Claire Howard is a Stroke Specialist Research Orthoptist based at Salford Royal Hospital and is part of the VISION research unit at University of Liverpool. She holds an NIHR clinical fellowship and is currently researching the area of adaptation to post stroke visual field loss. Her main field of interest is rehabilitation of visual impairment following stroke. She will be speaking at the upcoming BGS Spring Meeting in Nottingham.
The size of the problem: the point prevalence of visual impairment in stroke survivors has been reported as 72% (Rowe, Hepworth, Hanna, & Howard, 2016). This visual impairment can be the result of a range of different problems either individually or in combination; these problems include visual field loss, eye movement disorders, reduced / blurred vision and visual perception defects. In the post stroke period, a person may be experiencing a visual impairment that is of new onset, or their visual problems may pre-exist the stroke.
Impact of visual impairment: visual impairments, whether of acute or longstanding origin, have the potential to impact on a person’s quality of life and ability to perform everyday tasks, as well as their rehabilitation progress. Visual impairment can cause loss of confidence, impaired mobility, inability to judge distances as well as an increased risk of falls. This is particularly true if the visual impairment is unidentified and therefore not recognised by the multi-disciplinary team. Not all people with a visual impairment will be able to report symptoms or indeed have an awareness of these symptoms. It is vital therefore that as stroke clinicians you are equipped with the skills to be able to identify these problems and have appropriate referral pathways in place for early access to advice and treatment.
Identification of visual impairment: post stroke screening for visual impairment is not standard practice in the UK, leading to limited identification of this common and important deficit. The Vision Impairment Screening Assessment (VISA) tool is a newly developed tool intended for use by the stroke team to improve identification of visual impairment in stroke survivors (Rowe, Hepworth, Hanna, & Howard, BMJ Open in press 2018).
Think VFAST: In addition, it is important that people who have visual symptoms of sudden onset are recognised as a potential stroke and if appropriate, are entered onto a stroke pathway as a matter of urgency. There is a great deal to be done in the area of visual symptoms and stroke recognition. Individuals with isolated visual symptoms can be overlooked. At the VISION research unit at University of Liverpool, we are urging clinicians to think VFAST for stroke, to consider that visual symptoms may be a consequence of stroke and hence require immediate medical attention.
Related research: Ongoing research and recently published work will be presented at the meeting. The Impact of Visual Impairment after Stroke study, led by Professor Fiona Rowe has recently been completed and reports on the incidence and impact of the problems faced by this group of people (more information and updated results can be found on the IVIS website at http://ivis.org.uk/index.html).
At the BGS Spring Meeting I will give an overview of visual impairment following stroke, the impact of these and current guidance into the inclusion of an orthoptist as part of the stroke team
Register for the BGS Spring Meeting, 11 – 13 April at NCC in Nottingham