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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Yousif Subhi, University of Southern Denmark
- Second opponent: Professor David Julian Seiffge, University of Bern
- Third member and chair of the evaluation committee: Professor Siri Rostoft, University of Oslo
Chair of Defence
Associate Professor Anette Ramm-Pettersen, University of Oslo
Principal Supervisor
Anne Hege Aamodt, Oslo University Hospital
Summary
Vision is commonly affected by acute cerebrovascular events, placing their assessment and treatment at the interface between neurology and ophthalmology. Visual dysfunction can arise from acute retinal ischaemia, most notably central retinal artery occlusion (CRAO), or from cerebral stroke involving the distributed brain networks supporting vision. Despite advances in acute stroke care, effective treatment for CRAO has been lacking, and post-stroke visual dysfunction is frequently under-recognised.
This thesis investigated two complementary clinical questions: whether systemic thrombolysis improves visual outcome in acute CRAO, and how reliably visual dysfunction can be identified in acute stroke care.
The Tenecteplase in Central Retinal Artery Occlusion Study (TenCRAOS) was an international, multicentre, double-blind, double-dummy randomised controlled trial comparing intravenous tenecteplase with oral aspirin within 4.5 hours of symptom onset. The Oslo Study for Vision Impairment after Stroke (StrokeVIS) was a prospective single-centre diagnostic accuracy study validating the Norwegian translation of the Vision Impairment Screening Assessment (VISA) against comprehensive neuro-ophthalmic examination.
In TenCRAOS, tenecteplase did not improve visual acuity at 30 days compared with aspirin and was associated with more serious adverse events, including one fatal intracranial haemorrhage. The findings do not support routine systemic thrombolysis in acute CRAO.
In StrokeVIS, visual abnormalities were identified in 70% of patients, frequently affecting multiple visual domains. VISA demonstrated high sensitivity (94.5%) and identified substantially more clinically relevant deficits than the visual items of the NIHSS (60.7%), which assess a narrower range of visual functions. VISA thus represents a feasible supplement to standard stroke assessment.
Together, the studies define the limits of acute reperfusion in retinal ischaemia and support structured visual screening as a core component of acute stroke care.
Additional information
Contact the research support staff.