Abstract P19: Developing an Innovative Visual Fields Rapid Assessment Device (VRAD) for Acute Telestroke Use

Abstract

Background: Acute telestroke evaluations rely on the ability to rapidly and accurately calculate the NIH Stroke Scale. Remote visual field deficit (VFD) testing is often challenging, requiring trained bedside assistance particularly in rural hospital settings. These deficits account for up to 3 points on the NIHSS, which is enough to affect treatment decisions and impact outcomes. Objective: To create a simple, rapid, and robust screening telemedicine peripheral device to standardize visual field testing during acute telestroke consults and to reduce reliance on bedside assistants for this task. Methods: A one-size-fits-all device was designed such that an LED stimulus is located in each quadrant of the peripheral visual field. Bioengineers, neuro-ophthalmologists, and vascular neurologists collaborated in the development of the prototype. A randomized investigator-blinded pilot clinical trial is in progress. Stroke patients with fully-mapped visual fields were selected. The device, in the form of glasses, is easily placed on the patient’s face, and LED lights are flashed in the standard 8 fields, via a repeatable algorithm, during a simulated acute telestroke encounter. Lights are visible to the remote teleprovider for interpretation of the responses. Patients and examiners will be surveyed for feedback on ease of use of the device (primary outcome). Results from device will be compared to in-person confrontational testing and to previously recorded Humphrey mapped deficits in this same patient population (secondary). Validation is set at a sensitivity of 90% compared to confrontational or to the Humphrey static visual field test results. Results/Conclusion: Remote testing of VFDs in acute telestroke patients is difficult, especially in smaller community rural hospitals. We developed a simple and rapidly applied facial device that can assist the teleprovider in VFD evaluations, potentially affecting treatment options of thrombectomy, thrombolytics, or transfer. An on-going pilot study will test the sensitivity of the device against confrontational and static VF assessments. Innovative telestroke peripherals represent the future of the next generation of diagnostic tools specifically engineered fo remote acute stroke patient evaluations.