High incidence and prevalence of visual problems after acute stroke: An epidemiology study with implications for service delivery

Abstract

Background Visual problems are an under-reported sequela following stroke. The aim of this study is to report annual incidence and point prevalence of visual problems in an acute adult stroke population and to explore feasibility of early timing of visual assessment. Methods and findings Multi-centre acute stroke unit, prospective, epidemiology study (1 st July 2014 to 30 th June 2015). Orthoptists reviewed all patients with assessment of visual acuity, visual fields, ocular alignment, ocular motility, visual inattention and visual perception. 1033 patients underwent visual screening at a median of 3 days (IQR 2) and full visual assessment at a median of 4 days (IQR 7) after the incident stroke: 52% men, 48% women, mean age 73 years and 87% ischaemic strokes. Excluding pre-existent eye problems, the incidence of new onset visual sequelae was 48% for all stroke admissions and 60% in stroke survivors. Three quarters 752/1033 (73%) had visual problems (point prevalence): 56% with impaired central vision, 40% eye movement abnormalities, 28% visual field loss, 27% visual inattention, 5% visual perceptual disorders. 281/1033 (27%) had normal eye exams. Conclusions Incidence and point prevalence of visual problems in acute stroke is alarmingly high, affecting over half the survivors. For most, visual screening and full visual assessment was achieved within about 5 days of stroke onset. Crucial information can thus be provided on visual status and its functional significance to the stroke team, patients and carers, enabling early intervention.

Vision‐related quality of life in patients with occipital stroke

“…They were tested with confrontational testing as a part of NIHSS, which has been proven to underestimate the frequency of stroke‐related VFD . Full visual assessment including perimetry was done at a median of 8 days, which is somewhat earlier than in other comparable studies . With perimetry, the frequency of detected VFD in our study was higher at admittance, 79%.…”

“…In our opinion, early identification of visual problems in acute stroke patients would benefit patients, caregivers, and the healthcare system in general. Optimal multidisciplinary structures for this should be established, as also suggested by otherss . Stroke‐related visual field defects are a silent, but serious handicap, easily overlooked by healthcare workers, patients, and surroundings.…”

“…The reported prevalence of visual field defects after stroke varies considerably in the literature. A recent epidemiological study from England reported a point prevalence of 28% VFD among 1033 patients in acute stroke units …”

“…Although the incidence and point prevalence of visual impairment in acute stroke are alarmingly high and affect over half of the survivors, visual problems are often not reflected in the rehabilitation process. The focus has traditionally been on restoring motor and speech function.…”

Orthoptic Home Visits for Stroke Survivors: Results from a UK Professional Practice Survey

“…Stroke-related visual impairment is a well-documented post stroke sequelae with new onset visual impairment affecting about 60% of acute stroke survivors (Rowe et al 2019) Where visual impairment is identified, followup after discharge from hospital stroke units is typically required in outpatient eye clinics. However, many stroke survivors cannot be followed up in hospital for various reasons due to their stroke and/or visual impairments, including transport difficulties, being too unwell and forgetting about appointments due to various additional ongoing outpatient appointments.…”