Stroke-Related Visual Impairment; is There an Association with Atrial Fibrillation?

BACKGROUND/OBJECTIVES: Stroke-related visual impairment and atrial fibrillation are both common following stroke. This study explores whether presence of visual impairment following stroke is associated with presence of atrial fibrillation (AF). SUBJECTS/METHODS: The Impact of Visual Impairment after Stroke (IVIS) study is a multi-centre, acute stroke unit, prospective epidemiology study. Standardised visual assessments included visual acuity, reading, visual fields, eye movements and visual perception. AF and blood pressure (BP) were measured on admission. Further data capture included stroke type, age, gender, stroke severity. Analysis included descriptive statistics, independent samples analysis and multivariate analysis for comparison of AF and visual impairment against covariates. RESULTS: 1500 stroke admissions were recruited of which 1204 stroke survivors had visual assessment. New onset stroke-related visual impairment (n = 703) was significantly associated with older age and stoke severity. AF and BP data were available for 889 stroke survivors. AF was present on admission for 258 stroke survivors and significantly associated with older age, stroke severity and discharge destination. A significant association was found for presence of AF and presence of visual impairment. However, stroke severity was a contributing factor for this association. High systolic BP (>140 mmHg) was present in 62% and high diastolic BP (>90 mmHg) in 29%, but not associated with presence of visual impairment. CONCLUSIONS: AF and visual impairment, independently, occur commonly in stroke. Although our results show an association between AF and visual impairment, this appears to be independently influenced by stroke severity. AF was not associated with type of visual impairment or extent of visual recovery. It remains unknown if AF causes more severe visual impairment.

"They've got a lot of needs and I don't think they're being met fully": A qualitative study of the multi-professional team approach to the management of children with optic pathway gliomas.

BACKGROUND: Optic pathway gliomas (OPGs) are low-grade tumours of the visual pathway. Although survival rates are high, there is considerable morbidity and hence treatment focuses on preservation of vison and quality of life. The multiple, complex issues faced by these patients are often confounded by a concurrent diagnosis of neurofibromatosis type-1 (NF1). As there is a paucity of literature addressing the current practices of the multi-professional team (MPT) caring for children diagnosed with an OPG, individual professional experiences often guide the MPT's approach to the care of these children and their families. AIMS: This study aimed to gain views on the management of children with OPGs, from MPT members involved in their care, in order to inform recommendations on how to improve the service offered to these children and their families. METHODS: A qualitative design collected experiential data from MPT members via semi-structured interviews. MPT focus groups were used to validate the data. RESULTS: Data collected from 20 MPT members resulted in the overarching themes of Issues Faced by the Patient and Family and Challenges to the Holistic Care of the Patient. Four recommendations are suggested, namely (1) the production of an MPT training resource, (2) improved visual team links, (3) an OPG patient passport and (4) a joint NF1-OPG clinic. CONCLUSION: There are many challenges to MPT members providing holistic care to patients with OPGs. As no OPG clinical practice guidelines currently exist, it is suggested that the above recommendations be piloted with evaluation to validate their use.