Diagnosis and Rehabilitation of Visual Field Defects in Stroke Patients: A Retrospective Audit

Abstract

Objective: Visual field defects (VFD) after stroke can cause significant disability and reduction in quality of life. Adequate diagnosis of VFD and referral to visual rehabilitation are important to improve outcome. Our aim was to conduct a retrospective clinical audit to investigate how neurologists detect and follow up VFD in stroke patients in a university hospital in Norway. Methods: All patients registered in the Bergen NORSTROKE Registry from February 2006 to May 2009 with (1) occipital lobe infarctions and (2) non-occipital infarction and clinically detected VFD were included in the study. Their medical records were reviewed for referral to perimetry for examination of VFD and for referral to a visual rehabilitation program within the first year after brain injury. Results: Of 353 patients, 34 (9.6%) were referred to perimetry and 8 (2.3%) to visual rehabilitation. Patients referred to perimetry were younger (65.1 vs. 74.7 years, p < 0.001), had lower modified Rankin Scale scores (2.53 vs. 3.47, p = 0.003), and scored lower on the National Institutes of Health Stroke Scale upon admission (6.68 vs. 13.90, p < 0.001). Men were more often referred to perimetry than women (73.5 vs. 26.5%, p < 0.001), and those referred were younger (61.2 vs. 75.8 years, p = 0.03). Conclusions: Only few patients were referred to perimetry, and even fewer were offered visual rehabilitation. Age and gender were negative predictors for referral. Neurologists’ awareness of the significant disability related to VFD must be increased. Focused diagnostics on visual impairment and early referral to a visual rehabilitation program should be mandatory in stroke unit services.

Prediction of on‐road driving ability after traumatic brain injury and stroke

“…Medical examination at the time of admission consisted of medical history and somatic and neurological status. The examination included test of visual function with the Snellen visual acuity test chart and test of the visual field with Donder's test . All patients underwent opthalmological examination with a perimeter either before referral or during their stay in the rehabilitation unit.…”

Visual dysfunction is underestimated in patients with acquired brain injury

“…Otherwise it is difficult to see a pattern in the referrals; at least it is difficult to connect patients' symptoms with a referral. Sand et al (29) showed in a Norwegian study only 9% of their patients with VFD were referred to perimetry, and 8% to vision rehabilitation. These results indicate a lack of connection between the eye specialists, neurorehabilitation and acute care units.…”

Vision problems in ischaemic stroke patients: effects on life quality and disability

“…Vision problems have also been shown to have a substantial effect on quality of life [10][11][12][13] and on activities of daily life (ADL) [1,2,14,15]. Still, stroke patients with vision problems are rarely offered thorough investigation and/or visual rehabilitation [16]. Lately, vision problems after stroke have received increasing attention.…”