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Validation of the Vision Impairment Screening Assessment in acute stroke care: a prospective diagnostic accuracy
Stephen James Ryan1,2, Anna-Katharina E L Jørstad3, Morten C Moe2,3
1Department of Neurology, Oslo University Hospital, Oslo, Norway.
Introduction:
Visual abnormalities are common after stroke but are often overlooked in acute care. The Vision Impairment Screening Assessment (VISA) was developed to support non-specialist clinicians in identifying visual abnormalities. This study evaluated the diagnostic accuracy of the Norwegian translation of VISA against structured neuro-ophthalmic examination in acute stroke. Secondary analyses examined the prevalence of early post-stroke visual abnormalities and compared VISA with the visual items of the National Institutes of Health Stroke Scale (NIHSS), the routine acute stroke assessment tool.
Patients And Methods:
The Oslo Study for Vision Impairment after Stroke was a prospective diagnostic accuracy study including consecutive patients admitted for acute stroke management at a regional thrombectomy centre. Patients underwent bedside VISA assessment and neuro-ophthalmic examination within 72 h of admission. Diagnostic accuracy measures were calculated, and feasibility was assessed by completion rates and timing of assessments.
Results:
A total of 127 patients were included, of whom 81 completed both assessments. VISA demonstrated high sensitivity (94.5%) and lower specificity (34.6%), with a negative predictive value of 75.0%. Neuro-ophthalmic examination identified visual abnormalities in 70.1% of patients. The NIHSS visual items showed lower sensitivity (60.7%) than VISA, despite higher specificity (64.9%).
Discussion And Conclusions:
Visual abnormalities were common in the acute phase after stroke and were more frequently detected by VISA than by the NIHSS, supporting routine early visual screening in acute stroke care beyond the NIHSS.
