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Dealing with Visual Problems Following a Stroke

The visual system involves more than the eyes. You need nerves and muscles to make your eyes work, and your brain to get and make sense of what you see. Visual problems are a common problem following a stroke. Visual problems may result from damage to any part of the visual system.

visionTypical signs and symptoms of visual problems may be:

-Headache
-Squinting
-Head tilt
-Tired eyes
-Not doing things that require vision
-Red eyes
-Dizziness
-Losing place when reading
-Moving items closer or moving self closer to visual item
-Decreased ability to separate head and eye movements

Visual problems can be classified into two main categories, primary visual problems and secondary visual problems.

Primary visual problems result from damage to the eye or the nerves, which control the muscles of the eyes. The following is a description of common primary visual problems:

-Acuity problems can affect the clearness or sharpness of the image.
-Visual field cuts are damage to specific parts of the visual system that can result in a partial loss of vision. The most common loss is called homonymous hemianopsia or hemianopia, which is a loss of 1/2 of the visual field from each eye.

(Click here to see a simulation http://www.lighthouse.org/about-low-vision-blindness/vision-disorders/hemianopia/)

-This visual field loss is typically the same side as the motor weakness. There are other locations of damage in the visual system, which can result in loss of 1/4 of vision or 1/2 vision in only one eye, etc., but these combinations occur less frequently.

Eye movement disorders can result from damage to the nerves that control the eye muscles to open the eyes, move the eyes and focus the eyes. This can result in double vision, difficulty focusing on or following a moving object, and difficulty scanning or moving the eyes from side to side.

Secondary Visual Problems result from damage to the parts of the brain that are responsible for receiving visual information and making sense of what your eyes see. The following is a description of some common secondary visual problems:vision2

Neglect is the inability of the brain to receive or process information from one side of the body. This results in behaviors such as running into doorways, combing one half of your head of hair, or eating only 1/2 of the food on the plate. Neglect typically involves the same side of the body as the weakness that the stroke has caused. Neglect of the left side of the world is most common, which results from a right brain stroke. However, right neglect from a left-brain stroke does also occur. This visual neglect may occur with or without the visual field cut described above.

Agnosia is the difficulty relating the visual information with knowledge or making sense of what you are seeing. There are many different kinds of agnosia, which can result in difficulty relating faces with names, objects with names, letters, numbers or words with their meaning, or directions to a location.

Visual spatial problems can include problems with depth perception or altered awareness of spatial relationships.

General Guidelines

Seek assistance from a vision specialist to evaluate the visual system and to rule out other possible complications such as age related vision changes, medication effects, and so on and so forth.

Explore potential treatment options such as patching an eye, scanning exercises, compensatory strategies, and stimulation. These treatment options have varying proof of usefulness.

Explore potential modifications that can be done to the surrounding environment to improve function such as placing things on the side of the visual field that is most easily seen.


Additional Information:

The following are some web sites to provide you with more information on visual impairments:

Low Vision Specialist Directory

Neuro-Optometric Rehabilitation Association

Lighthouse International


References:

Eye problems and diseases. (2009). Retrieved from http://allaboutvision.com

Geyer, J.D., & Gomez, C.R. (2008). Stroke: A practical approach. Philadelphia, PA: Lippincott.

National Stroke Association. (2011). Types of rehabilitation: Vision therapy. (2011). Retrieved from http://www.stroke.org/site/PageServer?pagename=REHABTT

National Stroke Association. (2009). Vision rehabilitation: Possible vision repair for stroke survivors. Retrieved from http://www.stroke.org

Stein, J. (2009). Stroke recovery and rehabilitation. New York, NY: Demos Medical Publishing.

Developed in 2003 by Karen L. Lance M.S. CCC-SLP at the University of Toledo for Caring~Web©.

Revised 2010, 2012


Last Updated: 6/17/14