Vision Screening Assessment (VISA) tool: diagnostic accuracy validation of a novel screening tool in detecting visual impairment among stroke survivors

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Abstract

Purpose

Screening for visual problems in stroke survivors is not standardised. Visual problems that remain undetected or poorly identified can create unmet needs for stroke survivors. We report the validation of a new Vision Impairment Screening Assessment (VISA) tool intended for use by the stroke team to improve identification of visual impairment in stroke survivors.

Methods

We conducted a prospective case cohort comparative study in four centres to validate the VISA tool against a specialist reference vision assessment. VISA is available in print or as an app (Medicines and Healthcare products Regulatory Agency regulatory approved); these were used equally for two groups. Both VISA and the comprehensive reference vision assessment measured case history, visual acuity, eye alignment, eye movements, visual field and visual inattention. The primary outcome measure was the presence or absence of visual impairment.

Results

Two hundred and twenty-one stroke survivors were screened. Specialist reference vision assessment was by experienced orthoptists. Full completion of screening and reference vision assessment was achieved for 201 stroke survivors. VISA print was completed for 101 stroke survivors; VISA app was completed for 100. Sensitivity and specificity of VISA print was 97.67% and 66.67%, respectively. Overall agreement was substantial; K=0.648. Sensitivity and specificity of VISA app was 88.31% and 86.96%, respectively. Overall agreement was substantial; K=0.690. Lowest agreement was found for screening of eye movement and near visual acuity.

Conclusions

This validation study indicates acceptability of VISA for screening of potential visual impairment in stroke survivors. Sensitivity and specificity were high indicating the accuracy of this screening tool. VISA is available in print or as an app allowing versatile uptake across multiple stroke settings.

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Most cited references 16

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Improving outcome in stroke patients with visual problems.

Sally Jones, Roger Shinton (2006)

stroke is a common condition, frequently with significant effects on a patient's ability to live an active and independent life. Anything that may potentially have a beneficial effect on the rehabilitation of such patients should therefore be explored, and as ocular and visual problems are common in patients with stroke, it is important that their implications are understood. this article aims at providing a broad overview of the literature relating to visual problems in stroke patients, looking particularly at the impact on, and the potential for, recovery and rehabilitation. the online database PubMed was searched for literature relating to visual and ocular problems in stroke. The resulting abstracts and articles were then reviewed to extract clinically relevant information. Findings are summarised and discussed. visual problems in stroke are associated with problems with activities of daily living (ADL), falls and rehabilitation. Because many visual problems are easily corrected or improve with intervention, there may be a role for formal screening for visual problems in stroke patients in a rehabilitation setting. The orthoptist has an important role to play in stroke rehabilitation, and links between the stroke and orthoptic departments should be established in all units.

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Vision- and health-related quality of life in patients with visual field loss after postchiasmatic lesions.

Carolin Gall, Johanna Lucklum, Bernhard A. Sabel … (2009)

The purpose of the study was to assess vision-related quality of life (QoL) in patients with visual field loss (VFL) after lesions of the postchiasmatic visual pathway and to investigate the influence of VFL and reduced visual acuity (VA) on vision-related QoL. In 312 patients with postchiasmatic damage, VFL was measured by automated computer campimetry, and vision-related QoL was assessed by the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ). Health-related QoL was obtained by the SF-36 Health Survey in 272 patients. In addition, 90 degrees visual fields and VA data were obtained. NEI-VFQ and SF-36 scores were compared with those of healthy subjects and poststroke, brain-injured patients in general. Multiple analyses of covariance and multiple linear regression models for QoL results were performed with VA and VFL as independent variables. Patients with postchiasmatic lesions who had VFL had markedly lower NEI-VFQ scores than did healthy subjects and also lower SF-36 scores than did poststroke, brain-injured patients, particularly in the domain of role functioning. VFL and VA correlated significantly with vision-related but not with health-related QoL estimates when age was considered as confounding variable. Most scales of NEI-VFQ (9/12) were sensitive to differences in VFL. VFL and VA had a coordinate influence on vision-related QoL in brain-injured patients with postchiasmatic lesions. Diminished health-related QoL was not associated with VFL and VA. Both VFL and VA should be considered when trying to explain variance of NEI-VFQ results in patients with postchiasmatic lesions of the visual pathway.

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Association between visual impairment and depression in the elderly.

Pesus Chou, T. Su, Ching-Lan Cheng … (2003)

Visual disturbances greatly influence daily activities and social activities of the elderly. The purpose of this study was to investigate the association between impaired vision and depression among the elderly in a metropolitan community. A population-based survey of eye diseases among subjects 65 years of age and older was conducted in Taipei between July 1, 1999, and December 31, 2000. A total of 2045 subjects were invited to participate, and 1361 (66.6%) participated in the survey. A structured questionnaire was used for door-to-door data collection. Interviewers also collected information on subjects' demographic characteristics, medical history, and from the Geriatric Depression Scale-Short Form (GDS-S). Those subjects who had been interviewed were invited to the hospital for detailed eye examinations, including best-corrected visual acuity measurement. Among the participants, the prevalence of impaired vision (visual acuity less than 6/12 in the better eye) was 7.2% and the percentage with depression (GDS-S scores of > or = 5) was 8.8%. Impaired vision [p < 0.05, odds ratio (OR) = 2.11], female gender (p < 0.05, OR = 2.03), cardiovascular disease (p < 0.05, OR = 1.72), and stroke (p < 0.05, OR = 2.85) were significantly associated with depression in multivariate analyses. Multiple logistic regression models were used to evaluate the impact of impaired vision on each depressive item of the GDS-S. After controlling for all other covariates, impaired vision was a positive predictor for the following 4 items of the GDS-S: elderly with impaired vision feel unhappy most of the time [OR = 1.73; 95% confidence interval (CI) = 1.01 to 2.88]; they do not think it is wonderful to be alive now (OR = 2.13; 95% CI = 1.21 to 3.64); they feel worthless the way they are now (OR = 2.23; 95% CI = 1.24 to 3.90); and they feel that their situation is hopeless (OR = 1.95; 95% CI = 1.03 to 3.52). Visual impairment was associated with feelings of worthlessness and hopelessness in this community population of older adults. However, elderly people often ignore disturbances or impact associated with worsening vision. There is an ongoing need for public education regarding the need for elderly people to pay active attention to visual care in their later life.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2020

Publication date (Electronic): 11 June 2020

Volume: 10

Issue: 6

Electronic Location Identifier: e033639

Affiliations

[1 ]departmentHealth Services Research , University of Liverpool , Liverpool, UK

[2 ]departmentBradford Institute for Health Research , Bradford Teaching Hospitals NHS Foundation Trust , Bradford, UK

[3 ]departmentHealth Sciences , University of York , York, UK

[4 ]departmentOrthoptics , Arrowe Park Hospital , Wirral, UK

[5 ]departmentComputer Science , University of Liverpool , Liverpool, Merseyside, UK

[6 ]departmentBiostatistics , University of Liverpool Faculty of Health and Life Sciences , Liverpool, UK

Author notes

[Correspondence to ] Prof Fiona J Rowe; rowef@ 123456liverpool.ac.uk

Author information

Fiona J Rowe http://orcid.org/0000-0001-9210-9131

Lauren Hepworth http://orcid.org/0000-0001-8542-9815

Claire Howard http://orcid.org/0000-0002-2806-9144

Alison Bruce http://orcid.org/0000-0002-6028-6587

Article

Publisher ID: bmjopen-2019-033639

DOI: 10.1136/bmjopen-2019-033639

PMC ID: 7295409

PubMed ID: 32532765

SO-VID: 707a5789-2f4b-4b9b-a375-b0cedc7efd0a

License:

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

History

Date received : 14 August 2019

Date revision received : 12 December 2019

Date accepted : 29 April 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000836, University of Liverpool;

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ScienceOpen disciplines: Medicine

Keywords: visa,screening,stroke,visual impairment,orthoptics,detection

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ScienceOpen disciplines: Medicine

Keywords: visa, screening, stroke, visual impairment, orthoptics, detection

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Vision Screening Assessment (VISA) tool: diagnostic accuracy validation of a novel screening tool in detecting visual impairment among stroke survivors

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Abstract

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Related collections

Stroke MRI

Most cited references 16

Improving outcome in stroke patients with visual problems.

Vision- and health-related quality of life in patients with visual field loss after postchiasmatic lesions.

Association between visual impairment and depression in the elderly.

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