.g., Gall et al, 2009).…”

Visual Contrast Sensitivity Deficits in ‘Normal' Visual Field of Patients with Homonymous Visual Field Defects due to Stroke: A Pilot Study

“…Stroke commonly causes homonymous visual field defects (VFD), impairing daily activities [1] and quality of life [2]. VFD may recover on perimetry [3], but perimetry is limited in describing visual function, and is often underutilised in clinical practice, perhaps due to insufficient awareness of the impact of VFD on patients' disability [4].…”

Long-Term Visual Functioning After Eclampsia

“…A broad spectrum of ocular conditions has been shown to potentially alter vision-related QOL as measured by the National Eye Institute Visual Function Questionnaire-39/Nederlands, including glaucomatous and poststroke visual field loss, 29,30 congenital cataract, 31 and diabetic retinopathy. 32 In contrast with the objective visual field assessment as a measure of visual function, the National Eye Institute Visual Function Questionnaire-39/Nederlands comprises aspects of daily functioning in relation to vision strictly from a participant's perspective.…”