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Background: Wearable technologies offer potential telestroke applications that are more mobile and potentially less expensive than traditional telemedicine carts. In an earlier, pilot phase of this research program the best performing software and hardware combination for transmission of encrypted video and audio streaming was selected for further testing.Method: We tested Vuzix M100 smart glasses device and Pristine EyeSight HIPAA-compliant video streaming services. The device wearers, emergency physicians, performed the NIHSS, and a remote vascular neurologist or neurology resident viewed the exam. Providers recorded their score and evaluated the functionality of the device with a standardized list of questions.Results: The device was assessed in 52 subjects. The providers wearing the device reported the device useful (Agree or Strongly Agree) in making an assessment in 79% of cases and that they could assess the patient well 90% of the time. However, the wearers also reported both distraction from and interference with patient interaction due to the device in 98% of cases evaluated. The viewers also reported finding the device useful in making an assessment of stroke symptoms in 79% of cases (a different set of 79% than the wearers), but in only 65% of cases did they Agree or Strongly Agree that they could assess the patient well. Viewers reported an inadequate field of view for visual field testing in 63% of cases. The inter-rater agreement between the wearer and viewer on the total NIHSS showed moderate agreement (κ = 0.45). Although the technology was easy to use in 92% of the assessments, technical problems (mainly connectivity lags) were reported by the wearer 46% of the time and by the viewer 31% of the time. The technology was rated inadequate for assessing patients in 1 case by the wearers and 3 cases by the viewers.Conclusion: Wearable smart glass technology is feasible in assessing stroke patients and shows promise as a telestroke solution, however interference with physician-patient interaction, limited field of view for visual field testing and connectivity glitches are perceived limitations.