Vision After Stroke

Visual problems after stroke

Visual problems are very common after stroke: over one-fifth of stroke survivors will be affected. Stroke can alter many different components of what makes up good vision, causing:

• Visual field loss – an inability to see one half of space, in both eyes
• Eye movement problems – making it difficult for both eyes to maintain their position to look at an object, or causing eye movements that are slow and inaccurate
• Visual inattention – difficulty in paying attention to one side of space
• Visual perceptual problems – difficulty processing and understanding visual information, which may affect the ability to recognise objects and people, visual hallucinations and difficulty with understanding space and position.

Our programme of work

We have been researching visual problems after stroke for over 13 years. This work has explored the nature of visual problems after stroke, including their frequency, recovery, and impact on daily life. We have studied the many different treatment options available, with a focus on rehabilitation for visual field loss. We have also explored clinical practice: identifying what clinicians on stroke wards and in eye clinics currently do to assess and treat these problems, and the key barriers to providing better services.

Our current research includes the PIONEER study, exploring treatments for visual perceptual disorders due to stroke. This project dovetails with a five-year, non-clinical Lectureship (Improving care services for stroke survivors with visual impairment | Stroke Association) awarded by the Stroke Association. Using this funding, Dr Hazelton plans to develop interventions for visual field loss, as well as improve the assessment methods used in both stroke care and vision care settings. This work includes collaboration with GCU Vision Sciences to develop of our neuro-rehabilitation clinic (Specialist Clinics | GCU Vision Centre), specialising in those with visual problems caused by stroke, head injury and other neurological problems.

Our focus is typically on the period when a stroke survivor returns to their home and community after an initial hospital stay. PhD student Ciara Ryan is developing a self-management programme to help stroke survivors manage and adapt to visual problems and continue with their normal life as fully as possible.

Improving clinical care

The Vision After Stroke team’s aim is to maximise the rehabilitation outcomes of those with visual problems caused by stroke, by improving the clinical care delivered to them. To do so, we work very closely with the broad range of clinicians who provide vision and stroke care, including the NHS, social care and charities. We have been involved in numerous training activities including online STARs (https://www.chsselearning.org.uk/) modules, and advising the Scottish Government on what a progressive stroke service for those with visual problems should look like: A Progressive Stroke Pathway with further guidance on how to implement this (https://www.gov.scot/publications/progressive-stroke-pathway/documents/).

Collaborations

Ongoing collaborations in the UK include Dr Phil Clatworthy at the University of Bristol, Professor Fiona Rowe at the University of Liverpool, and Professor Audrey Bowen at the University of Manchester. International research links include the Netherlands and the USA.

Current research team

Dr Christine Hazelton, Research Fellow and Optometrist

Dr Katie Thomson, Occupational Therapy Lecturer and Researcher

Ciara Ryan, PhD student

Key publications

• Hazelton C, McGill K, Campbell P, Todhunter-Brown A, Thomson K, Nicolson DJ, Cheyne JD, Chung C, Dorris L, Gillespie DC, et al. Perceptual Disorders After Stroke: A Scoping Review of Interventions. Stroke. 2022;53:1772–1787.
• Longley V, Hazelton C, Heal C, Pollock A, Woodward-Nutt K, Mitchell C, Pobric G, Vail A, Bowen A. Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury. Cochrane Database Syst. Rev. 2021;Jul 1:CD003586.
• Hazelton, C., Pollock, A., Dixon, D., Taylor, A., Davis, B., Walsh, G., & Brady, M. C. (2020). The feasibility and effects of eye movement training for visual field loss after stroke: a mixed methods study. British Journal of Occupational Therapy.
• Pollock, Alex, Hazelton, C., Rowe, F., Jonuscheit, S., Kernohan, A., Angilley, J., Henderson, C., Langhorne, P., & Campbell, P. (n.d.). Interventions for visual field defects in people with stroke. Cochrane Database of Systematic Reviews 2019, Issue 5, Art. No.: CD008388.
• Hazelton, C., Pollock, A., Taylor, A., Davis, B., Walsh, G., & Brady, M. C. (2019). A qualitative exploration of the effect of visual field loss on daily life in home-dwelling stroke survivors. Clinical Rehabilitation, 1–10.
• Ali, M., Hazelton, C., Lyden, P., Pollock, A., & Brady, M. on behalf of the V. C. (2013). Recovery From Poststroke Visual Impairment: Evidence From a Clinical Trials Resource. Neurorehabilitation and Neural Repair, 27(2), 133–141.
• Pollock, A, Hazelton, C., & Brady, M. (2011). Visual problems after stroke: a survey of current practice in UK stroke inpatient settings. Topic in Stroke Rehabilitation, 18(5), 643–651.
• Pollock, Alex, Hazelton, C., & Brady, M. (2011). Orthoptic assessment and management of patients with stroke in Scotland. British and Irish Orthoptic Journal, 8, 37–41.