Visual impairment following stroke: do stroke patients require vision assessment?

Rowe, Fiona; Brand, Darren; Jackson, C. A.; Price, Alison; Walker, Linda; Harrison, Shirley; Eccleston, Carla; Scott, Claire; Akerman, Nicola; Dodridge, Caroline; Howard, Claire; Shipman, Tracey; Sperring, Una; MacDiarmid, Sonia; Freeman, Cicely

doi:10.1093/ageing/afn230

Cited by 197 publications

(165 citation statements)

References 27 publications

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“…Many individuals have low vision, ocular alignment or movement problems, visual field loss, visual inattention, and other processing abnormalities following their stroke. 1,2,8 There are various treatment options for these visual problems, which can have a positive beneficial effect in terms of their vision but also in their general rehabilitation. 1,2,9 Additionally, many individuals have pre-existent ocular disease such as glaucoma, age-related macular degeneration, and cataract.…”

Section: Discussionmentioning

confidence: 99%

“…1 The study is a prospective multicentre observational case-cohort study, which conforms to the Tenets of Helsinki, with multicentre ethical approval in the UK. The VIS group consists of local investigators responsible for assessing stroke patients and collecting patient data.…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3][4] In many units, the stroke multidisciplinary team includes an Orthoptist, and hence there exists an ease of access to eye services. 5 In other units, there is no formal eye service link for stroke survivors.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of referrals for visual assessment in a stroke population

Rowe

2010

Eye

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Purpose To evaluate accuracy of referrals from multidisciplinary stroke teams requesting visual assessments. Patients and methods Multicentre prospective study undertaken in 20 acute Trust hospitals. Stroke survivors referred with suspected visual difficulty were recruited. Standardised screening/referral and investigation forms were used to document data on referral signs and symptoms, plus type and extent of visual impairment. Results Referrals for 799 patients were reviewed: 60% men, 40% women. Mean age at onset of stroke was 69 years (SD 14: range 1-94 years). Signs recorded by referring staff were nil in 58% and positive in the remainder. Symptoms were recorded in 87%. Diagnosis of visual impairment was nil in 8% and positive in the remainder. Sensitivity of referrals (on the basis of signs detected) was calculated as 0.42 with specificity of 0.52. Kappa statistical evaluation of agreement between referral and diagnosis of visual impairment was 0.428 (SE 0.017: 95% confidence interval of À0.048, 0.019). Conclusion More than half of patient referrals were made despite no signs of visual difficulty being recorded by the referring staff. Visual impairment of varying severity was diagnosed in 92% of stroke survivors referred for visual assessment. Referrals were made based predominantly on visual symptoms and because of formal orthoptic liaison in Trusts involved.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Accuracy of referrals for visual assessment in a stroke population

Rowe

2010

Eye

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“…Rowe et al. (2009a) found reduced convergence of <10 cm was present in one third of stroke survivors which frequently contributed to reading difficulty.…”

Section: Interventionsmentioning

confidence: 99%

“…The visual problems (types of visual impairment) can be complex including ocular as well as cortical damage (Jones & Shinton, 2006; Rowe et al., 2009a). Visual impairments can have wide reaching implications on daily living, independence, and quality of life.…”

Section: Introductionmentioning

confidence: 99%

The treatment methods for post‐stroke visual impairment: A systematic review

2017

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AimTo provide a systematic overview of interventions for stroke related visual impairments.MethodA systematic review of the literature was conducted including randomized controlled trials, controlled trials, cohort studies, observational studies, systematic reviews, and retrospective medical note reviews. All languages were included and translation obtained. This review covers adult participants (aged 18 years or over) diagnosed with a visual impairment as a direct cause of a stroke. Studies which included mixed populations were included if over 50% of the participants had a diagnosis of stroke and were discussed separately. We searched scholarly online resources and hand searched articles and registers of published, unpublished, and ongoing trials. Search terms included a variety of MESH terms and alternatives in relation to stroke and visual conditions. Article selection was performed by two authors independently. Data were extracted by one author and verified by a second. The quality of the evidence and risk of bias was assessed using appropriate tools dependant on the type of article.ResultsForty‐nine articles (4142 subjects) were included in the review, including an overview of four Cochrane systematic reviews. Interventions appraised included those for visual field loss, ocular motility deficits, reduced central vision, and visual perceptual deficits.ConclusionFurther high quality randomized controlled trials are required to determine the effectiveness of interventions for treating post‐stroke visual impairments. For interventions which are used in practice but do not yet have an evidence base in the literature, it is imperative that these treatments be addressed and evaluated in future studies.

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Extent of Exacerbation of Chronic Health Conditions by Visual Impairment in Terms of Health-Related Quality of Life

et al. 2015

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IMPORTANCE Visual impairment (VI) causes a considerable public health burden and substantial deterioration in health-related quality of life (HRQoL). However, the relative effect of VI on HRQoL compared with other chronic health conditions is unknown as is the additive effect of VI with other conditions. OBJECTIVE To investigate whether the impact of chronic health conditions on HRQoL varies according to VI presence. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study involving 29 639 participants aged 19 years and older and using a multistage, probability-cluster survey, which can produce nationally representative estimates. We analyzed data from the 2008-2012 Korean National Health and Nutrition Examination Survey, which included results for vision assessment and HRQoL, measured using the European Quality of Life-5 Dimensions Questionnaire (EQ-5D). All analyses were conducted in October and November 2014. Visual impairment was defined as the presenting distance best-corrected visual acuity of less than decimal 0.32 (approximate Snellen equivalent 20/63). Linear regression models accounting for sample weights were used to examine interactions between VI and each of 14 chronic health conditions on the EQ-5D index score, adjusted for demographic and socioeconomic covariates. MAIN OUTCOMES AND MEASURES The EQ-5D index score for participants with VI or 14 chronic health conditions, as well as the effect of the interactions between VI and each condition on the EQ-5D index score. RESULTS The EQ-5D index score with VI was substantially lower than without VI (mean difference, −0.158; 95% CI, −0.186 to −0.130; P < .001). In most conditions, the comorbidity with VI resulted in lower EQ-5D index scores; furthermore, participants with stroke, osteoarthritis or rheumatic arthritis, hepatitis B or C, and depression showed lower EQ-5D index scores than expected when they were comorbid with VI, indicating an interaction between VI and each condition. The estimated β coefficients for interaction terms were −0.256 (95% CI, −0.480 to −0.032) for stroke, −0.124 (95% CI, −0.223 to −0.026) for osteoarthritis or rheumatic arthritis, −0.183 (95% CI, −0.327 to −0.038) for hepatitis B or C, and −0.130 (95% CI, −0.229 to −0.032) for depression. CONCLUSIONS AND RELEVANCE These results suggest that VI has a substantial effect on HRQoL, even in the presence of concurrent chronic health conditions, and the combined effect of VI and stroke, osteoarthritis/rheumatic arthritis, hepatitis, or depression on HRQoL was greater. However, because this study group was a representative sampling of South Koreans, generalization to other races/ethnicities and countries should be approached with caution.

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Visual impairment following stroke: do stroke patients require vision assessment?

Cited by 197 publications

References 27 publications

Accuracy of referrals for visual assessment in a stroke population

Accuracy of referrals for visual assessment in a stroke population

The treatment methods for post‐stroke visual impairment: A systematic review

Extent of Exacerbation of Chronic Health Conditions by Visual Impairment in Terms of Health-Related Quality of Life

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