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Identifying visual effects of stroke essential to early intervention
More than half of all stroke survivors have problems with visual acuity.
Vision screening and full visual assessment detected these issues within 5 days of stroke, according to a study published in PLOS ONE.
Issues with visual acuity are an underreported consequence of stroke, so the authors sought to create an annual incidence and point prevalence evaluation on visual acuity in an adult stroke population and also explore early timing of visual assessment after stroke.
In this prospective, multicenter epidemiology study, researchers reviewed data on acute stroke unit patients who were assessed for visual acuity, visual fields, ocular alignment, ocular motility, visual inattention and visual perception. A total of 1,033 stroke survivors completed visual assessment.
Researchers found that these patients underwent visual screening at a median of 3 days and full visual assessment at a median of 4 days after their stroke. The incidence of new visual acuity issues after stroke was 48% for all admissions and 60% for all survivors.
Approximately 75% of patients had visual acuity (point prevalence) effects, 56% had impaired central vision, 40% presented with eye movement abnormalities, 28% with visual field loss, 27% with visual inattention and 5% with visual perceptual disorders.
Researchers concluded that early vision screening is possible within the first 72 hours following stroke. Not only are there possible benefits for patients’ lives but also for their stroke team and care givers by enabling early intervention. – by Scott Buzby
Disclosure: The authors report no relevant financial disclosures.
Perspective
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As eye care providers, we know all too well the devastating effects that a neurological stroke can have on the visual system. This interesting study, which was performed in three stroke centers in England, sheds light on the severity of this problem.
Most of the patients included in the study underwent visual evaluations within several days of having suffered an acute ischemic or hemorrhagic stroke. Many were actually assessed within the first 72 hours. Issues with the visual system were roughly categorized as affecting central vision, ocular motility, the visual field or visual perception. Overall, 60% of assessed stroke survivors (some patients were too impaired to assess) exhibited one or more new onset visual deficits. Interestingly, patients with visual system abnormalities tended to have suffered much more severe strokes, and their average discharge time from the hospital was 36 days longer than stroke survivors who did not have visual system involvement.
For interventional and rehabilitative purposes, it is critical to screen for deficits as early as possible, with early identification perhaps leading to early attempts at remediation. This work shows that many stroke sufferers will suffer with visual system abnormalities and, furthermore, that they can often be effectively evaluated very soon after the event. Rapid identification of those in need has the potential to lead to improved long-term outcomes with reduced disability.