Impact of visual impairment following stroke (IVIS study): a prospective clinical profile of central and peripheral visual deficits, eye movement abnormalities and visual perceptual deficits

Abstract

Aim

This study evaluates the spectrum of visual impairment in stroke survivors.

Methods

The Impact of Visual Impairment after Stroke (IVIS) study is a multi-centre, acute stroke unit, prospective epidemiology study. Comprehensive visual examination was offered to all stroke survivors.

Results

1500 stroke admissions were recruited. 1204 stroke survivors had visual assessment. Reduced central vision was documented in 529, visual field loss in 308, ocular motility abnormalities in 533 stroke survivors, visual perception deficits in 59 stroke survivors and visual inattention in 315 stroke survivors. About half, regardless of visual impairment type, were visually asymptomatic. Recovery, whether full or partial, was best for central vision, ocular motility abnormalities and visual perception deficits (about 70% improvement) occurring over a mean follow-up period of 2–3 months.

Conclusions

Incidence of impaired central vision, visual field loss, ocular motility disorders and visual inattention was 29.4%, 24.8%, 39.3% and 26.2% respectively. Visual impairment was more likely to occur in more severe stroke and older stroke survivors. Asymptomatic cases raise concerns for acute stroke units where robust specialist vision screening is not routine. Those with partial/no recovery require specialist follow-up and management whilst the wide range of abnormalities highlight the need for specialist visual assessment acutely.

Implications for rehabilitation

• Visual impairment is a common consequence of stroke.

• Incidence of visual impairment is about 60%.

• Significant numbers of stroke survivors are visually asymptomatic, highlighting the need for standardised vision assessments.

• Many stroke survivors have persistent long-term visual impairment, necessitating referral and access to specialist eye care services.

Keywords:

• Stroke
• visual impairment
• incidence
• symptoms
• recovery

Disclosure statement

The lead author confirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Data availability statement

Data is available from the lead author on reasonable request.

Additional information

Funding

Fiona Rowe is funded by a National Institute for Health Research (NIHR) Career Development Fellowship award (NIHR-CDF-2012-05-126) for this research project. This paper presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.