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Systematic review

Interventions for visual field defects after stroke: a systematic review

  • Year: 01.2017
  • By: Folkehelseinstituttet
  • Authors Smedslund G, Myrhaug HT.
  • ISBN (digital): 978-82-8082-800-2
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After a stroke, many patients lose parts of their visual field. We searched for randomised controlled trials on interventions given to persons with visual field defects after stroke.

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Key message

After a stroke, many patients lose parts of their visual field. It is common to lose half of the visual field (right or left) on both eyes. Interventions that have been tried include regaining (parts of) the visual field (restitution), compensate for the visual field defect by changing behavior and activities (compensation), or finding replacements for the visual defect by using aids (substitution). We have included 10 studies (6 on compensation, 2 on substitution, and 2 on restitution).

  • Compensation strategies (training on eye scanning, reading, and exploration of the visual field) may improve the visual field, reading, and the ability to perform activities of daily living (ADL)

  • The documentation for substitutional- and restitutional strategies is of very low quality and the effects are uncertain

  • We have not found studies that deal with assessment and screening interventions

Summary

Background

Reduced vision due to visual deficits in stroke is a large problem after stroke and it is reported in 20 to 57 % of stroke survivors. There is a need for developing an updated knowledge base that can inform the national recommendation on interventions for visual field defects. We have been commissioned by the Norwegian Directorate of Health to update a Cochrane review by Pollock et al. from 2011.

Objective

To update the Cochrane review by Pollock et al. from 2011.

Method

We searched seven electronic databases for randomised controlled trials on interventions given to persons with visual field defects after stroke and other causes of visual field defects.

Results

We have included 10 studies (6 on compensation, 2 on substitution, and 2 on restitution).

 Compensation strategies (training on eye scanning, reading, and exploration of the visual field) may improve the visual search strategies (Standardized mean difference [SMD]: 1.04 with 95 percent confidence interval [CI] from 0.39 to 1.68).

Compensation strategies may also improve reading skills in patients with visual neglect (SMD: 0.84, 95% KI from 0.39 to 1.28) and the ability to perform activities of daily living (ADL, SMD: 0.54, 95% KI from 0.08 to 1.00). The documentation for compensational strategies is of low quality.

The documentation for substitutional- and restitutional strategies is of very low quality and the effects are uncertain.

We have not found studies that deal with assessment and screening interventions.

Discussion

The included studies have a poor level of reporting, and there is a high risk of bias in the effect estimates. Moreover, the studies are very small and, therefore, provide very imprecise estimates. The first problem can be remedied if authors of future studies follow the CONSORT-criteria for the reporting of randomized controlled trials and pre-register their study protocols in study registries. The other problem can be solved by conducting larger studies.

Conclusion

At the present time, the evidence for effect of interventions for visual field defects is mostly of very low quality, and the effects are uncertain. An exception involves compensational strategies for which there may be positive effects on visual search, reading and abilities to perform daily activities (ADL).