Adaptation to post-stroke homonymous hemianopia - a prospective longitudinal cohort study to identify predictive factors of the adaptation process

Purpose To determine any factors that predict how an individual will adapt to post-stroke hemianopic visual field loss, with close monitoring of the adaptation process from an early stage. Materials and methods The Hemianopia Adaptation Study (HAST) is a prospective observational longitudinal cohort clinical study. Adult stroke survivors (n = 144) with new onset homonymous hemianopia were monitored using standardised mobility assessment course (MAC) as the primary outcome measure of adaptation. Results Several baseline variables were found to be good predictors of adaptation. Three variables were associated with adaptation status at 12-weeks post-stroke: inferior % visual field, % total MAC omissions, and MAC completion time (seconds). Baseline measurements of these variables can predict the adaptation at 12 weeks with moderate to high accuracy (area under ROC curve, 0.82, 95% CI 0.74-0.90). A cut-off score of <= 25% target omissions is suggested to predict which individuals are likely to adapt by 12-weeks post-stroke following gold standard care. Conclusions Adaptation to hemianopia is a personal journey with several factors being important for prediction of its presence, including MAC outcomes and extent of inferior visual field loss. A clinical recommendation is made for inclusion of the MAC as part of a functional assessment for hemianopia.