Suchoff, I. B. et al. The frequency of occurrence, types, and characteristics of visual field defects in acquired brain injury: a retrospective analysis. Optometry 79, 259-265
The purpose of this retrospective study was to determine the frequency of occurrence of visual field defects in a sample of visually symptomatic, ambulatory outpatients who have acquired brain injury (ABI), either traumatic brain injury (TBI) or cerebral vascular accident (CVA).
The medical records of 220 individuals with TBI (n=160) or CVA (n=60) were reviewed retrospectively. This was determined by a computer-based query spanning the years 2000 through 2003. The individuals' records were reviewed to determine the frequency of targeted visual field defects that were classified as scattered, restricted, homonymous, nonhomonymous, and visual neglect. The altitudinal and lateral characteristics of these defects were also determined.
In the total ABI sample of 220, some 102 (46.36%) individuals had 1 of the targeted defects diagnosed. These defects were present in 62 (38.75%) of the TBI subgroup and in 40 (66.67%) of the CVA subgroup. The most frequent defects in the TBI group were scattered (58.06%) followed by homonymous (22.58%). In the CVA group, the most numerous were homonymous (47.5%), with scattered and nonhomonymous accounting for 20% each.
The uniqueness of the current study is that it reports the frequency of occurrence of specified visual field defects in the total ABI sample and in the TBI and CVA subgroups. This enabled comparisons with other studies that generally have reported on just 1 of these groupings. The current results are in accord with most of the other studies that are reviewed. The findings of this study should alert the reader to the high frequency of occurrence of visual field defects in the ABI population, and make the reader aware of the adverse effects they can have on quality of life and rehabilitation.
Available from: Fiona Rowe
- "Stroke or cerebrovascular accident is estimated to occur in approximately 150,000 people per year in the UK, and disabilities following stroke affect about 300,000 . Visual field loss is reported as occurring in 8–67%       although some visual field impairment is due to a previous stroke or "
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To profile site of stroke/cerebrovascular accident, type and extent of field loss, treatment options, and outcome.
Prospective multicentre cohort trial. Standardised referral and investigation protocol of visual parameters.
915 patients were recruited with a mean age of 69 years (SD 14). 479 patients (52%) had visual field loss. 51 patients (10%) had no visual symptoms. Almost half of symptomatic patients (n = 226) complained only of visual field loss: almost half (n = 226) also had reading difficulty, blurred vision, diplopia, and perceptual difficulties. 31% (n = 151) had visual field loss as their only visual impairment: 69% (n = 328) had low vision, eye movement deficits, or visual perceptual difficulties. Occipital and parietal lobe strokes most commonly caused visual field loss. Treatment options included visual search training, visual awareness, typoscopes, substitutive prisms, low vision aids, refraction, and occlusive patches. At followup 15 patients (7.5%) had full recovery, 78 (39%) had improvement, and 104 (52%) had no recovery. Two patients (1%) had further decline of visual field. Patients with visual field loss had lower quality of life scores than stroke patients without visual impairment.
Stroke survivors with visual field loss require assessment to accurately define type and extent of loss, diagnose coexistent visual impairments, and offer targeted treatment.
Available from: Josef Zihl
- "Unilateral homonymous visual field disorders (HVFD) resulting from post-chiasmatic visual pathway injury are most common. Patients show severe impairments of reading (hemianopic dyslexia; incidence , 80%) and visual exploration (60%) (Suchoff et al., 2008; Rowe et al., 2009; Zihl, 2011). "
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ABSTRACT: Reading and visual exploration impairments in unilateral homonymous visual field disorders are frequent and disabling consequences of acquired brain injury. Compensatory therapies have been developed, which allow patients to regain sufficient reading and visual exploration performance through systematic oculomotor training. However, it is still unclear whether the reading and visual exploration impairments require specific compensatory training for their improvement. We present the first cross-over rehabilitation study to determine whether the training-related performance improvements are task-specific, or whether there is a transfer of training-related improvements between reading and visual exploration. We compared the therapeutic effects of compensatory oculomotor reading and visual exploration training in 36 patients with unilateral homonymous visual field loss in a cross-over design. In addition, we explored whether the training sequence determines the overall treatment outcome. Our findings demonstrate that the training-related improvements in reading and visual exploration are highly specific and task-dependent, and there was no effect of training sequence.
Available from: Gregory L Goodrich
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ABSTRACT: The purpose of this paper is to describe the response of a Department of Veterans Affairs medical center's development of a rehabilitation program for patients with hemianopsia. Hemianopsia affects significant numbers of troops returning from Afghanistan and Iraq and their neurological vision loss presented unique challenges in developing an appropriate and effective rehabilitation program. A literature review indicated that existing therapies lacked supporting sci-entific evidence and that traumatic brain injury (TBI)-related vision loss affects large numbers of civilians. The increasing number of patients with TBI-related vision loss necessitated the develop-ment of an innovative program which combined elements of therapies that the literature suggested were most promising. In this paper we briefly review the literature, describe the rehabilitation program developed, and present case studies of two patients who incurred vision loss as a result of a motor vehicle accident and a gunshot wound. The intent of the article is to begin the docu-mentation of our ongoing, evidence-based neurological vision loss rehabilitation program. We also encourage others who do not currently do so to assess the need for implementing vision rehabilitation programs for patients with TBI-related vision loss.
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