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Sheila Gillard Crewther, Chamini Wijesundera, Tissa Wijeratne, George Kong, Algis J Vingrys; High prevalence of visual field impairments in acute stroke patients. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2182.
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© ARVO (1962-2015); The Authors (2016-present)
The prevalence of visual field deficits following stroke is not well appreciated. Acute effects have not been published. This is surprising given that vision drives most behavior and that visual projections occupy a substantial volume of cortex. Furthermore hemineglect and cognitive impairments have long been recognized as severe limitations on recovery. Thus the development of an iPAD based app, Melbourne Rapid Fields (MRF), https://glance-optical.com/portal.html validated against the Humphrey, has now made in-patient perimetry assessments feasible.
A total of 87 unselected acute stroke patients (x= 68yrs, range 32-95, 49 males, 38 females) have recently been recruited for visual field assessments with the MRF app, while in the neurology ward (3-7 days) of Sunshine Hospital Melbourne Australia. The protocol is performed monocularly, instructions are simple and easily understood by most stroke survivors. The iPAD is positioned comfortably at 33 cms with patient wearing appropriate visual correction. Patients are asked to fixate a target and indicate if they detect any peripheral light spots. Reliability indices are based on number of false positives/negatives over 3 full runs.
Of the 87 patients, (x= 73.3yrs), 22 (10 males)were too sick to undertake the visual field assessment, while the results for another 18 patients were associated with a major pre-existing ophthalmic conditions, leaving a total of 47 available participants of whom 36 performed consistently taking 3-2.5minutes per test run per eye. Among this group 21 (58%) showed visual field deficits, with 9 (25%) showing hemi/quadranopia, 5 (~14%) altitudinal depression, 3 (8.3%) bilateral non-specific VF losses and 4 (~11%) mild visual field losses. Similar prevalences of field deficits existed among the retinal disorder-co-morbid group.
Over half of our unselected hospitalized, acute stroke patients, showed significant acute visual field deficits, highlighting the medical value of the MRF app as a fast, sensitive and easy to administer measure of visual field integrity for assessment of acute TBI such as stroke. Longitudinal studies are now needed to ascertain the duration of such deficits, especially as many of these Australian patients return to driving without ever being required to undergo visual assessments.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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