European Stroke Organisation (ESO) guideline on visual impairment in stroke
ESO · 2025 · Europe
Source and licence
- Authors
- Fiona J Rowe, Lauren R Hepworth, María Begoña Coco-Martin et al.
- Title
- European Stroke Organisation (ESO) guideline on visual impairment in stroke
- Journal
- European Stroke Journal, 2025
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC12098360
Licence statement of the original publication
This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
PICO 2 for adults with visual problems due to stroke, does early assessment within 1 week of stroke admission, compared to later assessment, improve activities and quality of daily life?
- For adults with visual problems due to stroke, there are insufficient data to make an evidence-based recommendation on the use of early vision screening. Please see the expert consensus statement to the right.Quality of evidence: Low ⊕⊕ Strength of recommendation:Not assessable (–)Expert consensus statement: 10 of 10 experts suggest:1. In adults with stroke, early vision screening should be undertaken to detect their visual problems. This is feasible and acceptable within 3–4 days post onset of stroke. The majority can be assessed within 1 week post-stroke onset.2. Vision screening should be undertaken by specialist eye team assessment or at least by using a validated vision screening tool.
PICO 3 for adults with visual field loss due to stroke, does identification of visual field loss by vision screening or specialist eye team, compared to routine stroke screen, improve detection rate and activities/quality of life?
- For adults with visual field loss due to stroke, there are insufficient data to make an evidence-based recommendation on the use of vision screening or specialist eye team assessment compared to routine stroke screen. Please see the expert consensus statement to the right.Quality of evidence:QUADAS-2 Medium risk of bias Strength of recommendation:Not assessable (–)Expert consensus statement: 10 of 10 experts suggest:1. In adults with stroke, early vision screening should be undertaken to detect visual field loss. This is feasible and acceptable within 3–4 days post onset of stroke. The majority can be assessed within 1 week post onset. Visual field loss screening should be undertaken by specialist eye team assessment or at least by using a validated vision screening tool.2. Vision screening versus routine stroke screening improves the detection rate of presence of visual field loss while specialist visual assessment further improves the accuracy of detection of visual impairment.
PICO 4 for adults with central vision impairment due to stroke, does identification of visual acuity loss by vision screening or specialist eye team, compared to routine stroke screen, improve detection rate and activities/quality of life?
- For adults with central vision impairment due to stroke, there are insufficient data to make an evidence-based recommendation on the use of vision screening or specialist eye team assessment compared to routine stroke screen. Please see the expert consensus statement to the right.Quality of evidence:QUADAS-2 Medium risk of bias Strength of recommendation:Not assessable (–)Expert consensus statement: 10 of 10 experts suggest:1. In adults with stroke, early vision screening should be undertaken to detect central vision impairment. This is feasible and acceptable within 3–4 days post onset of stroke. The majority can be assessed within 1 week post onset. Visual acuity loss screening should be undertaken by specialist eye team assessment or at least by using a validated vision screening tool.2. Vision screening versus routine stroke screening improves the detection rate of presence of central vision impairment while specialist visual assessment further improves the accuracy of detection of visual impairment.
PICO 5 for adults with eye movement disorders due to stroke, does identification of strabismus and/or ocular motility deficit loss by vision screening or specialist eye team, compared to routine stroke screen, improve detection rate and activities/quality of life?
- For adults with eye movement disorders due to stroke, there are insufficient data to make an evidence-based recommendation on the use of vision screening or specialist eye team assessment compared to routine stroke screen. Please see the expert consensus statement to the right.Quality of evidence:QUADAS-2 Medium risk of bias Strength of recommendation:Not assessable (–)Expert consensus statement: 10 of 10 experts suggest:1. In adults with stroke, early vision screening should be undertaken to detect eye movement disorders. This is feasible and acceptable within 3–4 days post onset of stroke. The majority can be assessed within 1 week post onset. Screening for eye movement disorders should be undertaken by specialist eye team assessment or at least by using a validated vision screening tool.2. Vision screening versus routine stroke screening improves the detection rate of presence of eye movement disorders while specialist visual assessment further improves the accuracy of detection of visual impairment.
PICO 6 for adults with visual perceptual disorders due to stroke, does identification of visual perceptual disorders by screening proforma/tool or specialist team, compared to routine stroke screen, improve detection rate and activities/quality of life?
- For adults with visual perceptual disorders due to stroke, there are insufficient data to make an evidence-based recommendation on the use of vision screening or specialist eye team assessment compared to routine stroke screen. Please see the expert consensus statement to the right.Quality of evidence:QUADAS-2 Medium risk of bias Strength of recommendation:Not assessable (–)Expert consensus statement: 10 of 10 experts suggest:1. In adults with stroke, early vision screening should be undertaken to detect visual perceptual disorders. This is feasible and acceptable within 3–4 days post onset of stroke. The majority can be assessed within 1 week post onset. Screening for visual perceptual disorders should be undertaken by specialist eye team assessment or at least by using a validated vision screening tool.2. Vision screening versus routine stroke screening improves the detection rate of presence of visual perceptual disorders while specialist visual assessment further improves the accuracy of detection of visual impairment.
PICO 10 For adults with central vision impairment due to stroke, does compensatory, substitute or restitutive intervention, compared to no intervention, improve activities and quality of daily life?
- For adults with central vision impairment due to stroke, there are insufficient data to make an evidence-based recommendation on the use of compensatory, substitutive or restitutive interventions. Please see the expert consensus statement to the right.Quality of evidence: Very low ⊕ Strength of recommendation:Not assessable (–)Expert consensus statement: 10 of 10 experts suggest:1. For adults with central vision impairment due to stroke, early management options to improve visual acuity should be offered as soon as possible after stroke onset.2. Stroke survivors should wear their prescribed spectacles and these should be updated promptly if lost/broken or old. Clinicians should signpost to appropriate information, resource materials and vision aids.
Abstract
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.
Contents of the original publication
The section headings of the original.
- Table of key recommendations/suggestions of the Vision Guideline
- Table of Contents
- Introduction
- Methods
- Composition and approval of the Module Working Group
- Development and approval of clinical questions
- Literature search
- Data analysis
- Evaluation of the quality of evidence and formulation of recommendations
- Basis for recommendations:
- Drafting of the document, revision and approval
- Results
- DIAGNOSIS
- Analysis of current evidence
- Analysis of current evidence
- Analysis of current evidence
- Analysis of the current evidence
- Analysis of current evidence
- Analysis of current evidence
- Analysis of current evidence
- TREATMENT
- Analysis of the current evidence
- Analysis of current evidence
- Analysis of the current evidence
- Analysis of current evidence
- Analysis of current evidence
- Analysis of current evidence
- Discussion
- Supplemental Material
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