Evolution of Visual Field Defects After Occipital Stroke: A Quantitative Analysis

To quantitatively re-evaluate the natural progression of homonymous visual defects in occipital stroke patients using metrics derived from automated perimetry.

We performed a retrospective chart review of stroke patients with homonymous hemianopia who underwent repeated, monocular Humphrey perimetry using the 24-2 SITA standard pattern from 2011 to 2019 at a large US academic medical center. Reliable tests in either eye were analyzed to track progression of the perimetric mean deviation (PMD) and deficit area before and after a temporal boundary set at 6 ± 1 months post-stroke.

Out of 532 patients diagnosed with homonymous hemianopia, repeated Humphrey tests meeting reliability criteria were available for 73 individuals, who ranged from 0 to 2986 days post-stroke. Over 77% of these patients experienced spontaneous perimetric improvements in the subacute post-stroke period (<6 months), much larger for partial than complete visual field defects. In the chronic period (>6 months), perimetric measurements were stable overall, but spontaneous changes > ±1 dB in PMD were seen in about half of the cohort.

Quantitative analysis of Humphrey perimetry confirmed prior reports of prevalent spontaneous improvements early after occipital stroke in adults. Though much less frequent, improvements as well as worsening of the visual defects still occurred in the chronic period.

Our quantification of perimetric changes over time after occipital stroke provides an empirical and methodological basis for future studies aiming to better understand and prognostically manage patient expectations regarding recovery. It also provides a necessary benchmark against which to contrast the impact of restorative therapies being developed for this condition.