Disclosures: Nicholas E. Peterson, MD: Nothing to disclose

Objective: Visual field defects are seen in 25-60% of patients after cortical stroke. Effectiveness of rehabilitation is controversial but earlier interventions show better outcomes. Current visual defect screening is performed at the bedside with confrontation which has limitations resulting in delayed or missed management/rehabilitation. We evaluated the success rate of our visual defect screening methods in patients after stroke and developed open source software for virtual reality headsets to replace screening with confrontation.

Design: Retrospective analysis was performed to evaluate the success rate of visual defect screening. Prospective study was performed to evaluate agreement of visual perimetry data between the virtual reality headset and oculokinetic perimetry.

Setting: University of Minnesota Medical Center Acute Rehab.

Participants: Electronic medical records of stroke patients were reviewed for the evaluation of screening methods. Healthy individuals were used to evaluate agreement between perimetry technologies.

Interventions: Visual perimetry with virtual reality headset.

Main Outcome Measures: Number of patients diagnosed with visual impairment, rate of successful screening during admission, time to vision referral and agreement of measured visual fields between VR and oculokinetic perimetry.

Results: 50 medical records were reviewed from 05-10-2009 to 10-01-2018, 18 males and 32 females with ischemic cortical strokes. 26% patients had visual impairment diagnosis after stroke, 69% were successfully screened during admission, 31% were diagnosed by ophthalmologist after admission. Average vision follow up was 228 days after stroke. 66% of positive screened patients did not have a vision follow up. Bland-Altman plots showed good agreement between VR perimetry and oculokinetic perimetry (meandiff: 1.75°, CI:-3.94-7.72 P<.05).

Conclusions: Our current visual impairment screening methods are not adequate. We are not detecting patients who might benefit from early rehabilitation and many patients are likely living impaired without proper diagnosis. Virtual reality headsets are a feasible and low cost screening tool which may provide an early diagnosis of visual field deficits and prompt early vision referrals.

Level of Evidence: Level I

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/visual-field-screening-after-stroke-with-virtual-reality-headsets/