
Vision problems are common among stroke patients, with about one-third to two-thirds of survivors experiencing some form of visual impairment. The impact of a stroke on vision depends on the area of the brain affected, with most strokes impacting one side of the brain. This can lead to unilateral vision loss, where patients experience missing areas in their field of vision, typically on the side opposite the affected area of the brain. This is known as homonymous hemianopia and can affect daily activities such as reading, mobility, and driving. In addition to visual field loss, stroke patients may also experience eye movement disorders, visual processing difficulties, and other sight problems such as light sensitivity and dry eyes. While complete recovery from vision loss is rare, rehabilitation and treatment options, including visual scanning training and optical aids, can help improve function and independence.
Characteristics | Values |
---|---|
Vision loss | About one-third of stroke survivors experience vision loss. |
Vision recovery | Most people who have vision loss after a stroke do not fully recover their vision. Some recovery is possible, usually in the first few months after a stroke. |
Vision loss types | Homonymous hemianopia, Quadrantanopia, Eye movement control |
Vision loss causes | Stroke, Transient ischemic attack (TIA), Multiple sclerosis |
Vision loss treatment | Training, equipment, home modifications, prism lenses, eye drops, taping eyelids shut, sunglasses |
Vision loss support | Ophthalmologists, orthoptists, doctors, occupational therapists |
Visual field loss | About 30% of stroke survivors have visual field loss. |
Visual spatial inattention | Can result in not paying attention to the side of your body affected by the stroke. |
Double vision | Can be treated with an eye patch. |
Oculomotor dysfunction | Occurs when eyes can't track or move smoothly between objects. |
Visual midline shift | Can be addressed with balance activities and special prism glasses. |
What You'll Learn
- About one-third of stroke survivors experience vision loss
- Temporary vision loss can be a sign of an impending stroke
- Vision loss after a stroke may not be fully recoverable
- Visual field loss is a well-recognised complication of stroke
- Visual neglect is a common behavioural syndrome in patients following a stroke
About one-third of stroke survivors experience vision loss
One-third of stroke survivors experience vision loss
Vision loss after a stroke is a common occurrence, with about one-third of stroke survivors experiencing some form of vision impairment. While some may regain their vision over time, others may have to deal with long-term changes or undergo vision therapy and other treatments to improve their condition.
Types of Vision Loss
The type of vision loss experienced by stroke survivors depends on which area of the brain is affected by the stroke. The most common types of vision loss include:
- Homonymous hemianopia: Vision loss in either the right or left half of the visual field in each eye.
- Homonymous quadrantanopia: Vision loss in either the upper or lower quarter of the visual field.
- Scotoma: A blind spot in one or both eyes.
Other Vision Issues
In addition to the types of vision loss mentioned above, stroke survivors may also experience other vision issues, such as:
- Spatial inattention or neglect: This occurs when the brain doesn't process visual information on the side affected by the stroke.
- Eye movement disorders: Damage to the nerves or muscles around the eyes can lead to impaired eye function, including nystagmus, strabismus, diplopia, and oculomotor dysfunction.
- Dry eyes and light sensitivity: Issues with blinking or closing the eyes can cause dry eyes, resulting in irritation, burning, or blurry vision. Sensitivity to bright light or disorientation in low light may also occur.
Diagnosis and Treatment
It is important for stroke survivors to have their vision checked, even if they don't notice any symptoms. Eye doctors, brain doctors, and brain-eye doctor specialists can diagnose vision problems and develop treatment plans, which may include rehabilitation therapies aimed at helping survivors compensate for losses and regain function. Examples of therapies include scanning techniques, the use of prism lenses or glasses, and relaxation and breathing techniques.
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Temporary vision loss can be a sign of an impending stroke
Vision loss can be a temporary symptom of an impending stroke, or it can be a lasting symptom of a stroke that has already occurred. Most strokes affect one side of the brain, and nerves from each eye travel together in the brain, so both eyes are usually affected. If the right occipital lobe is injured, the left field of vision in each eye may be affected, and vice versa. It is rare for both sides of the brain to be affected, but when it does happen, it can result in blindness.
The type of vision problem a person experiences depends on the location of the stroke. If the stroke affects the occipital lobe, which is responsible for processing visual inputs, or the brainstem, which handles visual balance, interpreting objects, and eye movements, vision problems are likely to occur.
Vision problems after a stroke may be temporary or permanent, and can include:
- Loss of vision in part of the field of vision, known as hemianopia
- Blind spots or scotoma
- Loss of the upper or lower area of the field of vision
- Loss of peripheral vision
- Nystagmus, or constant movement of the eyes
- Blurred vision or double vision
- Light sensitivity
- Dry eyes
It is important to note that stroke-related vision changes typically appear abruptly, according to Dr. Amanda Macone, a neurologist and headache medicine specialist. She states that "visual symptoms during a stroke happen all of a sudden...and often those symptoms include a complete loss of vision. It's like a black curtain suddenly sweeping across your visual field."
If you or someone you know is experiencing temporary vision loss, it is crucial to seek immediate medical attention, as it could be a sign of an impending stroke.
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Vision loss after a stroke may not be fully recoverable
Vision loss is a common occurrence after a stroke, with around 65% of stroke survivors reporting changes to their vision or vision loss. However, most people who experience vision loss after a stroke do not fully recover their vision. While some recovery is possible, particularly in the first few months after a stroke, many will be left with permanent visual impairments.
Vision loss after a stroke can take several forms, depending on the area of the brain that has been affected. Strokes can impact the brain in different ways, and the type of vision problem experienced will depend on the location of the stroke. Strokes can affect the occipital lobe, which is responsible for processing visual inputs, or the brainstem, which handles visual balance, interpreting objects, and eye movements.
One of the most common types of vision loss after a stroke is homonymous hemianopia, which is the loss of one half of the visual field in each eye. This can cause words and sentences to disappear when reading, and people may appear to have only half a face. Another type of vision loss is quadrantanopia, which is the loss of either the upper or lower quarter of the visual field.
Eye movement control can also be affected by a stroke. If the nerves that control eye movement are damaged, it may cause eye turning (strabismus) or double vision (diplopia). Other issues include nystagmus, which is constant, unsteady movement of the eyes, and problems with the nerves of the eyelid, which can cause dry eyes.
Visual neglect and agnosia are other potential consequences of a stroke. Visual neglect occurs when a person is not aware of, and does not respond to, things on their stroke-affected side. Agnosia is a rare neurological disorder that causes people to be unable to recognise familiar faces and objects due to damage to parts of the brain that perceive and interpret vision.
While full recovery of vision may not be possible for most people after a stroke, some treatments and therapies can help manage the condition. Ophthalmologists, orthoptists, doctors, and occupational therapists can advise on the best management options, which may include prism lenses, eye patches, eye drops, and taping eyelids shut at night. Training and home modifications can also help individuals live more independently and safely.
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Visual field loss is a well-recognised complication of stroke
Most strokes affect one side of the brain, and nerves from each eye travel together in the brain, so both eyes are affected. If the right side of the brain is damaged, the left side vision in each eye may be affected. It is rare for both sides of the brain to be affected by a stroke, but when it does happen, it can result in blindness.
The visual field is the entire area one can see when the eyes are fixed in one position. Homonymous hemianopia is the loss of one half of the visual field in each eye. One might feel they are unable to see out of one eye, but in fact, both eyes are affected. When reading, words and sentences disappear when in the missing visual field. People may appear to have only half a face.
Other types of vision loss include quadrantanopia, which is the loss of either the upper or lower quarter of the visual field, and scotoma, a small patch of vision loss, often near the centre of vision.
Visual field loss can improve, and some people make a complete recovery. However, many will have permanent visual field loss, but there are techniques to help make the most of the remaining vision. An eye specialist can assess eye problems and advise on the best course of action.
Visual scanning training encourages looking to the left and right sides in a more efficient way. Other options include using line guides when reading, having good lighting, and using edge markers on books and newspapers. These therapies aim to improve visual function by training eye movements to be more efficient.
Another way to widen the field of view is by wearing glasses with a plastic prism in one or both lenses. The prism creates an image of part of the side of the visual field loss and reflects it over to the good side. However, some vision on the good side is sacrificed, and some people find it gives them double vision and headaches.
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Visual neglect is a common behavioural syndrome in patients following a stroke
Visual neglect is often a result of damage to the right cerebral hemisphere, leading to neglect of the left-hand side of space. This is because the right hemisphere is specialised for spatial perception and memory, while the left is specialised for language. However, it is important to note that visual neglect can also occur following left hemisphere damage, resulting in neglect of the right side of space.
The underlying cause of visual neglect is believed to be a disruption in the internalised representation of the outer world, rather than a disorder of sensory inputs. Dysfunction of the cortical domains and white-matter tracts, as well as inter-hemispheric imbalance, have been implicated in the various manifestations of visual neglect.
Visual neglect can manifest in a variety of ways. Patients may ignore contralesional sights, sounds, smells, or tactile stimuli. They may also exhibit motor and pre-motor deficits, struggling to move contralesional limbs despite having the neuromuscular ability to do so. Visual neglect can also affect memory and recall, with patients only drawing or describing half of an object when asked to recall it from memory.
The impact of visual neglect can be significant. It has been found to have a more negative effect on functional ability than age, sex, power, side of stroke, balance, proprioception, cognition, and premorbid ADL status. Its presence within the first 10 days of a stroke is a strong predictor of poor functional recovery after one year.
Assessment of visual neglect typically involves a combination of pen-and-paper tests, behavioural assessment tools, clinical observation, and history-taking. Treatment options include prism adaptation, visual scanning therapy, and virtual reality-based techniques. However, there is currently no consensus on the optimal assessment and treatment approach.
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Frequently asked questions
Unilateral vision refers to the loss of vision in one eye.
Yes, stroke patients can experience unilateral vision. However, it is more common for stroke patients to experience visual field loss, where they have missing areas of vision in both eyes. This is called homonymous visual field loss and affects the same side of the visual field in both eyes.
Symptoms of unilateral vision in stroke patients can include bumping into things or not being aware of things happening on one side. Other symptoms may include difficulty reading, shopping, and watching videos.
Treatment for unilateral vision in stroke patients may include visual scanning training, optical aids such as glasses with a plastic prism, and eye movement exercises. In some cases, a patch may be placed over one eye to improve double vision.