{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T17:04:28Z","timestamp":1780074268558,"version":"3.54.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Norwegian Association of the Blind and Partially Sighted and Oslo University Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Visual abnormalities are common after stroke but are often overlooked in acute care. The Vision Impairment Screening Assessment (VISA) was developed to support non-specialist clinicians in identifying visual abnormalities. This study evaluated the diagnostic accuracy of the Norwegian translation of VISA against structured neuro-ophthalmic examination in acute stroke. Secondary analyses examined the prevalence of early post-stroke visual abnormalities and compared VISA with the visual items of the National Institutes of Health Stroke Scale (NIHSS), the routine acute stroke assessment tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>The Oslo Study for Vision Impairment after Stroke was a prospective diagnostic accuracy study including consecutive patients admitted for acute stroke management at a regional thrombectomy centre. Patients underwent bedside VISA assessment and neuro-ophthalmic examination within 72\u00a0h of admission. Diagnostic accuracy measures were calculated, and feasibility was assessed by completion rates and timing of assessments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 127 patients were included, of whom 81 completed both assessments. VISA demonstrated high sensitivity (94.5%) and lower specificity (34.6%), with a negative predictive value of 75.0%. Neuro-ophthalmic examination identified visual abnormalities in 70.1% of patients. The NIHSS visual items showed lower sensitivity (60.7%) than VISA, despite higher specificity (64.9%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and conclusions<\/jats:title>\n                    <jats:p>Visual abnormalities were common in the acute phase after stroke and were more frequently detected by VISA than by the NIHSS, supporting routine early visual screening in acute stroke care beyond the NIHSS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/esj\/aakag053","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T16:23:07Z","timestamp":1780071787000},"source":"Crossref","is-referenced-by-count":0,"title":["Validation of the Vision Impairment Screening Assessment in acute stroke care: a prospective diagnostic accuracy study"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5262-4862","authenticated-orcid":false,"given":"Stephen James","family":"Ryan","sequence":"first","affiliation":[{"name":"Department of Neurology, Oslo University Hospital , Oslo ,","place":["Norway"]},{"name":"Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna-Katharina E L","family":"J\u00f8rstad","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Oslo University Hospital , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0615-804X","authenticated-orcid":false,"given":"Morten C","family":"Moe","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo ,","place":["Norway"]},{"name":"Department of Ophthalmology, Oslo University Hospital , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7950-4882","authenticated-orcid":false,"given":"Mona","family":"Skjelland","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oslo University Hospital , Oslo ,","place":["Norway"]},{"name":"Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ansar","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oslo University Hospital , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9210-9131","authenticated-orcid":false,"given":"Fiona J","family":"Rowe","sequence":"additional","affiliation":[{"name":"Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool , Liverpool ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1259-0653","authenticated-orcid":false,"given":"\u00d8ystein Kalsnes","family":"J\u00f8rstad","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo ,","place":["Norway"]},{"name":"Department of Ophthalmology, Oslo University Hospital , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2824-2760","authenticated-orcid":false,"given":"Anne Hege","family":"Aamodt","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oslo University Hospital , Oslo ,","place":["Norway"]},{"name":"Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool , Liverpool ,","place":["United Kingdom"]},{"name":"Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology , Trondheim ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"2026052912230140500_ref1","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/0166-2236(92)90344-8","article-title":"Separate visual pathways for perception and action","volume":"15","author":"Goodale","year":"1992","journal-title":"Trends Neurosci"},{"key":"2026052912230140500_ref2","doi-asserted-by":"publisher","first-page":"105650","DOI":"10.1016\/j.neubiorev.2024.105650","article-title":"Two what, two where, visual cortical streams in humans","volume":"160","author":"Rolls","year":"2024","journal-title":"Neurosci Biobehav Rev"},{"key":"2026052912230140500_ref3","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1016\/j.neuron.2012.01.010","article-title":"How does the brain solve visual object recognition?","volume":"73","author":"DiCarlo","year":"2012","journal-title":"Neuron"},{"key":"2026052912230140500_ref4","doi-asserted-by":"publisher","first-page":"e57","DOI":"10.1212\/01.wnl.0000310640.37810.b3","article-title":"Pearls & oysters: the medial longitudinal fasciculus in ocular motor physiology","volume":"70","author":"Frohman","year":"2008","journal-title":"Neurology"},{"key":"2026052912230140500_ref5","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1136\/svn-2017-000079","article-title":"Eyes and stroke: the visual aspects of cerebrovascular disease. Stroke and vascular","volume":"2","author":"Pula","year":"2017","journal-title":"Neurology"},{"key":"2026052912230140500_ref6","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1161\/STROKEAHA.124.048907","article-title":"Incidence of visuospatial neglect in acute stroke: assessment and stroke characteristics in an unselected 1-year cohort","volume":"56","author":"Cazzoli","year":"2025","journal-title":"Stroke"},{"key":"2026052912230140500_ref7","doi-asserted-by":"publisher","DOI":"10.3389\/fopht.2025.1505836","article-title":"Persistent visual impairments following mild-to-moderate ischemic stroke","volume":"5","author":"Wijesundera","year":"2025","journal-title":"Front Ophthalmol"},{"key":"2026052912230140500_ref8","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1177\/1545968312454683","article-title":"Recovery from poststroke visual impairment: evidence from a clinical trials resource","volume":"27","author":"Ali","year":"2013","journal-title":"Neurorehabil Neural Repair"},{"key":"2026052912230140500_ref9","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1186\/s12913-020-05176-8","article-title":"\u201cInvisible\u201d visual impairments. A qualitative study of stroke survivors\u2019 experience of vision symptoms, health services and impact of visual impairments","volume":"20","author":"Falkenberg","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"2026052912230140500_ref10","doi-asserted-by":"publisher","first-page":"20170813","DOI":"10.1002\/brb3.778","article-title":"Stroke survivors' views and experiences on impact of visual impairment","volume":"7","author":"Rowe","year":"2017","journal-title":"Brain Behav"},{"key":"2026052912230140500_ref11","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1177\/23969873251314693","article-title":"European stroke organisation (ESO) guideline on visual impairment in stroke","volume":"10","author":"Rowe","year":"2025","journal-title":"Eur Stroke J"},{"key":"2026052912230140500_ref12","doi-asserted-by":"publisher","first-page":"e0213035","DOI":"10.1371\/journal.pone.0213035","article-title":"High incidence and prevalence of visual problems after acute stroke: an epidemiology study with implications for service delivery","volume":"14","author":"Rowe","year":"2019","journal-title":"PloS One"},{"key":"2026052912230140500_ref13","doi-asserted-by":"publisher","first-page":"2531","DOI":"10.1080\/09638288.2016.1231846","article-title":"Screening methods for post-stroke visual impairment: a systematic review","volume":"39","author":"Hanna","year":"2017","journal-title":"Disabil Rehabil"},{"key":"2026052912230140500_ref14","volume-title":"National Clinical Guideline for Stroke for the UK and Ireland"},{"key":"2026052912230140500_ref15"},{"key":"2026052912230140500_ref16"},{"key":"2026052912230140500_ref17","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1161\/STROKEAHA.116.015434","article-title":"Using the National Institutes of Health stroke scale","volume":"48","author":"Lyden","year":"2017","journal-title":"Stroke"},{"key":"2026052912230140500_ref18","doi-asserted-by":"publisher","first-page":"58 20221027","DOI":"10.3390\/medicina58111541","article-title":"Stroke scales as assessment tools in emergency settings: a narrative review","volume":"58","author":"Budin\u010devi\u0107","year":"2022","journal-title":"Medicina (Kaunas)"},{"key":"2026052912230140500_ref19","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1016\/s1474-4422(23)00237-5","article-title":"Prehospital screening of acute stroke with the National Institutes of Health Stroke Scale (ParaNASPP): a stepped-wedge, cluster-randomised controlled trial","volume":"22","author":"Guterud","year":"2023","journal-title":"Lancet Neurol"},{"key":"2026052912230140500_ref20","doi-asserted-by":"publisher","first-page":"e000574","DOI":"10.1136\/bmjno-2023-000574","article-title":"The precision by the Face Arm Speech Time (FAST) algorithm in stroke capture, sex and age differences: a stroke registry study","volume":"6","author":"Hagberg","year":"2024","journal-title":"BMJ Neurology Open"},{"key":"2026052912230140500_ref21","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1186\/s12883-021-02499-9","article-title":"Critical issue on the extinction and inattention subtest of NIHSS scale: an analysis on post-acute stroke patients attending inpatient rehabilitation","volume":"21","author":"Basagni","year":"2021","journal-title":"BMC Neurol"},{"key":"2026052912230140500_ref22","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.1136\/jnnp-2018-319668","article-title":"When neglect is neglected: NIHSS observational measure lacks sensitivity in identifying post-stroke unilateral neglect","volume":"90","author":"Moore","year":"2019","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2026052912230140500_ref23","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.annemergmed.2010.06.564","article-title":"Zero on the NIHSS does not equal the absence of stroke","volume":"57","author":"Martin-Schild","year":"2011","journal-title":"Ann Emerg Med"},{"key":"2026052912230140500_ref24","doi-asserted-by":"publisher","first-page":"e020562","DOI":"10.1136\/bmjopen-2017-020562","article-title":"Visual impairment screening assessment (VISA) tool: pilot validation","volume":"8","author":"Rowe","year":"2018","journal-title":"BMJ Open"},{"key":"2026052912230140500_ref25","doi-asserted-by":"publisher","first-page":"e033639","DOI":"10.1136\/bmjopen-2019-033639","article-title":"Vision screening assessment (VISA) tool: diagnostic accuracy validation of a novel screening tool in detecting visual impairment among stroke survivors","volume":"10","author":"Rowe","year":"2020","journal-title":"BMJ Open"},{"key":"2026052912230140500_ref26","doi-asserted-by":"publisher","first-page":"20151028","DOI":"10.1136\/bmj.h5527","article-title":"STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies","volume":"351","author":"Bossuyt","year":"2015","journal-title":"BMJ"},{"key":"2026052912230140500_ref27","volume-title":"Vision Impairment Screening Assessment (VISA)","author":"University of Liverpool VRU"},{"key":"2026052912230140500_ref28","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1080\/09638288.2020.1768302","article-title":"Developing a stroke-vision care pathway: a consensus study","volume":"44","author":"Rowe","year":"2022","journal-title":"Disabil Rehabil"},{"key":"2026052912230140500_ref29","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1310\/3JRY-B168-5N49-XQWA","article-title":"Visual deficits following stroke: maximizing participation in rehabilitation","volume":"13","author":"Wolter","year":"2006","journal-title":"Top Stroke Rehabil"},{"key":"2026052912230140500_ref30","doi-asserted-by":"publisher","DOI":"10.9734\/OR\/2016\/23272","volume":"5","author":"","journal-title":"Ophthalmol Res"},{"key":"2026052912230140500_ref31","author":""},{"key":"2026052912230140500_ref32","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s44250-024-00123-4","article-title":"Validation of the interdisciplinary Norwegian vision assessment tool KROSS in stroke patients admitted to hospital or rehabilitation services","volume":"3","author":"Falkenberg","year":"2024","journal-title":"Discover Health Systems"},{"key":"2026052912230140500_ref33","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1093\/ageing\/afn230","article-title":"Visual impairment following stroke: do stroke patients require vision assessment?","volume":"38","author":"Rowe","year":"2009","journal-title":"Age Ageing"},{"key":"2026052912230140500_ref34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.9734\/OR\/2016\/21767","article-title":"Post-stroke visual impairment: a systematic literature review of types and recovery of visual conditions","volume":"5","author":"Hepworth","year":"2015","journal-title":"Ophthalmol Res"},{"key":"2026052912230140500_ref35","doi-asserted-by":"publisher","first-page":"3139","DOI":"10.1080\/09638288.2020.1859631","article-title":"Impact of visual impairment following stroke (IVIS study): a prospective clinical profile of central and peripheral visual deficits, eye movement abnormalities and visual perceptual deficits","volume":"44","author":"Rowe","year":"2022","journal-title":"Disabil Rehabil"},{"key":"2026052912230140500_ref36","doi-asserted-by":"publisher","first-page":"20230504","DOI":"10.1016\/j.clineuro.2023.107749","article-title":"Visual symptoms in acute stroke - a systematic review of observational studies","volume":"229","author":"Helboe","year":"2023","journal-title":"Clin Neurol Neurosurg"}],"container-title":["European Stroke Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/11\/5\/aakag053\/68432641\/aakag053.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/11\/5\/aakag053\/68432641\/aakag053.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T16:23:08Z","timestamp":1780071788000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/esj\/article\/doi\/10.1093\/esj\/aakag053\/8698122"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":36,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5,6]]}},"URL":"https:\/\/doi.org\/10.1093\/esj\/aakag053","relation":{},"ISSN":["2396-9873","2396-9881"],"issn-type":[{"value":"2396-9873","type":"print"},{"value":"2396-9881","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,5]]},"article-number":"aakag053"}}