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Fiona Rowe, VIS Group; The Vision In Stroke (VIS) study: Profile of visual impairment following stroke. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5725.
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© ARVO (1962-2015); The Authors (2016-present)
The purpose of this paper is to profile the visual impairment of stroke survivors from the full dataset of the Vision In Stroke (VIS) study.
Multi-centre prospective observation study undertaken in 20 acute NHS Trust hospitals. Target population of stroke survivors with suspected visual difficulty. Standardised screening/referral forms and investigation forms were employed to document data on visual impairment, specifically assessment of visual acuity (logMAR), ocular pathology, eye alignment and movement (cover test, qualitative saccadic and smooth pursuit eye movements, stereopsis, fusion), visual perception (including inattention) and visual field defects (confrontation and perimetry).
915 patients were recruited with mean age of 69 years (SD 14). 8% had normal eye examinations and 92% had confirmed visual impairment: 64% had eye alignment/movement impairment, 52% had visual field impairment, 29% had low vision and 18% had perceptual difficulties. 84% reported symptoms including diplopia, blurred vision, reading difficulty, field loss, perceptual difficulty and oscillopsia. 23% of patients had communication difficulties (aphasia). There was no significant difference for type of visual impairment and quality of life score (Activities of Daily Living Dependent on Vision questionnaire). Treatment included refraction, prisms, occlusion, orthoptic exercises, low vision aids and advice. 25% of patients were discharged after eye examination, 63% offered review appointments and 12% referred to other vision services. Of those attending review appointments, 13.5% had full recovery of visual function, 45% improved, 1% deteriorated and 40% showed no change.
To our knowledge, this paper presents the first large prospective profile of visual impairment following stroke. Of patients referred with suspected visual difficulty, only 8% had normal vision status confirmed on examination. 92% had visual impairment, mostly relating to ocular motility or visual field loss. Treatment, even if only targeted advice, was possible for most patients. This study comprised a sub population of stroke survivors referred with suspected visual impairment. The true incidence of visual impairment following stroke remains, as yet, unknown.
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