Visual field loss after stroke: confrontation and perimetry in the assessment of recovery

The purpose of this study was to examine the recovery of visual field deficits after first-ever stroke and to determine the accuracy of standard clinical assessment using oculokinetic perimetry. Of 148 patients with a hemisphere stroke and a normal conscious level, 75 (50.6%) were found to have a visual field deficit by clinical examination. Only 19 (11 women) stroke patients with visual field deficits were able to complete a perimetric examination within 1 week of their stroke. They were followed-up for a period of 12 weeks with serial clinical and perimetric examinations every 4 weeks. Clinical assessment of the patient failed to note further recovery after 4 weeks. By using oculokinetic perimetry, 8 (42.1%) patients recovered central vision but had a persistent peripheral field loss; maximal recovery of central vision was noted in the first 4 weeks. By using oculokinetic perimetry as the gold standard, the sensitivity of clinical assessment of visual field deficits was 94.4% on admission. The sensitivity fell to 55.5% during follow-up because of the clinicians' inability to detect central recovery by confrontation. The small numbers recruited show the difficult in recruiting acute stroke patients in measurements of recovery.