Post-stroke Visual Impairment: A Systematic Literature Review of Types and Recovery of Visual Conditions

Hepworth, Lauren R.; Rowe, Fiona; Walker, Marion F; Rockliffe, Janet; Noonan, Carmel; Howard, Claire; Currie, Jim

doi:10.9734/or/2016/21767

Cited by 56 publications

(56 citation statements)

References 67 publications

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“…Poststroke visual impairment occurs frequently with an estimated prevalence of 65% in an acute stroke population (Hepworth et al., ). Visual impairment in this population can be broadly categorized into four impaired visual functions of: reduced central vision, peripheral visual field loss, eye movement disorders, and visual perceptual disorders (Jones & Shinton, ).…”

Section: Introductionmentioning

confidence: 99%

Vision In Stroke cohort: Profile overview of visual impairment

Rowe

2017

Brain and Behavior

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AimTo profile the full range of visual disorders from a large prospective observation study of stroke survivors referred by stroke multidisciplinary teams to orthoptic services with suspected visual problems.MethodsMulticenter prospective study undertaken in 20 acute Trust hospitals. Standardized screening/referral forms and investigation forms documented data on referral signs and symptoms plus type and extent of visual impairment.ResultsOf 1,345 patients referred with suspected visual impairment, 915 were recruited (59% men; mean age at stroke onset 69 years [SD 14]). Initial visual assessment was at median 22 days post stroke onset. Eight percent had normal visual assessment. Of 92% with confirmed visual impairment, 24% had reduced central visual acuity <0.3 logMAR and 13.5% <0.5 logMAR. Acquired strabismus was noted in 16% and acquired ocular motility disorders in 68%. Peripheral visual field loss was present in 52%, most commonly homonymous hemianopia. Fifteen percent had visual inattention and 4.6% had other visual perceptual disorders. Overall 84% were visually symptomatic with visual field loss the most common complaint followed by blurred vision, reading difficulty, and diplopia. Treatment options were provided to all with confirmed visual impairment. Targeted advice was most commonly provided along with refraction, prisms, and occlusion.ConclusionsThere are a wide range of visual disorders that occur following stroke and, frequently, with visual symptoms. There are equally a wide variety of treatment options available for these individuals. All stroke survivors require screening for visual impairment and warrant referral for specialist assessment and targeted treatment specific to the type of visual impairment.

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Section: Introductionmentioning

confidence: 99%

Vision In Stroke cohort: Profile overview of visual impairment

Rowe

2017

Brain and Behavior

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“…It has been estimated that there are 100,000 new strokes per annum (The Stroke Association, ). There is a high percentage of visual field loss reported acutely in the stroke population (Hepworth et al., ). Furthermore, there is the potential that reported estimates of hemianopia are an underestimate where screening assessments are not sufficient or appropriate to detect visual field loss and, where stroke survivors do not complain of visual symptoms (Rowe, , ).…”

Section: Discussionmentioning

confidence: 99%

“…In particular, homonymous hemianopia is the most frequently reported type of visual field loss accounting for two‐thirds of visual field loss poststroke (Rowe, ). Visual field loss, inclusive of homonymous hemianopia, is reported to occur in up to 57% of stroke survivors in the acute stages of stroke (within 1 month of stroke onset) but falling in frequency to 8%–25% in the long‐term (Gilhotra, Mitchell, Healey, Cumming, & Currie, ; Gray et al., ; Hepworth et al., ; Zhang, Kedar, Lynn, Newman, & Biousse, ). This reduction in frequency relates to many factors including long‐term mortality, recovery of field loss and under reporting of field loss.…”

Section: Introductionmentioning

confidence: 99%

Sight Impairment registration due to stroke—A small yet significant rise?

et al. 2017

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ObjectivesIn the United Kingdom, when an individual's sight falls to and remains at a certain threshold, they may be offered registration as sight impaired. Recent analysis of causes of registrable sight impairment in England/Wales indicated that visual impairment due to stroke had increased as a proportionate cause of sight loss. We aim to assess whether there is evidence of an increase in incidence of certification for sight impairment due to stroke in England/Wales between 2008 and 2014.Materials and MethodsThe number of certifications with a main cause of sight impairment being stroke was obtained from the Certifications Office London. Directly standardized rates per 100,000 were computed with 95% confidence intervals and examined. Poisson regression was used to assess evidence of trend over time.ResultsIn the year ending 31st March 2008, 992 people were newly certified with stroke with an estimated DSR of 2.1 (2.0 to 2.2) per 100,000 persons at risk. In the year ending March 31st 2014, there were 1310 certifications with a DSR of 2.5 (2.4 to 2.7). Figures were higher for men than women. Poisson regression indicated an estimated incidence rate ratio of 1.03 per year with 95% confidence intervals of 1.028 to 1.051, P < .001.ConclusionsThese data suggest a small but statistically significant increase in the incidence of certifiable visual impairment due to stroke between 2008 and 2014. Figures are, however, considerably lower than estimated, perhaps suggesting that more should be done to address the visual needs of those who have suffered stroke.

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“…1 These include impairments of central vision (up to 70%); peripheral vision (up to 57%); ocular motility (up to 68%); and perceptual disorders including inattention (up to 80%). 1,2 The resulting impact includes loss of confidence, mobility, and inability to return to work or driving. 1,2 It is estimated that there are 111,000 new strokes in the United Kingdom (UK) every year.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 The resulting impact includes loss of confidence, mobility, and inability to return to work or driving. 1,2 It is estimated that there are 111,000 new strokes in the United Kingdom (UK) every year. 3 In 2009, stroke mortality rate in the UK was recorded at 53,000 per year, with premature death rates shown to be 3 times higher in the most economically deprived areas than the least deprived, 3 largely due to the association of risk factors such as smoking, obesity, and poor diet.…”

Section: Introductionmentioning

confidence: 99%

Health Inequalities Associated with Post-Stroke Visual Impairment in the United Kingdom and Ireland: A Systematic Review

Hanna

Rowe

2017

Neuro-Ophthalmology

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The aim of this study was to report on the health inequalities facing stroke survivors with visual impairments as described in the current literature. A systemic review of the literature was conducted to investigate the potential health inequalities facing stroke survivors with subsequent visual impairments. A quality-of-evidence and risk-of-bias assessment was conducted for each of the included articles using the appropriate tool dependent on the type of article. Only four articles discussed health inequalities affecting stroke survivors with visual impairment specifically. A further 23 articles identified health inequalities after stroke, and 38 reported on health inequalities within the visually impaired UK or Irish population. Stroke survivors with visual impairment face inconsistency in eye care provision nationally, along with variability in the assessment and management of visual disorders. The subgroups identified as most at risk were females; black ethnicity; lower socioeconomic status; older age; and those with lower education attainment. The issue of inconsistent service provision for this population must be addressed in future research. Further research must be conducted in order to firmly establish whether or not stroke survivors are at risk of the aforementioned sociodemographic and economic inequalities. ARTICLE HISTORY

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Post-stroke Visual Impairment: A Systematic Literature Review of Types and Recovery of Visual Conditions

Cited by 56 publications

References 67 publications

Vision In Stroke cohort: Profile overview of visual impairment

Vision In Stroke cohort: Profile overview of visual impairment

Sight Impairment registration due to stroke—A small yet significant rise?

Health Inequalities Associated with Post-Stroke Visual Impairment in the United Kingdom and Ireland: A Systematic Review

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