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      The treatment methods for post‐stroke visual impairment: A systematic review

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          Abstract

          Aim

          To provide a systematic overview of interventions for stroke related visual impairments.

          Method

          A systematic review of the literature was conducted including randomized controlled trials, controlled trials, cohort studies, observational studies, systematic reviews, and retrospective medical note reviews. All languages were included and translation obtained. This review covers adult participants (aged 18 years or over) diagnosed with a visual impairment as a direct cause of a stroke. Studies which included mixed populations were included if over 50% of the participants had a diagnosis of stroke and were discussed separately. We searched scholarly online resources and hand searched articles and registers of published, unpublished, and ongoing trials. Search terms included a variety of MESH terms and alternatives in relation to stroke and visual conditions. Article selection was performed by two authors independently. Data were extracted by one author and verified by a second. The quality of the evidence and risk of bias was assessed using appropriate tools dependant on the type of article.

          Results

          Forty‐nine articles (4142 subjects) were included in the review, including an overview of four Cochrane systematic reviews. Interventions appraised included those for visual field loss, ocular motility deficits, reduced central vision, and visual perceptual deficits.

          Conclusion

          Further high quality randomized controlled trials are required to determine the effectiveness of interventions for treating post‐stroke visual impairments. For interventions which are used in practice but do not yet have an evidence base in the literature, it is imperative that these treatments be addressed and evaluated in future studies.

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          Most cited references158

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          Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

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            How effective is low vision service provision? A systematic review.

            Visual impairment is a large and growing socioeconomic problem. Good evidence on rehabilitation outcomes is required to guide service development and improve the lives of people with sight loss. Of the 478 potentially relevant articles identified, only 58 studies met our liberal inclusion criteria, and of these only 7 were randomized controlled trials. Although the literature is sufficient to confirm that rehabilitation services result in improved clinical and functional ability outcomes, the effects on mood, vision-related quality of life (QoL) and health-related QoL are less clear. There are some good data on the performance of particular types of intervention, but almost no useful data about outcomes in children, those of working age, and other groups. There were no reports on cost effectiveness. Overall, the number of well-designed and adequately reported studies is pitifully small; visual rehabilitation research needs higher quality research. We highlight study design and reporting considerations and suggest a future research agenda. Copyright © 2012 Elsevier Inc. All rights reserved.
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              Visual impairment following stroke: do stroke patients require vision assessment?

              the types of visual impairment followings stroke are wide ranging and encompass low vision, eye movement and visual field abnormalities, and visual perceptual difficulties. the purpose of this paper is to present a 1-year data set and identify the types of visual impairment occurring following stroke and their prevalence. a multi-centre prospective observation study was undertaken in 14 acute trust hospitals. Stroke survivors with a suspected visual difficulty were recruited. Standardised screening/referral and investigation forms were employed to document data on visual impairment specifically assessment of visual acuity, ocular pathology, eye alignment and movement, visual perception (including inattention) and visual field defects. three hundred and twenty-three patients were recruited with a mean age of 69 years [standard deviation (SD) 15]. Sixty-eight per cent had eye alignment/movement impairment, 49% had visual field impairment, 26.5% had low vision and 20.5% had perceptual difficulties. of patients referred with a suspected visual difficulty, only 8% had normal vision status confirmed on examination. Ninety-two per cent had visual impairment of some form confirmed which is considerably higher than previous publications and probably relates to the prospective, standardised investigation offered by specialist orthoptists. However, under-ascertainment of visual problems cannot be ruled out.
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                Author and article information

                Contributors
                rowef@liverpool.ac.uk
                Journal
                Brain Behav
                Brain Behav
                10.1002/(ISSN)2157-9032
                BRB3
                Brain and Behavior
                John Wiley and Sons Inc. (Hoboken )
                2162-3279
                06 April 2017
                May 2017
                : 7
                : 5 ( doiID: 10.1002/brb3.2017.7.issue-5 )
                : e00682
                Affiliations
                [ 1 ] Department of Health Services ResearchUniversity of Liverpool LiverpoolUK
                Author notes
                [*] [* ] Correspondence

                Fiona J. Rowe, University of Liverpool, Liverpool, UK.

                Email: rowef@ 123456liverpool.ac.uk

                Author information
                http://orcid.org/0000-0001-7357-7749
                http://orcid.org/0000-0001-9210-9131
                Article
                BRB3682
                10.1002/brb3.682
                5434187
                28523224
                df09c30e-ce57-4f5a-a48e-8faa3c6b0a77
                © 2017 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 03 November 2016
                : 15 February 2017
                : 16 February 2017
                Page count
                Figures: 1, Tables: 6, Pages: 26, Words: 17596
                Funding
                Funded by: National Institute of Health Research (CLAHRC NWC)
                Categories
                Review
                Reviews
                Custom metadata
                2.0
                brb3682
                May 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.0.9 mode:remove_FC converted:17.05.2017

                Neurosciences
                intervention,management,review,stroke,treatment,visual impairment
                Neurosciences
                intervention, management, review, stroke, treatment, visual impairment

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