Clinical research
The frequency of occurrence, types, and characteristics of visual field defects in acquired brain injury: A retrospective analysis

https://doi.org/10.1016/j.optm.2007.10.012Get rights and content

Abstract

Background

The purpose of this retrospective study was to determine the frequency of occurrence of visual field defects in a sample of visually symptomatic, ambulatory outpatients who have acquired brain injury (ABI), either traumatic brain injury (TBI) or cerebral vascular accident (CVA).

Methods

The medical records of 220 individuals with TBI (n=160) or CVA (n=60) were reviewed retrospectively. This was determined by a computer-based query spanning the years 2000 through 2003. The individuals' records were reviewed to determine the frequency of targeted visual field defects that were classified as scattered, restricted, homonymous, nonhomonymous, and visual neglect. The altitudinal and lateral characteristics of these defects were also determined.

Results

In the total ABI sample of 220, some 102 (46.36%) individuals had 1 of the targeted defects diagnosed. These defects were present in 62 (38.75%) of the TBI subgroup and in 40 (66.67%) of the CVA subgroup. The most frequent defects in the TBI group were scattered (58.06%) followed by homonymous (22.58%). In the CVA group, the most numerous were homonymous (47.5%), with scattered and nonhomonymous accounting for 20% each.

Conclusion

The uniqueness of the current study is that it reports the frequency of occurrence of specified visual field defects in the total ABI sample and in the TBI and CVA subgroups. This enabled comparisons with other studies that generally have reported on just 1 of these groupings. The current results are in accord with most of the other studies that are reviewed. The findings of this study should alert the reader to the high frequency of occurrence of visual field defects in the ABI population, and make the reader aware of the adverse effects they can have on quality of life and rehabilitation.

Section snippets

Previous studies of visual field defects in ABI

There have been several noteworthy investigations on the occurrence of visual field defects in individuals with ABI. The report by Zihl8 was based on a group of 392 patients who were examined between 1978 and 1986. His subjects were predominately individuals with CVA (79%). Zihl8 found that 370 (94%) of his subjects had unilateral defects, whereas the remaining 22 subjects had bilateral defects. Overall, hemianopias predominated, whereas quadrantanopias and paracentral scotomas were rare. He

Methods

A computer-based query was obtained for patients examined at the Raymond J. Greenwald Rehabilitation Center (RJGRC) between October 1, 2000, and October 7, 2003. This unit is a clinic at the State University of New York, State College of Optometry. The query used the 99203 (new patient evaluation) and 99213 (established patient evaluation) Current Procedural Terminology (CPT) codes. The majority of these patients were referred from rehabilitation professionals at the following institutions:

Frequency of occurrence of the targeted field defects in the total ABI sample and the TBI and CVA groups

Some type of visual field defect was specified in 102 records of the 220 in the sample of ABI patients (46.36%). The TBI group accounted for 62 of these defects, and the CVA group for 40. Table 3 presents these numbers and the percentages for the TBI and CVA groups and the total ABI sample (TBI+CVA).

The data for the types of the targeted visual field defects found in the total sample of 220 and the subgroups are presented in Table 4. It shows that, in the TBI group, the most frequent defect was

Comparison of the current findings with those of other studies

The findings for our overall ABI sample and the breakdown into the CVA and TBI groups allow for focused comparisons with other studies. Thus, in our combined pool of 160 TBI and 60 CVA subjects, 102 (46.36%) had some type of visual field defect according to the targeted categories. In the more numerous TBI group, 38.75% had 1 of these defects (see Table 3). This percentage is quite close to the findings of Sabates et al.10 of 35% in their sample of 188 TBI closed head patients. It is also close

General comments

An indication of the increasing involvement of optometrists in the ocular and visual care of ABI patients is the number of their contributions to the general rehabilitation literature pertaining to these patients.6, 7, 9, 23 Further, recent articles that studied the same sample as the present study's have indicated that these patients are at significant risk for various types of ocular disease24 and oculomotor dysfunctions.25 The potential negative effects of both conditions on one's quality of

Summary

  • 1

    The current study is unique in that the frequency of occurrence and the lateral and altitudinal characteristics of specific types of visual field defects are presented for a total group of ABI patients and additionally for the TBI and CVA subgroups.

  • 2

    In the total sample (ABI) of 220 subjects, 46.36% had a diagnosis of visual field defect (see Table 3).

  • 3

    In the TBI sample of 160 subjects, 38.75% had a diagnosis of visual field defect (see Table 3).

  • 4

    In the CVA sample of 60 subjects, 66.67% had a

References (29)

  • J. Beis et al.

    Detection of visual field deficits and visual neglect with computerized light emitting diodes

    Arch Physical Med Rehab

    (1994)
  • K.J. Ciuffreda et al.

    Occurrence of oculomotor dysfunction in acquired brain injury: A retrospective analysis

    J Am Optom Assoc

    (2007)
  • M.R. Hibbard et al.

    The neuropsychological evaluation: A pathway to understanding the sequelae of brain injury

  • I.B. Suchoff et al.

    An overview of acquired brain injury and optometric implications

  • I.B. Suchoff et al.

    The occurrence of ocular and visual dysfunctions in an acquired brain-injured patient sample

    J Am Optom Assoc

    (1999)
  • M. Scheiman et al.

    Clinical management of binocular vision

  • R.L. Morton

    Visual dysfunction following traumatic brain injury

  • P.S. Suter

    Rehabilitation and management of visual dysfunction following traumatic brain injury

  • N. Kapoor et al.

    Vision disturbances following traumatic brain injury

    Curr Treat Options Neurol

    (2002)
  • J. Zihl

    Cerebral disturbances of elementary visual dysfunctions

  • I.B. Suchoff et al.

    Rehabilitative optometric interventions for the adult with acquired brain injury

  • N.R. Sabates et al.

    Neuro-ophtlalmological findings in closed head injury

    J Clin Neurol Ophthalmol

    (1991)
  • R.A. Frieden

    Early rehabilitation after stroke

  • C. Macintosh

    Stroke re-visited: visual problems following stroke and their effect on rehabilitation

    British Orthoptic Journal

    (2003)
  • Cited by (72)

    • Intrinsically photosensitive retinal ganglion cell-driven pupil responses in patients with traumatic brain injury

      2021, Vision Research
      Citation Excerpt :

      Symptoms in TBI patients are often multifactorial, including both physical and cognitive impairments. Up to 60% of TBI patients report some form of visual impairment (Ciuffreda et al., 2007), including oculomotor and binocular deficits (Cockerham et al., 2009, Kapoor & Ciuffreda, 2002), photophobia (Capo-Aponte et al., 2012, Waddell & Gronwall, 1984), and visual field defects (Lemke et al., 2013, Suchoff et al., 2008). Similar to findings in other neurological conditions, such as Alzheimer’s (Kirbas et al., 2013, Parisi et al., 2001) and multiple sclerosis (Cheng et al., 2007, Narayanan et al., 2014), patients with TBI have been shown to demonstrate abnormal findings in the inner retina, specifically, of the retinal ganglion cells.

    • Disrupted resting-state EEG alpha-band interactions as a novel marker for the severity of visual field deficits after brain lesion

      2021, Clinical Neurophysiology
      Citation Excerpt :

      Homonymous visual field defects (HFVDs) are a common consequence of acquired brain injuries and greatly affect quality of life (Hepworth et al., 2016; Rowe et al., 2013; Suchoff et al., 2008).

    • Scan path during change-detection visual search

      2021, Computers in Biology and Medicine
    • Rehabilitation Assessment and Management of Neurosensory Deficits After Traumatic Brain Injury in the Polytrauma Veteran

      2019, Physical Medicine and Rehabilitation Clinics of North America
      Citation Excerpt :

      Visual compensatory strategies include the following: Use rehabilitation that stresses peripheral awareness and teaches patients to continuously scan their environment.51,54 Scroll or tilt reading material away from the field of loss.51

    • Vision Rehabilitation After Traumatic Brain Injury

      2019, Physical Medicine and Rehabilitation Clinics of North America
      Citation Excerpt :

      Visual field deficits have been found in 35% of patients with TBI in a sample clinic population having a range of visual symptoms.27 Deficits of all types may be present, ranging from hemianopia to small, scattered regions of reduced sensitivity (Table 6).27 Fig. 2 is an algorithm that outlines the steps and clinical decision points in the eye care and rehabilitation process for patients with visual field loss associated with TBI/acquired brain injury.

    View all citing articles on Scopus
    View full text