Visual problems after stroke

Visual problems are very commons 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 – causing 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 – causing difficulty in paying attention to one side of space
  • Visual perceptual problems – difficulty processing and understanding visual information, which may affect ability to recognize 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 11 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 improving 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.

 

Collaborations

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

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.

Bowen, A., Hazelton, C., Pollock, A., & Lincoln, N. (2013). Cognitive rehabilitation for spatial neglect following stroke. Cochrane Database of Systematic Reviews, 7.CD003586.pub3

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. https://doi.org/10.1177/0308022620936052

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 survivorshttps://journals.sagepub.com/doi/abs/10.1177/0269215519837580?journalCode=crea. Clinical Rehabilitation, 1–10.

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.

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. https://doi.org/DOI: 10.1002/14651858.CD008388.pub3.