Stroke survivors face high risk of visual problems

Author: Ingrid Torjesen

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The incidence and prevalence of visual problems in acute stroke survivors is extremely high, a study* published in PLOS ONE shows.

The study included 1033 patients who had stroke assessments at three stroke units over a one-year period. Each patient's visual acuity, visual fields, ocular alignment, ocular motility, visual inattention and visual perception was assessed by an orthoptist.


The researchers from the University of Liverpool found that the average number of days post-stroke until a visual screening was conducted was three, and it was four before a full visual assessment.

The incidence of new onset visual conditions picked up by the assessments was 48% for all stroke admissions and 60% in stroke survivors.

Three quarters of patients (752/1033 - 73%) had visual problems: 56% with impaired central vision, 40% eye movement abnormalities, 28% visual field loss, 27% visual inattention, 5% visual perceptual disorders.

Professor Rowe said: "Incidence and prevalence of visual problems in acute stroke is alarmingly high, affecting over half the survivors.

"There 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.

"Our research shows that early visual screening and assessment is feasible and achievable within 72 hours of stroke onset and for those initially unable to be visually assessed, most can be assessed within one week of stroke onset.

"It is important to detect visual problems, regardless of whether it is pre-existent or of new onset, and disseminate the functional consequences and impact of this to patients, carers and stroke teams so this can be accounted for in activities of daily living and general mobilisation/rehabilitation. There are likely wide-ranging benefits to patients, their carers and the NHS through early and accurate identification of stroke-related visual problems."

The researchers pointed out that many stroke survivors could not be assessed because they were unwell, had extreme fatigue or lacked sufficient cognition or attention to comply with vision assessment.

“It is widely acknowledged that strokes of greater severity are likely to cause visual disturbance,” they said.

“Thus, we suggest it is likely that a proportion of these stroke survivors had visual problems of some form.”


*Rowe FJ, Hepworth LR, Howard C, et al. High incidence and prevalence of visual problems after acute stroke: An epidemiology study with implications for service delivery. PLOS ONE, March 6, 2019, DOI: 10.1371/journal.pone.0213035

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