A Prospective Profile of Visual Field Loss following Stroke: Prevalence, Type, Rehabilitation, and Outcome

Abstract

Aims. To profile site of stroke/cerebrovascular accident, type and extent of field loss, treatment options, and outcome.Methods. Prospective multicentre cohort trial. Standardised referral and investigation protocol of visual parameters.Results. 915 patients were recruited with a mean age of 69 years (SD 14). 479 patients (52%) had visual field loss. 51 patients (10%) had no visual symptoms. Almost half of symptomatic patients (n=226) complained only of visual field loss: almost half (n=226) also had reading difficulty, blurred vision, diplopia, and perceptual difficulties. 31% (n=151) had visual field loss as their only visual impairment: 69% (n=328) had low vision, eye movement deficits, or visual perceptual difficulties. Occipital and parietal lobe strokes most commonly caused visual field loss. Treatment options included visual search training, visual awareness, typoscopes, substitutive prisms, low vision aids, refraction, and occlusive patches. At followup 15 patients (7.5%) had full recovery, 78 (39%) had improvement, and 104 (52%) had no recovery. Two patients (1%) had further decline of visual field. Patients with visual field loss had lower quality of life scores than stroke patients without visual impairment.Conclusions. Stroke survivors with visual field loss require assessment to accurately define type and extent of loss, diagnose coexistent visual impairments, and offer targeted treatment.