Article

PURPOSE: To provide a systematic overview of the various tools available to
screen for post-stroke visual impairment. METHODS:
A review of the literature was
conducted including randomised controlled trials, controlled trials, cohort
studies, observational studies, systematic reviews and retrospective medical note
reviews. All languages were included and translation was obtained. Participants
included adults >/=18 years old diagnosed with a visual impairment as a direct
cause of a stroke. We searched a broad range of scholarly online resources and
hand-searched articles registers of published, unpublished and on-going trials.
Search terms included a variety of MESH terms and alternatives in relation to
stroke and visual conditions. Study selection was performed by two authors
independently. The quality of the evidence and risk of bias were assessed using
the STROBE, GRACE and PRISMA statements.
RESULTS: A total of 25 articles (n =
2924) were included in this review. Articles appraised reported on tools
screening solely for visual impairments or for general post-stroke disabilities
inclusive of vision. The majority of identified tools screen for visual
perception including visual neglect (VN), with few screening for visual acuity
(VA), visual field (VF) loss or ocular motility (OM) defects. Six articles
reported on nine screening tools which combined visual screening assessment
alongside screening for general stroke disabilities.
Of these, three included
screening for VA; three screened for VF loss; three screened for OM defects and
all screened for VN. Two tools screened for all visual impairments. A further 19
articles were found which reported on individual vision screening tests in stroke
populations; two for VF loss;
11 for VN and six for other visual perceptual
defects. Most tools cannot accurately account for those with aphasia or
communicative deficits, which are common problems following a stroke. CONCLUSION:
There is currently no standardised visual screening tool which can accurately
assess all potential post-stroke visual impairments. The current tools screen for
only a number of potential stroke-related impairments, which means many visual
defects may be missed. The sensitivity of those which screen for all impairments
is significantly lowered when patients are unable to report their visual
symptoms. Future research is required to develop a tool capable of assessing
stroke patients which encompasses all potential visual deficits and can also be
easily performed by both the patients and administered by health care
professionals in order to ensure all stroke survivors with visual impairment are
accurately identified and managed. Implications for Rehabilitation Over 65% of
stroke survivors will suffer from a visual impairment, whereas 45% of stroke
units do not assess vision. Visual impairment significantly reduces the quality
of life, such as being unable to return to work, driving and depression. This
review outlines the available screening methods to accurately identify stroke
survivors with visual impairments. Identifying visual impairment after stroke can
aid general rehabilitation and thus, improve the quality of life for these patients.

Langue : ANGLAIS