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

Abstract

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 We searched scholarly online resources and hand searched articles and registers of published, unpublished, and ongoing trials.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.

Gamifying Motor Rehabilitation Therapies: Challenges and Opportunities of Immersive Technologies

“…Considering the aforementioned visual impairments that stroke patients may have, visual scanning training is a commonly used technique that encourages and guides patients to look in a systematic way to both their left and right sides of their visual field. By constantly looking on their blind side, visual processing problems that are related with difficulties of the brain processing the information received by the eyes should disappear over time [29].…”

“Invisible” visual impairments. A qualitative study of stroke survivors` experience of vision symptoms, health services and impact of visual impairments

“…This statement is true in the sense that there is no sufficient evidence to support that visual field defects can be restored with rehabilitation [24]. However, appropriate glasses, vision rehabilitation, and personalized information and guidance can improve visual function and adaption to VIs [22,24,34]. Valuable tools and advice on strategies to help adapt to and cope with their VIs were unavailable for participants, and they had the impression that nothing could help them.…”

“…Learning to live with a visual loss is a comprehensive and complex task closely intertwined with existential and social aspects [18][19][20]. Regardless of severity, much can be done to recover from or improve VIs through vision rehabilitation [21,22], even if high quality randomized controlled trial (RCT) studies do not show evidence of effective treatment for visual field loss [23]. Several studies have concluded that identifying and give advice on VIs and coping strategies will raise self-awareness [22], and that visual compensatory training is useful for vision outcomes [23,24], rehabilitation of other consequences of stroke, and the overall rehabilitation process [25].…”

“…Regardless of severity, much can be done to recover from or improve VIs through vision rehabilitation [21,22], even if high quality randomized controlled trial (RCT) studies do not show evidence of effective treatment for visual field loss [23]. Several studies have concluded that identifying and give advice on VIs and coping strategies will raise self-awareness [22], and that visual compensatory training is useful for vision outcomes [23,24], rehabilitation of other consequences of stroke, and the overall rehabilitation process [25]. The Norwegian guidelines for treatment and rehabilitation of stroke [26] state that vision function should be examined after stroke, VI patients should be referred to an eye care specialist, and compensatory training is recommended after vision field loss [26].…”

Visual Function Questionnaire as an outcome measure for homonymous hemianopia: subscales and supplementary questions, analysis from the VISION trial

“…Two clinically used interventions to improve vision in hemianopia are visual search compensatory training and provision of monocular prisms [9]. These interventions for homonymous hemianopia were evaluated by a Cochrane systematic review and limited evidence was found in favour of visual search training [10].…”