Improving outcome in stroke patients with visual problems

Jones, Sally; Shinton, Roger

doi:10.1093/ageing/afl074

Cited by 135 publications

(119 citation statements)

References 39 publications

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“…Many individuals have low vision, ocular alignment or movement problems, visual field loss, visual inattention, and other processing abnormalities following their stroke. 1,2,8 There are various treatment options for these visual problems, which can have a positive beneficial effect in terms of their vision but also in their general rehabilitation. 1,2,9 Additionally, many individuals have pre-existent ocular disease such as glaucoma, age-related macular degeneration, and cataract.…”

Section: Discussionmentioning

confidence: 99%

“…1,8 Ensuring that the correct glasses prescription is available can significantly aid central vision and any treatment regime for coexistent ocular disease must be continued during any inpatient stay for stroke survivors as well as following their discharge. 1,2 For the above reasons, it is important that patients with visual impairment are identified by the stroke multidisciplinary team and appropriate onward referral made for vision assessment. We sought in this study to evaluate the referral forms, from a large observational study, made by the stroke team, to evaluate the accuracy of the referral information.…”

Section: Discussionmentioning

confidence: 99%

“…A strong recommendation of this study is that every stroke unit implements a visual screening protocol (as a minimum) to consider factors of visual acuity, visual field, eye movement, and vision perception with a clear care pathway for appropriate referral of these patients to eye care services. 15 It is apparent that a considerable impact occurs to quality of life and activities of daily living, [1][2][3][4] and that early referral is warranted for provision of vision assessment and rehabilitation. 15,16 In conclusion, accuracy of referrals by the stroke multidisciplinary team when requesting ocular examination has a low sensitivity and specificity when evaluating the identification of presence or absence of ocular signs.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] In many units, the stroke multidisciplinary team includes an Orthoptist, and hence there exists an ease of access to eye services. 5 In other units, there is no formal eye service link for stroke survivors.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of referrals for visual assessment in a stroke population

Rowe

2010

Eye

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Purpose To evaluate accuracy of referrals from multidisciplinary stroke teams requesting visual assessments. Patients and methods Multicentre prospective study undertaken in 20 acute Trust hospitals. Stroke survivors referred with suspected visual difficulty were recruited. Standardised screening/referral and investigation forms were used to document data on referral signs and symptoms, plus type and extent of visual impairment. Results Referrals for 799 patients were reviewed: 60% men, 40% women. Mean age at onset of stroke was 69 years (SD 14: range 1-94 years). Signs recorded by referring staff were nil in 58% and positive in the remainder. Symptoms were recorded in 87%. Diagnosis of visual impairment was nil in 8% and positive in the remainder. Sensitivity of referrals (on the basis of signs detected) was calculated as 0.42 with specificity of 0.52. Kappa statistical evaluation of agreement between referral and diagnosis of visual impairment was 0.428 (SE 0.017: 95% confidence interval of À0.048, 0.019). Conclusion More than half of patient referrals were made despite no signs of visual difficulty being recorded by the referring staff. Visual impairment of varying severity was diagnosed in 92% of stroke survivors referred for visual assessment. Referrals were made based predominantly on visual symptoms and because of formal orthoptic liaison in Trusts involved.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Accuracy of referrals for visual assessment in a stroke population

Rowe

2010

Eye

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“…The visual problems (types of visual impairment) can be complex including ocular as well as cortical damage (Jones & Shinton, 2006; Rowe et al., 2009a). Visual impairments can have wide reaching implications on daily living, independence, and quality of life.…”

Section: Introductionmentioning

confidence: 99%

The treatment methods for post‐stroke visual impairment: A systematic review

2017

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AimTo provide a systematic overview of interventions for stroke related visual impairments.MethodA systematic review of the literature was conducted including randomized controlled trials, controlled trials, cohort studies, observational studies, systematic reviews, and retrospective medical note reviews. All languages were included and translation obtained. This review covers adult participants (aged 18 years or over) diagnosed with a visual impairment as a direct cause of a stroke. Studies which included mixed populations were included if over 50% of the participants had a diagnosis of stroke and were discussed separately. We searched scholarly online resources and hand searched articles and registers of published, unpublished, and ongoing trials. Search terms included a variety of MESH terms and alternatives in relation to stroke and visual conditions. Article selection was performed by two authors independently. Data were extracted by one author and verified by a second. The quality of the evidence and risk of bias was assessed using appropriate tools dependant on the type of article.ResultsForty‐nine articles (4142 subjects) were included in the review, including an overview of four Cochrane systematic reviews. Interventions appraised included those for visual field loss, ocular motility deficits, reduced central vision, and visual perceptual deficits.ConclusionFurther high quality randomized controlled trials are required to determine the effectiveness of interventions for treating post‐stroke visual impairments. For interventions which are used in practice but do not yet have an evidence base in the literature, it is imperative that these treatments be addressed and evaluated in future studies.

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Interventions for perceptual disorders following stroke

Hazelton

Thomson

Todhunter‐Brown

et al. 2022

Cochrane Database of Systematic Reviews

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Background Perception is the ability to understand information from our senses. It allows us to experience and meaningfully interact with our environment. A stroke may impair perception in up to 70% of stroke survivors, leading to distress, increased dependence on others, and poorer quality of life. Interventions to address perceptual disorders may include assessment and screening, rehabilitation, non‐invasive brain stimulation, pharmacological and surgical approaches. Objectives To assess the effectiveness of interventions aimed at perceptual disorders after stroke compared to no intervention or control (placebo, standard care, attention control), on measures of performance in activities of daily living. Search methods We searched the trials registers of the Cochrane Stroke Group, CENTRAL, MEDLINE, Embase, and three other databases to August 2021. We also searched trials and research registers, reference lists of studies, handsearched journals, and contacted authors. Selection criteria We included randomised controlled trials (RCTs) of adult stroke survivors with perceptual disorders. We defined perception as the specific mental functions of recognising and interpreting sensory stimuli and included hearing, taste, touch, smell, somatosensation, and vision. Our definition of perception excluded visual field deficits, neglect/inattention, and pain. Data collection and analysis One review author assessed titles, with two review authors independently screening abstracts and full‐text articles for eligibility. One review author extracted, appraised, and entered data, which were checked by a second author. We assessed risk of bias (ROB) using the ROB‐1 tool, and quality of evidence using GRADE. A stakeholder group, comprising stroke survivors, carers, and healthcare professionals, was involved in this review update. Main results We identified 18 eligible RCTs involving 541 participants. The trials addressed touch (three trials, 70 participants), somatosensory (seven trials, 196 participants) and visual perception disorders (seven trials, 225 participants), with one (50 participants) exploring mixed touch‐somatosensory disorders. None addressed stroke‐related hearing, taste, or smell perception disorders. All but one examined the effectiveness of rehabilitation interventions; the exception evaluated non‐invasive brain stimulation. For our main comparison of active intervention versus no treatment or control, one trial reported our primary outcome of performance in activities of daily living (ADL): Somatosensory disorders : one trial (24 participants) compared an intervention with a control intervention and reported an ADL measure. Touch perception disorder: no trials measuring ADL compared an intervention with no treatment or with a control intervention. Visu...

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Improving outcome in stroke patients with visual problems

Cited by 135 publications

References 39 publications

Accuracy of referrals for visual assessment in a stroke population

Accuracy of referrals for visual assessment in a stroke population

The treatment methods for post‐stroke visual impairment: A systematic review

Interventions for perceptual disorders following stroke

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