Network


Latest external collaboration on country level. Dive into details by clicking on the dots.

Hotspot


Dive into the research topics where Claire Howard is active.

Publication


Featured researches published by Claire Howard.


Age and Ageing | 2008

Visual impairment following stroke: do stroke patients require vision assessment?

Fiona Rowe; Darren Brand; Carole Jackson; Alison Price; Linda Walker; Shirley Harrison; Carla Eccleston; Claire Scott; Nicola Akerman; Caroline Dodridge; Claire Howard; Tracey Shipman; Una Sperring; Sonia MacDiarmid; Cicely Freeman

BACKGROUND the types of visual impairment followings stroke are wide ranging and encompass low vision, eye movement and visual field abnormalities, and visual perceptual difficulties. OBJECTIVE the purpose of this paper is to present a 1-year data set and identify the types of visual impairment occurring following stroke and their prevalence. METHODS a multi-centre prospective observation study was undertaken in 14 acute trust hospitals. Stroke survivors with a suspected visual difficulty were recruited. Standardised screening/referral and investigation forms were employed to document data on visual impairment specifically assessment of visual acuity, ocular pathology, eye alignment and movement, visual perception (including inattention) and visual field defects. RESULTS three hundred and twenty-three patients were recruited with a mean age of 69 years [standard deviation (SD) 15]. Sixty-eight per cent had eye alignment/movement impairment, 49% had visual field impairment, 26.5% had low vision and 20.5% had perceptual difficulties. CONCLUSIONS of patients referred with a suspected visual difficulty, only 8% had normal vision status confirmed on examination. Ninety-two per cent had visual impairment of some form confirmed which is considerably higher than previous publications and probably relates to the prospective, standardised investigation offered by specialist orthoptists. However, under-ascertainment of visual problems cannot be ruled out.


BioMed Research International | 2013

A Prospective Profile of Visual Field Loss following Stroke: Prevalence, Type, Rehabilitation, and Outcome

Fiona Rowe; David W. Wright; Darren Brand; Carole Jackson; Shirley Harrison; Tallat Maan; Claire Scott; Linda Vogwell; Sarah Peel; Nicola Akerman; Caroline Dodridge; Claire Howard; Tracey Shipman; Una Sperring; Sonia MacDiarmid; Cicely Freeman

Aims. To profile site of stroke/cerebrovascular accident, type and extent of field loss, treatment options, and outcome. Methods. Prospective multicentre cohort trial. Standardised referral and investigation protocol of visual parameters. Results. 915 patients were recruited with a mean age of 69 years (SD 14). 479 patients (52%) had visual field loss. 51 patients (10%) had no visual symptoms. Almost half of symptomatic patients (n = 226) complained only of visual field loss: almost half (n = 226) also had reading difficulty, blurred vision, diplopia, and perceptual difficulties. 31% (n = 151) had visual field loss as their only visual impairment: 69% (n = 328) had low vision, eye movement deficits, or visual perceptual difficulties. Occipital and parietal lobe strokes most commonly caused visual field loss. Treatment options included visual search training, visual awareness, typoscopes, substitutive prisms, low vision aids, refraction, and occlusive patches. At followup 15 patients (7.5%) had full recovery, 78 (39%) had improvement, and 104 (52%) had no recovery. Two patients (1%) had further decline of visual field. Patients with visual field loss had lower quality of life scores than stroke patients without visual impairment. Conclusions. Stroke survivors with visual field loss require assessment to accurately define type and extent of loss, diagnose coexistent visual impairments, and offer targeted treatment.


International Journal of Stroke | 2011

Reading difficulty after stroke: ocular and non ocular causes.

Fiona Rowe; David W. Wright; Darren Brand; Carole Jackson; Alison Price; Linda Walker; Shirley Harrison; Carla Eccleston; Tallat Maan; Claire Scott; Linda Vogwell; Sarah Peel; Leonie Robson; Nicola Akerman; Caroline Dodridge; Claire Howard; Tracey Shipman; Una Sperring; Sue Yarde; Sonia MacDiarmid; Cicely Freeman

Background Ocular causes of reading impairment following stroke include visual field loss, eye movement impairment and poor central vision. Non ocular causes may include cognitive errors or language impairment. Aim The purpose of this study was to identify all patients referred with suspected visual impairment who had reported reading difficulty to establish the prevalence of ocular and non ocular causes. Methods Prospective, multicentre, observation study with standardised referral and assessment forms across 21 sites. Visual assessment included visual acuity measurement, visual field assessment, ocular alignment, and movement and visual inattention assessment. Multicentre ethical approval and informed patient consent were obtained. Results A total of 915 patients were recruited, with a mean age of 69·18 years (standard deviation 14·19). Reading difficulties were reported by 177 patients (19·3%), with reading difficulty as the only symptom in 39 patients. Fifteen patients had normal visual assessment but with a diagnosis of expressive or receptive aphasia. Eight patients had alexia. One hundred and nine patients had visual field loss, 85 with eye movement abnormality, 27 with low vision and 39 patients with visual perceptual impairment. Eighty-seven patients had multiple ocular diagnoses with combined visual field, eye movement, low vision or inattention problems. All patients with visual impairment were given targeted treatment and/or advice including prisms, occlusion, refraction, low vision aids and scanning exercises. Conclusions Patients complaining of reading difficulty were mostly found to have visual impairment relating to low vision, eye movement or visual field loss. A small number were found to have non ocular causes of reading difficulty. Treatment or advice was possible for all patients with visual impairment.


Archive | 2015

Post-stroke visual impairment: a systematic literature review of types and recovery of visual conditions

Lauren R. Hepworth; Fiona Rowe; Marion Walker; Janet Rockliffe; Carmel Noonan; Claire Howard; Jim Currie

Aim: The aim of this literature review was to determine the reported incidence and prevalence of visual impairment due to stroke for all visual conditions including central vision loss, visual field loss, eye movement problems and visual perception problems. A further aim was to document the reported rate and extent of recovery of visual conditions post stroke. Methods: A systematic review of the literature was conducted including all languages and translations obtained. The review covered adult participants (aged 18 years or over) diagnosed with a visual impairment as a direct cause of a stroke. Studies which included mixed populations were included if over 50% of the participants had a diagnosis of stroke. We searched scholarly online resources and hand searched journals and registers of published, unpublished and ongoing trials. Search terms included a variety of MESH terms and alternatives in relation to stroke and visual conditions. The quality of the evidence was assessed using key reporting guidelines, e.g. STROBE, CONSORT. Results: Sixty-one studies (n=25,672) were included in the review. Overall prevalence of visual impairment early after stroke was estimated at 65%, ranging from 19% to 92%. Visual field loss reports ranged from 5.5% to 57%, ocular motility problems from 22% to 54%, visual inattention from 14% to 82% and reduced central vision reported in up to 70%. Recovery of visual field loss varied between 0% and 72%, with ocular motility between 7% and 92% and visual inattention between 29% and 78%. Conclusion: The current literature provides a range of estimates for prevalence of visual impairment after stroke. Visual impairment post stroke is a common problem and has significant relevance to the assessment and care these patients receive. Prospective figures regarding incidence remain unknown.


Optometry and Vision Science | 2006

Is the Cardiff Acuity Test effective in detecting refractive errors in children

Claire Howard; Alison Y. Firth

Purpose. Refractive error is a common cause of reduced visual acuity in young children. This reduced vision should be detected as soon as possible to avoid development of squinting and educational disadvantage. The Bailey-Lovie Chart (BLC) is based on the logarithm of the minimal angle of resolution (logarithm of the minimum angle of resolution [logMAR]) and is widely accepted as the clinical standard for visual acuity testing. However, most young children are unable to perform this test because of its symbolic level. The Cardiff Acuity Test (CAT) overcomes these symbolic demands and is the test of choice for young children in most U.K. orthoptic departments. The purpose of this study is to determine how effective the CAT is in detecting reduced visual acuity caused by refractive error in young children. Methods. Visual acuity of the right eye was tested without spectacles in 68 children (mean age, 74 ± 14.6 months) with known bilateral symmetric refractive error (40 male) using the CAT and the BLC. Subjects were randomized to receive CAT or BLC first in a single assessment using a crossover design. Subjects scoring 0.2 logMAR or better were classified as having passed the test. Results. The CAT correctly identified reduced vision caused by uncorrected refractive error in 25% (17) of the children compared with a detection rate of 97% (66) for the BLC using the specified pass criteria. Further analysis with an adjusted cut point for the CAT (0.0 logMAR), as used to identify abnormal vision in clinical practice, identified a detection rate of 56% (38 of the children). Conclusions. This study casts doubt on the current clinical practice used in orthoptic clinics by suggesting that assessment of visual acuity with the CAT alone will underdiagnose reduced acuity caused by refractive errors.


BMJ Open | 2014

A randomised controlled trial to compare the clinical and cost-effectiveness of prism glasses, visual search training and standard care in patients with hemianopia following stroke: a protocol

Fiona Rowe; P. G. Barton; Emma Bedson; R. Breen; Elizabeth J Conroy; Emma Cwiklinski; Caroline Dodridge; Avril Drummond; Marta García-Fiñana; Claire Howard; Stevie Johnson; Claire Macintosh; Carmel Noonan; Alex Pollock; Janet Rockliffe; Catherine Sackley; Tracey Shipman

Introduction Homonymous hemianopia is a common and disabling visual problem after stroke. Currently, prism glasses and visual scanning training are proposed to improve it. The aim of this trial is to determine the effectiveness of these interventions compared to standard care. Methods and analysis The trial will be a multicentre three arm individually randomised controlled trial with independent assessment at 6 week, 12 week and 26 week post-randomisation. Recruitment will occur in hospital, outpatient and primary care settings in UK hospital trusts. A total of 105 patients with homonymous hemianopia and without ocular motility impairment, visual inattention or pre-existent visual field impairment will be randomised to one of three balanced groups. Randomisation lists will be stratified by site and hemianopia level (partial or complete) and created using simple block randomisation by an independent statistician. Allocations will be disclosed to patients by the treating clinician, maintaining blinding for outcome assessment. The primary outcome will be change in visual field assessment from baseline to 26 weeks. Secondary measures will include the Rivermead Mobility Index, Visual Function Questionnaire 25/10, Nottingham Extended Activities of Daily Living, Euro Qual-5D and Short Form-12 questionnaires. Analysis will be by intention to treat. Ethics and dissemination This study has been developed and supported by the UK Stroke Research Network Clinical Studies Group working with service users. Multicentre ethical approval was obtained through the North West 6 Research ethics committee (Reference 10/H1003/119). The trial is funded by the UK Stroke Association. Trial Registration: Current Controlled Trials ISRCTN05956042. Dissemination will consider usual scholarly options of conference presentation and journal publication in addition to patient and public dissemination with lay summaries and articles. Trial Registration Current Controlled Trials ISRCTN05956042.


International Scholarly Research Notices | 2013

Profile of Gaze Dysfunction following Cerebrovascular Accident

Fiona Rowe; David W. Wright; Darren Brand; Carole Jackson; Shirley Harrison; Tallat Maan; Claire Scott; Linda Vogwell; Sarah Peel; Nicola Akerman; Caroline Dodridge; Claire Howard; Tracey Shipman; Una Sperring; Sonia MacDiarmid; Cicely Freeman

Aim. To evaluate the profile of ocular gaze abnormalities occurring following stroke. Methods. Prospective multicentre cohort trial. Standardised referral and investigation protocol including assessment of visual acuity, ocular alignment and motility, visual field, and visual perception. Results. 915 patients recruited: mean age 69.18 years (SD 14.19). 498 patients (54%) were diagnosed with ocular motility abnormalities. 207 patients had gaze abnormalities including impaired gaze holding (46), complete gaze palsy (23), horizontal gaze palsy (16), vertical gaze palsy (17), Parinauds syndrome (8), INO (20), one and half syndrome (3), saccadic palsy (28), and smooth pursuit palsy (46). These were isolated impairments in 50% of cases and in association with other ocular abnormalities in 50% including impaired convergence, nystagmus, and lid or pupil abnormalities. Areas of brain stroke were frequently the cerebellum, brainstem, and diencephalic areas. Strokes causing gaze dysfunction also involved cortical areas including occipital, parietal, and temporal lobes. Symptoms of diplopia and blurred vision were present in 35%. 37 patients were discharged, 29 referred, and 141 offered review appointments. 107 reviewed patients showed full recovery (4%), partial improvement (66%), and static gaze dysfunction (30%). Conclusions. Gaze dysfunction is common following stroke. Approximately one-third of patients complain of visual symptoms, two thirds show some improvement in ocular motility.


Acta Neurologica Scandinavica | 2017

A pilot randomized controlled trial comparing effectiveness of prism glasses, visual search training and standard care in hemianopia

Fiona Rowe; Elizabeth J Conroy; Emma Bedson; Emma Cwiklinski; Avril Drummond; Marta García-Fiñana; Claire Howard; Alex Pollock; Tracey Shipman; Caroline Dodridge; Claire Macintosh; Stevie Johnson; Carmel Noonan; Graham Barton; Catherine Sackley

Pilot trial to compare prism therapy and visual search training, for homonymous hemianopia, to standard care (information only).


Disability and Rehabilitation | 2016

Delivery of high quality stroke and vision care: experiences of UK services

Fiona Rowe; Marion Walker; Janet Rockliffe; Alex Pollock; Carmel Noonan; Claire Howard; Jim Currie

Abstract Purpose: We sought to identify exemplars of high quality care provision from established stroke vision services. Methods: We identified areas of high quality services across the UK, judged as having integrated stroke/vision care provision for stroke survivors. Healthcare professionals were selected to participate in 1:1 interviews or focus groups. A strengths–weaknesses–opportunities–threats (SWOT) framework was used to lead the discussion in a semi-structured format. Thematic analysis was undertaken. Results: Interviewees (n = 24) from 14 NHS Trusts included eye clinic managers, nurses, orthoptists, occupational therapists and physiotherapists. Identified strengths of their services included established communication, training provision for stroke team staff, “open access” for referrals, use of standardised screening/referral forms, provision of lay summaries and information sheets, patients assessed on the stroke unit with continued follow-up and initial visual assessments made within 1 week of stroke onset. Weaknesses included lack of funding, insufficient orthoptic cover, and time consuming retraining of stroke staff because of staff rotation and changes. Opportunities included increasing the number (or length) of orthoptic sessions and training of stroke staff. Perceived threats related to funding and increased appointment waiting times. Conclusions: Practical elements for improved stroke and vision care provision are highlighted which can be implemented with relatively little financial inputs. Implications for Rehabilitation Integrated vision services within stroke units can improve the detection of visual problems in stroke survivors leading to earlier visual rehabilitation. Orthoptists within core stroke teams are beneficial to the delivery of a high quality service. This study illustrates clear practical elements to support the provision of high quality integrated stroke and vision services. Relatively little financial inputs are required to fund such services but with larger potential to improve patient care.


Neuro-Ophthalmology | 2015

Detection of Visual Field Loss in Pituitary Disease: Peripheral Kinetic Versus Central Static

Fiona Rowe; Christopher P. Cheyne; Marta García-Fiñana; Carmel Noonan; Claire Howard; Jayne Smith; Joanne Adeoye

Abstract Visual field assessment is an important clinical evaluation for eye disease and neurological injury. We evaluated Octopus semi-automated kinetic peripheral perimetry (SKP) and Humphrey static automated central perimetry for detection of neurological visual field loss in patients with pituitary disease. We carried out a prospective cross-sectional diagnostic accuracy study comparing Humphrey central 30-2 SITA threshold programme with a screening protocol for SKP on Octopus perimetry. Humphrey 24-2 data were extracted from 30-2 results. Results were independently graded for presence/absence of field defect plus severity of defect. Fifty patients (100 eyes) were recruited (25 males and 25 females), with mean age of 52.4 years (SD = 15.7). Order of perimeter assessment (Humphrey/Octopus first) and order of eye tested (right/left first) were randomised. The 30-2 programme detected visual field loss in 85%, the 24-2 programme in 80%, and the Octopus combined kinetic/static strategy in 100% of eyes. Peripheral visual field loss was missed by central threshold assessment. Qualitative comparison of type of visual field defect demonstrated a match between Humphrey and Octopus results in 58%, with a match for severity of defect in 50%. Tests duration was 9.34 minutes (SD = 2.02) for Humphrey 30-2 versus 10.79 minutes (SD = 4.06) for Octopus perimetry. Octopus semi-automated kinetic perimetry was found to be superior to central static testing for detection of pituitary disease-related visual field loss. Where reliant on Humphrey central static perimetry, the 30-2 programme is recommended over the 24-2 programme. Where kinetic perimetry is available, this is preferable to central static programmes for increased detection of peripheral visual field loss.

Collaboration


Dive into the Claire Howard's collaboration.

Top Co-Authors

Avatar

Fiona Rowe

University of Liverpool

View shared research outputs
Top Co-Authors

Avatar

Carmel Noonan

Aintree University Hospitals NHS Foundation Trust

View shared research outputs
Top Co-Authors

Avatar
Top Co-Authors

Avatar

Tracey Shipman

Royal Hallamshire Hospital

View shared research outputs
Top Co-Authors

Avatar

Alex Pollock

Glasgow Caledonian University

View shared research outputs
Top Co-Authors

Avatar
Top Co-Authors

Avatar

Avril Drummond

University of Nottingham

View shared research outputs
Top Co-Authors

Avatar
Top Co-Authors

Avatar

Cicely Freeman

Worcestershire Acute Hospitals NHS Trust

View shared research outputs
Top Co-Authors

Avatar
Researchain Logo
Decentralizing Knowledge