Development of core outcome sets for vision screening and assessment in stroke: a Delphi and consensus study

ObjectivesVisual impairment following stroke is common with a reported incidence of visual impairment in 60% of stroke survivors. Screening for visual impairment is neither routine nor standardised. This results in a health inequality where some stroke survivors receive comprehensive vision assessment to identify any existent visual problems while others receive no vision assessment leaving them with unmet needs from undiagnosed visual problems. The aim of this study was to define two core outcome sets (COS), one for vision screening and one for full visual assessment of stroke survivors.DesignA list of potentially relevant visual assessments was created from a review of the literature. The consensus process consisted of an online 3-round Delphi survey followed by a consensus meeting of the key stakeholders.ParticipantsStakeholders included orthoptists, occupational therapists, ophthalmologists, stroke survivors and COS users such as researchers, journal editors and guideline developers.SettingUniversity.Outcome measuresCOS.ResultsFollowing the consensus process we recommend the following nine assessments for vision screening: case history, clinical observations of visual signs, visual acuity, eye alignment position, eye movement assessment, visual field assessment, visual neglect assessment, functional vision assessment and reading assessment. We recommend the following 11 assessments for full vision assessment: case history, observations, visual acuity, eye alignment position, eye movement assessment, binocular vision assessment, eye position measurement, visual field assessment, visual neglect assessment, functional vision assessment, reading assessment and quality of life questionnaires.ConclusionsCOS are defined for vision screening and full vision assessment for stroke survivors. There is potential for their use in reducing heterogeneity in routine clinical practice and for improving standardisation and accuracy of vision assessment. Future research is required to evaluate the use of these COS and for further exploration of core outcome measures.

Vision and Athletic Performance: Data from Agility Dogs

Background: To explore the relationship between vision problems and athletic performance, we measured refractive error and binocular vision in highly trained canine athletes. This group offers the opportunity to examine vision effects pristinely, without any influence of corrective lenses or vision therapy. Such a study is impossible in humans, but can add insight about the influence vision has on athletic performance in general. Methods: 210 dogs were recruited via word of mouth and examined at agility events in California, Texas, and Washington for cover test near and far, prism bar vergence near and far, Hirschberg and Bruckner tests for eye alignment, and retinoscopy. Owners and/or trainers categorized each dog as a good or poor jumper. Results: 190 dogs qualified; 54 (28.4%) had binocular disorders and 136 (71.6%) did not. Among those without binocular problems, mean SE was +0.07 D for good jumpers and -0.82 D for poor jumpers; poor jumpers were significantly more myopic and had more astigmatism than good jumpers. However, because the distribution of refractive errors in our sample was broad (from -3.00 to +3.00 spherical equivalent), some myopic dogs were good jumpers and some emmetropic and hyperopic dogs were poor jumpers. Binocular vision problems had a separate and sometimes additive effect, with anisometropia and unilateral (constant) strabismus more strongly related to poor jumping than alternating strabismus. Regression analysis showed that binocular competence had relatively more weight in jumping than refraction. Conclusions: Refractive error and binocular problems can affect jumping behavior in highly trained canine athletes. However, these vision problems are not predictive for any individual case, and as with human athletes, some individuals appear able to overcome physical attributes that for others are limiting. The results support the importance of vision, and in particular binocular and refractive problems, to athletic performance for humans as well as canines.