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Evidence summaries

Interventions for Visual Field Defects in Patients with Stroke

For visual field defects in stroke, compensatory scanning training might possibly be beneficial at improving quality of life, but not other outcomes, although the evidence is insufficient. There is a lack of evidence relating to the effect of interventions on functional ability in activities of daily living. Level of evidence: "D"

Summary

A Cochrane review [Abstract] 1 included 20 studies with a total of 732 patients. However, only 10 of these studies compared the effect of an intervention with a placebo, control, or no treatment group, and eight had data which could be included in meta-analyses.

  • Restitutive intervention vs. control There was no effect on visual field outcomes (one study, n=19).
  • Scanning (compensatory) training vs. control or placebo: Scanning training was more beneficial than control or placebo on quality of life, measured using the Visual Function Questionnaire (VFQ-25) (MD 9.36, 95% CI 3.10 to 15.62; 2 studies, n=96).
  • Substitutive intervention (a type of prism) vs. control: Prisms did not have an effect on measures of activities of daily living (ADL), extended ADL, reading, falls, or quality of life, but they may have an effect on scanning ability (MD 9.80, 95% CI 1.91 to 17.69; one study, n=39).
  • Assessment by an orthoptist vs. standard care (no assessment): There was no effect on measures of activities of daily living (one study, n=39).

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment), inconsistency (heterogeneity in patients, interventions and outcomes), imprecise results (limited study size for each comparison) and indirectness (differences between the population of interest and those studied).

References

  • Pollock A, Hazelton C, Rowe FJ et al. Interventions for visual field defects in people with stroke. Cochrane Database Syst Rev 2019;5():CD008388. [PubMed]

Primary/Secondary Keywords