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Cardiovascular medicine
Original research
Vision Screening Assessment (VISA) tool: diagnostic accuracy validation of a novel screening tool in detecting visual impairment among stroke survivors
  1. Fiona J Rowe1,
  2. Lauren Hepworth1,
  3. Claire Howard1,
  4. Alison Bruce2,3,
  5. Victoria Smerdon4,
  6. Terry Payne5,
  7. Phil Jimmieson5,
  8. Girvan Burnside6
  1. 1Health Services Research, University of Liverpool, Liverpool, UK
  2. 2Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
  3. 3Health Sciences, University of York, York, UK
  4. 4Orthoptics, Arrowe Park Hospital, Wirral, UK
  5. 5Computer Science, University of Liverpool, Liverpool, Merseyside, UK
  6. 6Biostatistics, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
  1. Correspondence to Prof Fiona J Rowe; rowef{at}liverpool.ac.uk

Abstract

Purpose Screening for visual problems in stroke survivors is not standardised. Visual problems that remain undetected or poorly identified can create unmet needs for stroke survivors. We report the validation of a new Vision Impairment Screening Assessment (VISA) tool intended for use by the stroke team to improve identification of visual impairment in stroke survivors.

Methods We conducted a prospective case cohort comparative study in four centres to validate the VISA tool against a specialist reference vision assessment. VISA is available in print or as an app (Medicines and Healthcare products Regulatory Agency regulatory approved); these were used equally for two groups. Both VISA and the comprehensive reference vision assessment measured case history, visual acuity, eye alignment, eye movements, visual field and visual inattention. The primary outcome measure was the presence or absence of visual impairment.

Results Two hundred and twenty-one stroke survivors were screened. Specialist reference vision assessment was by experienced orthoptists. Full completion of screening and reference vision assessment was achieved for 201 stroke survivors. VISA print was completed for 101 stroke survivors; VISA app was completed for 100. Sensitivity and specificity of VISA print was 97.67% and 66.67%, respectively. Overall agreement was substantial; K=0.648. Sensitivity and specificity of VISA app was 88.31% and 86.96%, respectively. Overall agreement was substantial; K=0.690. Lowest agreement was found for screening of eye movement and near visual acuity.

Conclusions This validation study indicates acceptability of VISA for screening of potential visual impairment in stroke survivors. Sensitivity and specificity were high indicating the accuracy of this screening tool. VISA is available in print or as an app allowing versatile uptake across multiple stroke settings.

  • VISA
  • screening
  • stroke
  • visual impairment
  • orthoptics
  • detection
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2019-033639

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    Footnotes

    • Contributors FJR provided oversight for the study and led the writing of the paper. FJR, LH, CH, VS and AB contributed to data collection, reviewing the draft paper and approving the final version. TP and PJ contributed to the development of VISA app software and its testing, and reviewed the draft paper and approved the final version. GB contributed to the statistical analysis and interpretation, and reviewed draft amendments and approved the final version.

    • Funding This study was supported by the University of Liverpool.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Patient consent for publication Not required.

    • Ethics approval The clinical study was undertaken in accordance with the Tenets of Helsinki with NHS research ethical approval. Research ethics approval was obtained separately for VISA print (16/NI/0125) and for VISA app (17/WA/0411). The app was approved by the Medicines and Healthcare products Regulatory Authority (MHRA: Reference CI/2017/0065) for NHS use in this study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. Data can be accessed via direct contact with the lead author.