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Chamini Wijesundera, Algis J Vingrys, Yu Xiang George Kong, Tissa Wijeratne, Sheila Gillard Crewther; Visual Function and Visuo-Motor Coordination in Acute Stroke. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1046.
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© ARVO (1962-2015); The Authors (2016-present)
Cerebrovascular events such as Stroke are primarily diagnosised on the basis of motor impairments yet visual projections to the brain occupy 40% of cortical volume and drive most human behaviour. including attention,visuo-motor actions and emotional processing. To date there are few reports of in-patient vision assessments within 7 days of first episode stroke. Here we report such a trial using modern tablet technology.
A total of 60 unselected acute ischemic stroke patients (mean age=65±14 yrs, range 29-88 yrs, 33 males,27 females) with brain imaging confirmation and who were able to understand instructions, had no pre-existing visual disorder or cognitive impairment, were recruited in the Stroke Unit at the Western Hospital, Melbourne between June 2017 and July, 2018. All patients were tested on the iPad while seated or in bed with their habitual reading glasses. Monocular visual acuities were first measured in high contrast optotypes and then using optotypes immersed in luminance noise. Central visual fields were tested monocularly. Measures for the eye on side of lesion are compared to 37 age-similar controls. The visuo-motor capacity was assessed as a quantifiable measure of time needed to complete an eye-hand tracking task.
On average we tested patients 3.4 days after admission and required about 10 mins per eye to complete all tests. High contrast acuity was found to be marginally depressed (6/7.5, 0.1 ±0.09 LogMAR) with 1 person being worse than 6/12 (driving limit). Acuity in noise showed substantial loss (6/13, 0.35 ±0.18) with 85% worse than control and 40% worse than 6/12. Visual field losses were identified in 62% of patients. 55% of the stroke patients showed longer tracking time in the visual motor task.
Significant visual field, acuity in noise and visuo-motor impairments are measureable within a week of stroke onset. Mobile technology can be used for the evaluation of such cases at their bedside within a week of admission.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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