Symptoms of stroke-related visual impairment

Investigate the frequency and type of visual symptoms following stroke.

Prospective multicenter cohort study (Vision in Stroke [VIS]) in accordance with Declaration of Helsinki.

Standardized referral/investigation protocol with detailed assessment of visual acuity, ocular alignment/motility, visual field and visual perception, plus quality of life score.

A total of 915 patients were recruited with a mean age of 69.18 years (standard deviation 14.19). Reported symptoms included diplopia, blurred vision, reading difficulty, field loss, perceptual difficulty, and oscillopsia. Sixteen percent (149) had no visual symptoms: 22 patients had normal eye examinations by orthoptic assessment and 127 had diagnoses of central/peripheral visual loss, ocular motility or perceptual abnormalities. Eighty-four percent had visual symptoms, but 50 patients had normal eye examinations. There was no significant difference in type of symptom and quality of life score. Treatment included refraction, prisms, occlusion, orthoptic exercises, low vision aids, and advice.

Of those with no visual symptoms, 85% had objectively measured visual impairment. Conversely, 6.5% of those with visual symptoms had normal orthoptic examinations. Thus the presence or absence of visual symptoms does not infer absence or presence of visual impairment and may relate to recovery of visual impairment, cognitive, or communication impairment.