Impact of ischaemic stroke on visual function: a retrospective study

Introduction. The formation of rehabilitation programmes for patients who have suffered ischemic stroke (IS) practically does not take into account visual impairment caused by acute cerebral circulatory failure (ACCF), despite the fact that it can significantly reduce the quality of life, general functioning of such patients and, as a result, leading to a decrease in rehabilitation potential. Aim. To study the prevalence and structure of visual impairments in patients undergoing medical rehabilitation during the recovery period of IS based on retrospective analysis of case histories. Materials and methods. A retrospective analysis of 3457 case histories of patients who underwent a IS and were at the 2nd stage of medical rehabilitation in National Medical Research Center for Rehabilitation and Balneology of the Ministry of Health of the Russian Federation, for the period from 2021 to 2023 was carried out. All anamnestic data, age, gender, neurological status, brain computer/magnetic resonance imaging data, and examination by an ophthalmologist were taken into account. Results and discussion. There were 1521 (43.9 %) patients identified with visual impairment associated with stroke. Among the newly detected visual and oculomotor disorders, visual field defects prevailed — in 686 (45.1 %). Of these: homonymous hemianopsia in 607 (88.5 %) patients, upper quadrant hemianopsia in 56 (8.2 %), and lower quadrant hemianopsia in 23 (3.4 %). Along with this, the following was revealed: central vision impairment in the form of reduced visual acuity — 427 (28.1 %), eye motor impairment — 577 (37.9 %), perceptual difficulties — 228 (15.0 %). The greatest association with peripheral vision impairment was found when the ischaemic focus was localised in the posterior cerebral artery basin (OR = 6.24; 95% CI: 4.459–8.73; p 0.01). No statistically significant relationship between the presence of visual impairment and such factors as gender, age and severity of patients’ condition according to the accepted set of evaluation scales was revealed (p 0.05). Conclusion. The analysis of the structure of newly detected visual disorders has shown that such disorders are quite common and visual field defects predominate among them. For a comprehensive assessment, it is necessary to use additional tools that will also take into account newly detected visual impairments. The revealed regularities will help to determine the diagnostic algorithm for the management of patients after ACCF and the strategy of their visual rehabilitation, which should be aimed at the correction of visual disturbances from the first days of patients’ admission to medical rehabilitation.