Worse Visual Outcomes After Stroke Associated With Age

Among patients with stroke, older individuals had poor slow binocular and slow and fast monocular vergence. These findings, from a prospective study, were published in the Journal of Neuro-Ophthalmology.

Patients (n=305, 102 women, mean age 61.4±13.8 years) with stroke who were referred for a cerebrovascular workup and management at the University of Athens in Greece underwent a bedside convergence evaluation. The evaluation comprised 6 steps which assessed slow or fast, symmetrical or asymmetrical, binocular or monocular vergence. A group of age-matched control participants was used as a comparator group (n=50, 19 women, 68.1±11.1 years). The patients had ischemic (n=283) or hemorrhagic (n=22) stroke with Fazekas score of 0 to 1 (n=241) or 2 to 3 (n=64).

The patients had deficits in slow (χ², 65.8; P <.001) and fast (χ², 34.3; P <.001) binocular vergence as well as slow (χ², 14.1; P <.01) and fast (χ², 30.8; P <.001) monocular vergence of the right eye and slow (χ², 13.4; P <.01) and fast (χ², 16.4; P <.001) monocular vergence of the left eye.

Age was associated with slow binocular vergence and slow and fast monocular vergence of the right and left eyes (all P ≤.01); frontal stroke of the parietal lobe with slow and fast monocular vergence of the right and left eyes (all P ≤.01); and controls with slow binocular vergence and fast monocular vergence of the right eye (both P ≤.05).

Lesion side did not have an impact on vergence parameters, except that right-sided lesions were associated with poorer performance (χ², 13.4; P <.01). Patients with right occipital lesions and left homonymous hemianopia had deficient fast vergence of the right eye (χ², 13.4; P <.01) and left occipital lesions and right homonymous hemianopia with fast vergence of the left eye (χ², 10.6; P <.01).

For patients with magnetic resonance imaging data, patients with Fazekas scores of 2-3 had decreased fast binocular vergence (χ², 15.4; P <.05) and slow (χ², 6.6; P <.05) and fast (χ², 7.0; P <.05) vergence of the left eye.

This study was biased toward hemispheric stroke and may be underpowered for subcortical infarctions.

These data indicate that there was limited localizing value of deficits among patients who had a stroke. Parietal lobe infarctions were more frequently associated with binocular and monocular vergence.

Reference

Anagnostou E, Koutsoudaki P, Tountopoulou A, Spengos K, Vassilopoulou S. Bedside assessment of vergence in stroke patients. J Neuroophthalmol. 2021;41(4):424-430. doi:10.1097/WNO.0000000000001035