Interventions for age-related visual problems in patients with stroke

As people get older they are more likely to develop age-related visual problems (such as age-related macular degeneration, cataracts, glaucoma and diabetic retinopathy). As the incidence of stroke increases with age, a significant proportion of stroke patients will have age-related visual problems. This review aimed to determine if interventions for age-related visual problems improve functional ability following stroke. We were specifically interested in whether people with stroke responded differently from the general population when treated for age-related visual problems and also whether assessment and interventions for age-related visual problems could improve functional ability during stroke rehabilitation. After a complex search we identified no studies for inclusion in this review. Currently best evidence comes from a series of Cochrane reviews which evaluate the effect of specific interventions for different age-related visual problems (in the general population). We recommend that analyses are carried out within these reviews to explore the impact of these interventions on the subgroup of people with stroke. We encountered a number of methodological problems during this review, relating to selection criteria for including studies; we recommend that this is clarified before future updates of this review are carried out.

Authors' conclusions: 

There are no implications for practice arising from this review. Evidence relating to the management of patients (from the general population) with age-related visual problems is available from other Cochrane reviews and is likely to be the best evidence available for making treatment decisions about individual patients. Subgroup analyses within these reviews to explore the effect of interventions for age-related visual problems in patients with stroke are recommended. We recommend that the objectives and selection criteria for this Cochrane review are amended and clarified prior to any future updates.

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Background: 

The prevalence of eye problems increases with age and, consequently, so does the level of visual impairment. As the incidence of stroke also increases with age, a significant proportion of stroke patients will have age-related visual problems. It is possible that the effect of interventions for age-related visual problems may differ in the population of stroke patients compared to the wider population of older people. The interaction between the problems arising directly from stroke and those arising directly from age-related visual problems will be complex. Interventions for age-related visual problems may also be affected by the presence of other stroke-related co-morbidities. Consequently, the nature and outcome of interventions for age-related visual problems may be different in patients with stroke.

Objectives: 

The aim of this review is to determine if interventions for age-related visual problems improve functional ability following stroke.

Search strategy: 

We searched the Cochrane Stroke Group Trials Register (March 2011), the Cochrane Eyes and Vision Group Trials Register (December 2009) and nine electronic bibliographic databases including: the Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), MEDLINE (1950 to February 2011), EMBASE (1980 to February 2011), CINAHL (1982 to February 2011), AMED (1985 to February 2011) and PsycINFO (1967 to February 2011). We also searched reference lists and trials registers, handsearched journals and conference proceedings, and contacted experts.

Selection criteria: 

Randomised trials in adults after stroke, where the intervention is specifically targeted at assessing, treating or correcting age-related visual problems, or improving the ability of the patient to cope with visual impairment. Primary outcome was functional ability in activities of daily living and secondary outcomes included functional ability in extended activities of daily living, visual acuity, visual field, visual function, balance, falls, depression and anxiety, discharge destination/residence after stroke, quality of life and social isolation, adverse events and death.

Data collection and analysis: 

Two review authors independently screened abstracts and planned to extract data and appraise trials. We planned that assessment of methodological quality would be undertaken for allocation concealment, blinding of outcome assessor, method of dealing with missing data and other potential sources of bias.

Main results: 

We considered 7357 titles, 460 abstracts and 85 full papers. We identified no studies for inclusion in this review.

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