Rowe Fiona J, Hepworth Lauren R, Begoña Coco-Martin María, Gillebert Celine R, Leal-Vega Luis, Palmowski-Wolfe Anja, Papageorgiou Eleni, Ryan Stephen James, Skorkovska Karolina, Aamodt Anne Hege
Institute of Population Health, University of Liverpool, Liverpool, UK.
Department of Medicine, Dermatology and Toxicology, University of Valladolid, Valladolid, Spain.
Eur Stroke J. 2025 May 22:23969873251314693. doi: 10.1177/23969873251314693.
Visual impairment due to stroke is common. However, controversy exists on how best to screen for visual impairment, the timing at which to screen, and on the optimal management of the varying types of visual impairment. This European Stroke Organisation (ESO) guideline provides evidence-based recommendations to assist clinicians in decision-making on screening methods, timing of screening and assessment and management options in adult stroke survivors. The target audience for this guideline is health care providers involved in stroke care from prehospital screening, in stroke units and rehabilitation centres, ophthalmological departments and community stroke care, and for stroke survivors and care givers. The guideline was developed according to the ESO standard operating procedure and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and, where possible, meta-analyses of the literature, assessed the quality of the available evidence and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. We found evidence of acceptability and feasibility of early visual screening within 1 week of stroke onset. We describe the accuracy of various vision screening tools at pre-hospital and hyper/acute stages as well as specialist vision assessment. We suggest vision screening in all patients with stroke to improve detection of their visual problems We describe a range of treatment options for visual impairment post-stroke across the typical categories of impaired central vision, ocular stroke (central retinal artery occlusion), eye movements, visual fields, visual neglect and visual perception. This guideline highlights specific areas where robust evidence is lacking and where further definitive randomised controlled trials and diagnostic accuracy studies are required.
中风导致的视力障碍很常见。然而，在如何最好地筛查视力障碍、筛查时机以及如何对不同类型的视力障碍进行最佳管理方面存在争议。本欧洲中风组织（ESO）指南提供了基于证据的建议，以协助临床医生就成年中风幸存者的筛查方法、筛查时机、评估及管理方案做出决策。本指南的目标受众是参与中风护理的医疗保健提供者，包括院前筛查、中风单元和康复中心、眼科部门以及社区中风护理的人员，以及中风幸存者和护理人员。该指南是根据ESO标准操作程序以及推荐分级、评估、制定和评价（GRADE）方法制定的。工作组确定了相关临床问题，进行了系统评价，并在可能的情况下对文献进行了荟萃分析，评估了现有证据的质量并提出了具体建议。在没有足够证据根据GRADE方法提供建议的情况下，提供了专家共识声明。我们发现有证据表明在中风发作后1周内进行早期视力筛查具有可接受性和可行性。我们描述了各种视力筛查工具在院前和超急性/急性阶段以及专科视力评估中的准确性。我们建议对所有中风患者进行视力筛查，以改善对其视力问题的检测。我们描述了中风后视力障碍的一系列治疗选择，涵盖了受损中央视力、眼部中风（视网膜中央动脉阻塞）、眼球运动、视野、视觉忽视和视觉感知等典型类别。本指南强调了缺乏有力证据的特定领域，以及需要进一步进行确定性随机对照试验和诊断准确性研究的领域。
