Erratum: Diagnosis and Rehabilitation of Visual Field Defects in Stroke Patients: A Retrospective Audit

Objective: Visual field defects (VFD) after stroke can cause significant disability and reduction in quality of life. Adequate diagnosis of VFD and referral to visual rehabilitation are important to improve outcome. Our aim was to conduct a retrospective clinical audit to investigate how neurologists detect and follow up VFD in stroke patients in a university hospital in Norway. Methods: All patients registered in the Bergen NORSTROKE Registry from February 2006 to May 2009 with (1) occipital lobe infarctions and (2) non-occipital infarction and clinically detected VFD were included in the study. Their medical records were reviewed for referral to perimetry for examination of VFD and for referral to a visual rehabilitation program within the first year after brain injury. Results: Of 353 patients, 34 (9.6%) were referred to perimetry and 8 (2.3%) to visual rehabilitation. Patients referred to perimetry were younger (65.1 vs. 74.7 years, p < 0.001), had lower modified Rankin Scale scores (2.53 vs. 3.47, p = 0.003), and scored lower on the National Institutes of Health Stroke Scale upon admission (6.68 vs. 13.90, p < 0.001). Men were more often referred to perimetry than women (73.5 vs. 26.5%, p < 0.001), and those referred were younger (61.2 vs. 75.8 years, p = 0.03). Conclusions: Only few patients were referred to perimetry, and even fewer were offered visual rehabilitation. Age and gender were negative predictors for referral. Neurologists’ awareness of the significant disability related to VFD must be increased. Focused diagnostics on visual impairment and early referral to a visual rehabilitation program should be mandatory in stroke unit services.

研究目的：脑卒中后视野缺损（Visual Field Defects, VFD）可导致严重残疾及生活质量显著下降，明确诊断VFD并转诊至视觉康复治疗对改善预后具有重要意义。本研究旨在开展一项回顾性临床审计，以调查挪威某大学医院的神经科医师对脑卒中患者VFD的检出与随访情况。
研究方法：纳入2006年2月至2009年5月期间，于卑尔根NORSTROKE登记系统中注册的两类患者：（1）枕叶梗死患者；（2）非枕叶梗死且经临床检出VFD的患者。通过查阅其病历，收集卒中后1年内患者转诊至视野计检查以评估VFD，以及转诊至视觉康复项目的相关记录。
研究结果：共纳入353例患者，其中34例（9.6%）被转诊至视野计检查，8例（2.3%）被转诊至视觉康复治疗。转诊至视野计检查的患者年龄更小（65.1岁 vs 74.7岁，p<0.001），改良Rankin量表（modified Rankin Scale）评分更低（2.53 vs 3.47，p=0.003），入院时美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）评分亦更低（6.68 vs 13.90，p<0.001）。男性转诊至视野计检查的比例高于女性（73.5% vs 26.5%，p<0.001），且转诊患者的平均年龄更小（61.2岁 vs 75.8岁，p=0.03）。
研究结论：仅少数患者被转诊至视野计检查，能获得视觉康复治疗的患者占比更低。年龄与性别是影响转诊的负向预测因素。临床医师对VFD相关严重残疾的认知水平亟需提升。卒中单元应将针对视力受损的针对性诊断，以及早期转诊至视觉康复项目列为强制诊疗要求。