Scandinavian Journal of Optometry and Visual Science

Screening for visual deficits at a rehabilitation unit early in the rehabilitation process after stroke

Eike Wehling — 2025-05-16

Stroke patients are not routinely screened for visual deficits despite recommendations on the importance of vision for safety and design of rehabilitation plans. The aim was to examine if it was feasible to expose rehabilitation patients to vision screening. Secondly, we aimed to examine the agreement between the vision screening and items from a neurological stroke screening tool specifically targeting vision and neglect. Over a period of 6 months, patients arriving at a rehabilitation unit after having had a stroke were consecutively included. Data on aetiology, severity, and location of the stroke, time since the original admission, scores on the National Institutes of Health Stroke Scale (NIHSS), and results from a short screening/observation battery were registered. Cohen’s kappa was calculated to examine the agreement between results from the screening/observation battery and NIHSS items. Nighty-six percent of the patients were able to undergo screening of basic visual functions. Impairment was found in 52% of the patients, and 67% of these showed impairment in more than one function. Visual impairment occurred for all levels of stroke severity. Reduced distance visual acuity was found in 15% of all patients. Accordance between the screening/observation battery and NIHSS items varied between κ = 0.36 and κ = 0.64. Screening battery vs NIHSS items showed impairment in 31% vs. 21% of patients for oculomotor deficits, 31% vs. 34% for visual field deficits and 31% vs. 29% for neglect. Results show that patients are assessable for basic visual functions early in the rehabilitation process. Items from the NIHSS cannot replace a dedicated vision screening tool because they exclude essential functions such as visual acuity, and oculomotor deficits may go undetected. Only the visual field assessment indicates substantial agreement and high sensitivity. Regarding stroke severity, agreement was substantial only in the severe group. In summary, we conclude that the NIHSS items cannot be recommended to replace systematic screening of visual function and neglect.

One Eye on the Prize: The Impact of monocular vision on aiming responses

William Sheppard — 2025-04-23

The ability to move one's hand quickly and accurately towards a target is an essential skill that underpins many activities of daily living, such as writing or threading a needle. In-lab research has previously demonstrated that the time taken to complete an aiming task is proportional to task difficulty; however, the strength of this relationship appears to reduce as the quality of visual input becomes degraded (Wu et al, 2010). There is also evidence that when compared to full vision, monocular vision leads to a general increase in movement time during aiming tasks (Sheppard et al, 2021). Despite these valuable findings, logistical challenges (e.g. recruitment from hard-to-reach populations) make in-lab testing difficult or even impossible. These potential challenges could be overcome by introducing online tests if they are sufficiently sensitive to capture visual deficits accurately. The present study aimed to test (i) whether monocular vision was associated with increased response time and (ii) the feasibility of using simple, online tasks to probe the relationship between visual and motor function. Using a computer mouse or touchpad to move to targets as quickly as possible, 65 participants (aged 18–77) completed (i) a visual search task (moving to a 34 target embedded amongst a grid of distractors) and (ii) a basic visual-motor aiming task (moving to individual targets of varying size/distance). Participants completed both tasks online, either with full vision or monocular vision. Visual search time and aiming task response time increased significantly under monocular vision (≈1.8 s and ≈40 ms, respectively). These results suggest that a simple, online aiming task can be suitable for testing the effects of a visual deficit on motor function.

The Pediatric Cataract Register (PECARE): Challenges in scientific evaluation of visual development

Jenny Gyllén — 2025-09-23

The purpose of this study was to analyse visual acuity tests and methods used in children who have undergone cataract surgery in Sweden as well as the success rate of visual acuity testing, in order to improve current treatment.

Children registered in PECARE who underwent cataract surgery between 1st January 2007 and 31st July 2016 were included. Visual acuity test methods were analysed at the follow-up ages of 1, 2, 5 and 10 years.

A total of 424 children were operated, 209 girls (49%) and 215 boys (51%). The number of operated eyes was 584, of which 320 (55%) were bilateral cataracts and 264 (45%) unilateral. A total of 660 follow-up visits took place, and successful visual acuity measurements were achieved in 416 of these cases: 106/228 (46%) at 1 year of age, 128/226 (57%) at 2 years of age, 169/193 (88%) at 5 years of age, and 13/13 (100%) at 10 years of age.

Visual acuity test methods differed among the follow-up clinics, making comparisons challenging. The Kasper test was widely used before the age of 2, and has been validated, but not been published scientifically. The success rate was higher for Kasper than for other tests.

A challenging diversity of methods for testing visual acuity are used in Swedish paediatric cataract care. Age-related national guidelines regarding visual acuity tests methods are needed for the development and improvement of current treatment. Scientific evaluation of visual development is an important outcome in order to reach equal care. Furthermore, the Kasper test needs to be scientifically re-validated.

Keywords: paediatric cataract, congenital, visual acuity test

Kongsberg Vision Meeting Abstracts 2025

Helle K. Falkenberg — 2025-12-19

Kongsberg Vision Meeting 2025 was held for the 17^th time at the University of South-Eastern Norway in Kongsberg on October 20–21. The two-day event focused on clinical optometry and vision research, attracting more than 100 practicing optometrists, 60 final-year optometry students, and several commercial exhibitors, creating a dynamic arena for sharing knowledge and networking.

Keynote speakers included Jan Johannson (Karolinska Institute, Sweden), Hanne-Mari Schiøtz Thorud (University of South-Eastern Norway, Norway), Erik Roberstad (Interoptikk Holt, Norway), and Eike Wehling (University of Bergen, Norway). The program addressed vision problems following acquired brain damage, the expanding role and scope of optometrists in independent prescribing, and clinical approaches to headache management. A dedicated session showcased a decade of SNOW research on children’s vision in Norway. Practical skills and applied research were central, with workshops on neurorehabilitation, tear duct irrigation, and binocular vision in schoolchildren. Two panel discussions addressed the evolving role of Norwegian optometrists as independent prescribers, and the importance of using diagnostic drops in vision examination in children and adolescents.

The Scandinavian program was curated by Vibeke Sundling, Bente Monica Aakre, Rigmor C. Baraas, and Helle K. Falkenberg. Abstracts from invited and contributed talks are presented in the order they were given. The meeting reinforced the need for clinical innovation, evidence-based practice, and interdisciplinary collaboration to strengthen primary eye care services.

From practice to progress: vision research in Scandinavia

Karthikeyan Baskaran — 2025-12-31