Vision

Vision Changes

You may experience a variety of changes in your vision after your stroke. These visual changes can affect your ability to perform your own self care, move around your home, read, write, or drive. 

Visual tests completed by eye specialists can determine which type of vision problem you may be experiencing and recommend treatment. Learn more about eye specialists and locate a specialist near you on the Neuro-Optometric Rehabilitation Association website or the North American Neuro-Opthalmology Society.

Occupational therapists who specialize in neurological vision rehabilitation work with you on reducing the vision problems and teaching you strategies to compensate. 

Explore the sections below to learn more about different vision changes after stroke and treatment. Don't forget to check out vision exercises and adaptations on the StrokeOT.com Vision Exercise page


Visual Field Loss

A visual field loss is full or partial loss of vision in one or more parts of your visual field due to your brain's inability to process the information (images) coming into that area. Sometimes, people have visual hallucinations where they see images that are really not there.  

Treatment: 

Recent research has shown that the following treatments for visual field loss are most effective:

  • Computer and paper‐based search and scanning training programs teach you to compensate for the visual field loss. For more information about a free visual scanning program, please visit: www.eyesearch.ucl.ac.uk 
  • Lighted magnifiers, rulers, and line guides used when reading and writing also help teach you to compensate for the visual field loss.
  • Peli prisms are issued by an eye specialist and can help to widen your field of view.
  • Visual restoration therapy (VRT) is a computer-based treatment which claims to reduce visual field defects and regain visual functions through repetitive light stimulation. Not enough research exists to show which VRT is effective.

Below is an image of Paris from the eyes of a person with left visual field loss:


Eye Alignment/Movement Problems

    A stroke can cause damage to the nerves that control your eye movements which may lead to:

  • Impaired pursuits: Your eyes have difficulty following a moving object. Example: Unable to focus on a moving car. 
  • Impaired saccades: Your eyes have difficulty shifting from one object to another. Example: Difficulty reading. 
  • Diplopia (double vision): Your eyes are not working together as a pair.
  • Nystagmus: Weakness in the muscles that adjust your eye movements. Your eyes tend to move in rapid, uncontrollable movements.
  • Impaired depth perception: You may have difficulty perceiving the distance between two objects. Example: Difficulty pouring your coffee or difficulty walking down the stairs. 

Treatment:

Recent research has shown that the following treatments may be effective for eye movement problems:

  • Botox treatment and/or surgery on the eye muscles to reduce double vision
  • Visual scanning exercises
  • Rulers, line guides, natural daylight lamps, and other adaptive vision aids that occupational therapists use in treatment. 
  • Reduce your visual overload by keeping all the items needed to complete a task together in one place. Designate one storage place for a frequently used item, like your car keys.    


Light Sensitivity and Dry Eye

Florescent lights, bright sunlight, and vehicle headlights can result in eye pain and headache. Paralysis of the face and eye muscles can cause difficulty in blinking your eye and closing it fully. This produces dry eye.

Treatment:

  • Wear yellow UV shields at night to prevent glare from vehicle headlights
  • Wear plum or topaz UV shields during the daytime to reduce glare from florescent lights and bright sunlight
  • Install florescent light covers to reduce glare
  • Lubrication or ointment drops are used to treat dry eye as well as taping your eyelid closed at night. 


Reference: Hanna, KL, Hepworth, LR, Rowe, FJ. The treatment methods for post‐stroke visual impairment: A systematic review. Brain Behav. 2017; 7:e00682. https://doi.org/10.1002/brb3.682  

Page last updated: 1/2021