Eye Teaming: Post-Stroke Improvement Possibilities

Vision problems are a common occurrence after a stroke, with about 60% of stroke survivors experiencing some form of visual impairment. These issues can range from mild to severe and may include central vision loss, visual field loss, eye movement problems, and visual processing problems. While some people may spontaneously regain their sight after a stroke, most do not, and it was previously believed that vision stabilizes around six months after a stroke with no further opportunity for improvement. However, recent studies and advances in stroke rehabilitation have shown that this is not the case, and there is now hope for regaining sight after a stroke. Specific eye-training exercises can help improve eye functions and rewire the brain to process visual information more effectively. These exercises target oculomotor skills (control over eye muscles) and visual perceptual skills (the brain's ability to understand what the eyes see). While a full recovery is not guaranteed, many survivors find that they can at least partially recover their vision with consistent practice.

Eye-training exercises to rewire the brain

Vision problems are a common outcome of a stroke, with about 60% of survivors experiencing some form of visual impairment. The good news is that, just like motor function, eye injuries can improve following a stroke. With specific eye-training exercises, it is possible to rewire the brain and improve eye functions.

Computer games

Download word search games or other computer games that aid visual perception. For example, Eye Can Learn and Lumosity offer free games that can improve your visual-tracking skills.

Transitioning exercises

Focus on an object close to you, and then shift your gaze to an object farther away. Gradually increase the speed at which you look back and forth between the two objects until you can transition rapidly.

Tracking exercises

For this exercise, you will need a partner. Have them hold a pencil about 18 inches from your eyes. Ask them to move the pencil slowly up and down and side to side, while you track it with your eyes, keeping your head still.

The 20-20-20 rule

This exercise is especially helpful for those who experience digital eye strain from prolonged computer use. Every 20 minutes, take a break from looking at the screen and focus on an object at least 20 feet away for 20 seconds.

Focus change exercise

While sitting, hold one finger a few inches away from one eye. Focus your gaze on the finger, then slowly move your finger away from your face. Shift your focus to an object farther away, and then back to your finger. Repeat this process a few times.

Figure 8 exercise

Focus on an area on the floor about 8 feet away. Move your eyes in the shape of a figure 8 for 30 seconds, then switch directions.

Pencil pushups

Hold a pencil at arm's length, between your eyes. Look at the pencil and try to maintain a single image of it as you slowly move it toward your nose. Continue moving the pencil closer until it is no longer a single image, then position it at the closest point where it is still a single image. This exercise is particularly helpful for convergence insufficiency.

Brock string exercise

For this exercise, you will need a long string, some colored beads, and either a motionless object to secure the string or a partner to hold it. Hold one end of the string just below your nose. Place one bead on the string and look straight at it with both eyes open. If your eyes are functioning correctly, you should see the bead and two strings forming an X. Close one eye; if one of the strings disappears, it means that eye is suppressing. If you see two beads and two strings, your eyes are not converged on the bead.

Barrel cards

Draw three red barrels of increasing sizes on one side of a card and repeat with green barrels on the other side. Hold the card against your nose so that the largest barrel is the farthest away. Stare at the farthest barrel until it becomes one image with both colors, and the other two images double. Maintain your gaze for about 5 seconds, then repeat with the middle and smallest images. This exercise is particularly helpful for exotropia, a type of strabismus.

It is important to start eye exercises as soon as possible after a stroke to maximize the chances of recovering or improving your eyesight. While some people may experience spontaneous recovery, active participation in vision rehabilitation is crucial for optimal results.

Optical therapy to correct double vision

Optical therapy is a recommended treatment for double vision, or diplopia. This condition can be caused by a range of eye conditions, including damage to the eye-brain connection as a result of a stroke. While diplopia can sometimes resolve on its own, it can also be a symptom of a more serious health issue, so it is important to seek medical advice as soon as you notice any changes in your vision.

Optical therapy uses mirrors and prisms to position images in a way that the patient can see them in their line of sight. Prisms can be applied to glasses to blur or block the vision of one eye, minimising double vision.

An alternative to optical therapy is vision therapy, which is a specialised approach to solving certain visual problems. Vision therapy aims to strengthen the connection between the eyes and the brain, as well as how well your eyes work together. An optometrist or trained therapist will assign a series of exercises and programs to help train your brain and eyes to work together properly. These exercises may include:

• Distant focusing exercises: These help the brain learn to focus on objects at different distances and maintain focus while the object moves, with the end goal of stopping your double vision.
• Tracking moving objects: This involves carefully coordinating eye movements to follow a small object, such as a pen or a coin, as it is moved slowly in different directions.
• Changing focus between objects at different distances: This involves focusing on a nearby object for a few seconds, then switching to a distant object, and repeating this process. As you switch between objects, your brain should begin to automatically eliminate double images.

Eye movement therapy to improve eye muscle control

Eye movement therapy can be an effective way to improve eye muscle control and enhance vision after a stroke. Here are some ways in which eye movement therapy can be beneficial:

Improving Eye Muscle Control

Eye movement therapy focuses on training the eye muscles to move within the patient's new visual scope. This helps strengthen the eye muscles and improve eye movement control. Specific exercises, such as transitioning exercises where patients focus on objects at different distances, can enhance eye muscle coordination and control.

Enhancing Vision

Therapies targeting eye movement can help patients retrain their eyes to move within their new visual field, making it easier to read and scan objects. This type of therapy stimulates the brain and encourages neuroplasticity, which can lead to improvements in vision.

Correcting Double Vision

Eye movement therapy can be particularly effective in treating double vision, also known as diplopia, which is a common issue after a stroke. By improving eye alignment and coordination, this therapy can reduce double vision and improve overall visual comfort.

Stimulating Brain Healing

Vision rehabilitation, including eye movement therapy, is crucial for healing the brain after a stroke. It helps improve neuromuscular control and visual processing skills, allowing the brain to interpret visual information more effectively.

Adapting to New Eyesight

Even if complete eyesight recovery is not possible, eye movement therapy can help patients adapt to their new eyesight. By retraining the brain and eye muscles, individuals can make the most of their remaining vision and improve their overall visual functioning.

It is important to consult with a medical professional to determine the most appropriate treatment plan for vision recovery after a stroke. Eye movement therapy can be a valuable component of a comprehensive rehabilitation program aimed at improving eye muscle control and enhancing vision.

Visual restoration therapy to stimulate blind spots

Visual restoration therapy (VRT) is a type of treatment that can help improve eyesight after a stroke. It involves using lights to stimulate the blind spots in a patient's field of vision. This therapy targets the brain's visual processing skills, which can be affected by a stroke, rather than the mechanical functions of the eye, such as eye movement.

VRT works by using blinking or moving lights to activate neurons in the brain that have been damaged by a stroke. This can help to restore the connection between the eyes and the brain, improving the patient's ability to see. In some cases, VRT can even help patients regain partial functional vision.

One example of VRT is optogenetic therapy, which combines a gene therapy vector with light-stimulating goggles. The goggles detect changes in light intensity and project corresponding light pulses onto the retina in real time, activating retinal ganglion cells. This can help patients perceive and locate objects, as well as improve their visual processing skills.

Another form of VRT is optical therapy, which uses mirrors and prisms to position images so that the patient can see them. This type of therapy can also help correct double vision, depth perception, and other visual impairments caused by a stroke.

It is important to note that VRT is not a cure for blindness and it may not work for everyone. The effectiveness of VRT depends on the extent of the damage to the brain and the viability of the photoreceptor cells in the retina. Additionally, VRT does not restore colour vision and it may not improve vision for people with complete retinal degeneration. However, VRT can be a valuable tool to help improve eyesight and quality of life for many people who have experienced a stroke.

Compensatory strategies to adapt to new eyesight

While it is possible to improve eye function after a stroke, it is also important to consider compensatory strategies to adapt to any new limitations on your eyesight. Here are some strategies to help you adapt to your new eyesight:

• Optical therapy: This therapy uses mirrors and prisms to help position images so that they are within your line of sight. Prisms can also help correct issues such as double vision and depth perception problems.
• Eye movement therapy: This type of therapy trains your eyes to move within your new visual scope, making it easier to read and scan objects within your field of vision. It can also help strengthen eye muscles and improve eye movement control.
• Visual restoration therapy (VRT): VRT uses lights to stimulate blind spots in your visual field. The blinking or moving lights can help activate neurons in the brain that were damaged by the stroke.
• Eye surgery: In some cases, surgery may be the best option to treat double vision.
• Eye patches: If other treatments have been unsuccessful, wearing an eye patch temporarily or permanently may help treat double vision and other visual impairments.
• Computer games: Playing computer games, such as word searches, can aid in visual perception and visual-tracking skills.
• Transitioning exercises: Focus on an object close to you, then switch your focus to an object farther away. Gradually increase the speed at which you switch between the two objects.
• Tracking exercises: Have someone hold a pencil about 18 inches from your eyes and move it slowly up and down and side to side while you track it with your eyes. Keep your head still and move only your eyes.
• Limb activation treatment: If you are experiencing visual neglect, move the affected limbs within the neglected environment. For example, if you have left neglect, practice moving your left arm and leg.
• Visual scanning training: For conditions such as hemianopia and quadrantanopia, try drawing a line down the affected side of a book with a highlighter, then practice moving your eyes down a sentence until you reach the highlighter.

Frequently asked questions