The Natural History of Vision-Related Quality of Life after Unilateral Occipital Stroke

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Abstract
Background/Objectives: Stroke damage to the primary visual cortex induces large, homonymous visual field defects that impair daily living. Here, we asked if vision-related quality of life (V-QoL) is impacted by time since stroke. Subjects/Methods: We conducted a retrospective meta-analysis of 95 occipital stroke patients (F/M=26/69, 27-78 years old, 0.5 to 373.5 months post-stroke) in whom V-QoL was estimated using the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ) and its 10-item neuro-ophthalmic supplement (Neuro10). Visual deficit severity was represented by the Perimetric Mean Deviation (PMD) calculated from 24-2 Humphrey visual fields. Data were compared with published cohorts of visually-intact controls. The relationship between V-QoL and time post-stroke was assessed across participants, adjusting for deficit severity and age with a multiple linear regression analysis. Results: Occipital stroke patients had significantly lower NEI-VFQ and Neuro10 composite scores than controls. All subscale scores describing specific aspects of visual ability and functioning were impaired except for ocular pain and general health, which did not differ significantly from controls. Surprisingly, visual deficit severity was not correlated with either composite score, both of which increased with time post-stroke, even when adjusting for PMD and age. Conclusions: V-QoL appears to improve with time post-occipital stroke, irrespective of visual deficit size or patient age at insult. This may reflect the natural development of compensatory strategies and lifestyle adjustments. Thus, future studies examining the impact of rehabilitation on daily living in this patient population should consider the possibility that their V-QoL may change gradually over time, even without therapeutic intervention.

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