Abstract
Introduction: This study considers changes in vision from acute phase of ischemic stroke to 3-6 months post ischemic stroke. Methods: We tested Fifty ischemic stroke patients (age 32-95) within a week (mean:day3) of admission to Sunshine Hospital at the bed side using an iPad tablet, between July to December, 2017.We excluded: existing eye disease (twenty), cannot comprehend test (four) and unreliable testing (five).Testing was performed using the Melbourne Rapid Field (MRF-neural) Application for Visual Acuity, Visual Acuity in Noise and Visual Fields. The Eye-Hand co-ordination (EHC) was evaluated with timing of completing a tracking task generated by the iPad (UNSW L-R Eye Hand Coordination Application). The MRF-neural assays high contrast acuity (Landolt C optotype) and acuity targets immersed in luminance noise. It presents a modified 24-2 pattern (20 deg eccentricity and 4 foveal spots) for visual field testing. The results of the stroke group were compared to 30 age similar normal volunteers (controls). All participants provided written consent.These tests were repeated in cases who had abnormality 3-6 months later to determine long-term change or recovery. Results: During the acute phase, most stroke cases have normal high contrast visual acuity (p=0.11) but 46% return reduced acuity-in-noise (p<0.000). 62% cases have visual field defects (MD, p<0.000) with the majority (96%) being hemianopic or quadrantanopic. 34 of stroke cases (68%) return abnormal EHC tracking times (p<0.000). Failing at any of the tests (>95%) identifies 47 (94%) ischemic stroke cases as having abnormal visual capacity. At follow up: improvement was found in 73% cases for acuity in noise, 53% cases with visual field loss and 20% of cases with prolonged EHC. In 2 patients (13%) EHC was normal during the acute phase but showed deterioration over the recovery. Conclusion: Acute stroke cases (94%) have some form of vision abnormality on admission to hospital, despite near normal high contrast acuity. After 3-6 months, acuity-in-noise and visual fields normalize in the majority of cases but EHC shows variable outcomes.
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