Prognostic impact of visual impairment after stroke: a systematic review and meta-analysis

Résumé fourni par la source

Stroke-related visual impairment affects approximately two-thirds of stroke survivors and encompasses a broad spectrum of disorders, including central vision loss, visual field defects, eye movement problems, visual neglect, and visual perception deficits. These conditions may substantially influence recovery, functional independence, quality of life, and long-term health outcomes. However, the prognostic significance of post-stroke visual impairment remains unclear, as the available evidence is dispersed across different visual disorders, heterogeneous study populations, and diverse outcome measures. The aim of this systematic review and meta-analysis is to comprehensively evaluate the prognostic impact of visual impairment following stroke on clinically relevant health outcomes. Specifically, the review will investigate whether stroke survivors presenting with visual impairment experience poorer outcomes compared with those without visual impairment. Outcomes of interest include mortality, disability, activities of daily living, falls, length of stay, discharge disposition, and health-related quality of life. Eligible studies will include longitudinal observational studies (prospective and retrospective cohort studies, and case-control studies where appropriate) involving adult stroke survivors in whom visual impairment was assessed following stroke. Cross-sectional studies, case reports, reviews, conference abstracts, and studies without longitudinal outcome assessment will be excluded. Where multiple measures of visual impairment are reported within the same study, a single clinically relevant exposure will be selected to avoid double-counting participants. A comprehensive literature search will be conducted across major electronic databases without restrictions on publication date. Two independent reviewers will perform study selection, data extraction, and risk of bias assessment. The methodological quality of included studies will be evaluated using the Quality In Prognosis Studies (QUIPS) tool. Where sufficient homogeneous data are available, random-effects meta-analyses will be performed using raw event data or continuous outcome data. Studies reporting only adjusted effect estimates (e.g., odds ratios, hazard ratios, or risk ratios) that cannot be quantitatively combined with raw data will be synthesised narratively. The expected outcome of this review is to provide the first comprehensive synthesis of the prognostic evidence regarding visual impairment after stroke across multiple clinically relevant outcomes. The findings are expected to improve understanding of the impact of post-stroke visual impairment on recovery, identify visual disorders associated with poorer prognosis, highlight gaps in the current evidence base, and inform future research priorities, rehabilitation strategies, and clinical decision-making in stroke care.

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