From the Guidelines
A comprehensive vision assessment after a stroke should include visual acuity testing, visual field examination, ocular motility testing, and assessment for visual neglect, as soon as the patient is medically stable, typically within the first few days post-stroke, with follow-up evaluations at regular intervals during rehabilitation 1.
Vision Assessment Components
The assessment should comprise:
- Visual acuity testing using a Snellen chart or equivalent to determine central vision function
- Visual field testing, such as confrontation testing or automated perimetry, to identify hemianopia or other visual field deficits
- Ocular motility examination to assess for diplopia, strabismus, and nystagmus by testing eye movements in all directions
- Visual neglect testing using line bisection tests, cancellation tasks, or the Behavioral Inattention Test to identify spatial awareness deficits
Additional Assessments
Additional assessments should include:
- Contrast sensitivity testing
- Depth perception evaluation
- Screening for visual perceptual disorders
Importance of Early Assessment
Early identification of visual impairments is essential because they can significantly impact rehabilitation outcomes and daily functioning, affecting up to 60% of stroke survivors and potentially hindering recovery if not properly addressed 1.
Guideline Recommendations
The most recent guideline recommends performing a visual assessment urgently due to the potential consequences of undetected vision problems, such as accidents related to driving or falls 1.
Key Considerations
Key considerations in vision assessment after stroke include the potential for spontaneous restoration of visual fields, the importance of systematic training of visual organization skills, and the use of computer-based interventions to improve visual function 1.
From the Research
Vision Assessments After a Stroke
The following vision assessments can be administered after a stroke:
- Visual field tests to detect visual field defects, which are estimated to affect 20% to 57% of people who have had a stroke 2
- Visual acuity tests to assess high contrast visual acuity and visual acuity-in-noise, as visual acuity-in-noise was reduced in 62% of stroke patients in one study 3
- Visuospatial neglect tests to assess for visual neglect, which is a common visual perceptual defect after stroke 4, 5
- Eye alignment and eye movements tests to assess for ocular motility defects, which can be affected after a stroke 4, 6
- Visual inattention tests to assess for visual inattention, which can be affected after a stroke 6
Tools for Vision Assessment
Several tools are available for vision assessment after a stroke, including:
- The Melbourne Rapid Field-Neural iPad application, which can assess vision at the bedside or in the emergency ward in about 6 minutes per eye 3
- The Stroke Vision app, which includes assessments for visual acuity, visual fields, and visuospatial neglect, as well as education tools for patients, carers, and staff 5
- The Vision Screening Assessment (VISA) tool, which is available in print or as an app and has been validated for use in detecting visual impairment among stroke survivors 6
Importance of Vision Assessment
Vision assessment is important after a stroke because visual impairment can significantly reduce quality of life, including the ability to return to work, drive, and participate in daily activities 4. Early detection and treatment of visual impairment can aid in general rehabilitation and improve outcomes for stroke survivors.