Improving Eyesight Post-Stroke: Natural Ways To Enhance Vision

Vision loss is a common occurrence after a stroke, with around 60-65% of stroke survivors experiencing changes to their vision or vision loss. While some may regain their vision over time, others may have to deal with long-term changes and may need vision therapy or other treatments. Strokes occur when a part of the brain is starved of oxygen and nutrients, and this can affect the visual pathway, causing issues with eyesight and vision. The good news is that there is hope for regaining sight after a stroke, and this can be achieved through various treatments and therapies.

Eye exercises

Directional Tracking

Take a pencil and hold it about 18 inches from the face at eye level. With the eyes focused on the pencil, slowly move it from left to right as far as it can be seen without moving the head. Return to the centre, then move the pencil up and down within the field of vision, again keeping the head still. Repeat this 5 times in both directions.

Clock Rotations

Fix the gaze straight ahead, then picture a clock in front of the face and look directly at 12 o'clock, feeling a gentle stretch in the eye muscles. Hold for 3-5 seconds, then return to a relaxed forward gaze. Repeat this process for each number on the clock.

Near/Far Focusing

Hold a finger out at arm's length, then breathe in while looking at the fingertip and breathe out while gazing into the distance past the finger. Switch between focusing on the finger and the distance 10 times.

Visual Tracing

Focus on the finger again, then gently bring it towards the face, continuing to focus on it as it gets closer. Then, move the finger away while continuing to focus on it. Alternate between these movements, like slowly pumping a trombone, 10 times.

Word or Letter Searches

Practising word searches or letter searches can be a great way to improve visual perceptual skills. These require visual tracking skills, visual discrimination and attention.

Hidden Picture Puzzles

Hidden picture puzzles require numerous visual perceptual skills, including visual memory, form constancy, and figure-ground skills. They can also be generalised to larger-scale activities such as scavenger hunts or I-Spy.

Peripheral Vision Stimulation

Ask a family member or caregiver to hold two pencils, one on each side of the survivor's face, just within their peripheral vision. Ask them to move one pencil slightly closer and one slightly further away, then guess which pencil is closest. Repeat this 10 times.

Mazes and Visual Tracing

Practising mazes can help survivors enhance their brain's ability to process different visual spatial relationships. They can also be used to challenge individuals with hemineglect to improve their visual attention on their affected side.

Computer Games

Online vision games can improve both oculomotor and visual perceptual skills. Websites such as Eye Can Learn and Lumosity offer free games that can improve visual-tracking skills.

Scanning Exercises

Keep the head still and move the eyes around the room to the affected side of the vision. Puzzles and word search games can also be used to improve visual perception and visual-tracking skills.

Visual scanning training

There are several activities that can be used to help improve a person's awareness of their neglected side. These include:

• Presenting the patient with a set of printed stimuli (usually letters, numbers, or symbols) and asking them to find and cross out a specific stimulus wherever it appears on the page.
• Putting a bright line or coloured tape down the left side of a page in a book, newspaper or magazine, so that the person first looks for the line to know where it starts and then practices reading from left to right.
• Adding tactile reinforcement, such as a strip of Velcro or sandpaper, at the left margin of a page, which the person can feel to help find the margin on their neglected side.
• Drawing attention to the neglected side while cooking together, for example, by asking the patient to search for safety hazards like a running tap or a knife left out.
• Placing objects in front of the person and asking them to find specific items, including those on their affected side.
• Playing games such as "I Spy" or "Spot the Difference", or completing word searches, to encourage scanning of the full page or environment.
• Taking the person with neglect for a walk or community outing and encouraging them to look at and describe things on their affected side.

Visual training

Eye Exercises:

• Directional tracking: This involves moving a pencil horizontally and vertically across the field of vision while focusing on the eraser without moving the head.
• Clock rotations: Fixing the gaze straight ahead and then looking directly at each number on an imagined clock, holding the gaze for a few seconds at each "number" before returning to the starting position.
• Near/Far Focusing: Alternating between focusing on a finger extended at arm's length and gazing into the distance, or focusing on an object getting closer and further away.

Visual Perceptual Exercises:

• Word or letter searches: Practicing word searches or letter searches can improve visual tracking, discrimination, and attention skills.
• Hidden picture puzzles: These puzzles involve searching for small images within a larger picture, improving visual memory, form constancy, and figure-ground skills.
• Peripheral vision stimulation: This exercise involves a caregiver holding two pencils, one on each side of the survivor's face, and the survivor guessing which pencil is closest as they are moved closer and further away.
• Mazes and visual tracing: Completing mazes or visually tracing lines/outlines can enhance the brain's ability to process visual spatial relationships.

Visual scanning training is another important technique, particularly for those with hemianopia (loss of vision on one side of the visual field). This training involves repeatedly locating targets in both the "seeing" and "blind" sides of the visual field, increasing awareness of the blind side. This can be done through paper-based or computer-based methods.

Eye patches

The rationale behind eye patches is to improve visuospatial attention to the ignored field. The Sprague Effect theory suggests that eye patching inhibits contralesional collicular activity, which may lessen orienting deficits. The Interhemispheric Balance theory suggests that eye patching activates the non-damaged hemisphere, creating a balance between the two hemispheres. Lastly, the Visual Exploration Constraint theory suggests that eye patching may be viewed as an application of Constraint-Induced Therapy (CIT), which aims to reverse the affected limb's "learned non-use" phenomenon.

Several studies have been conducted to test the effectiveness of eye patches. Overall, the results tend to support the usefulness of right hemifield eye patches in clinical practice. However, more research is needed to define the level of evidence and to refine the procedure.

In terms of methodological quality, the studies on eye patches have had some limitations, including small patient sample sizes, lack of power and sample size calculation, lack of follow-up evaluations, inclusion of patients with visual field deficits, use of unchallenging neglect tests, and lack of sample size homogeneity.

In conclusion, eye patches are a promising procedure for treating hemispatial neglect after a stroke, but further research is needed to establish the level of evidence and refine the procedure.

Prism lenses

After a stroke, it is common for individuals to experience visual field loss, specifically hemianopia, where there is a loss of one half of the visual field. This can cause problems with day-to-day living such as locating things, coping with traffic, or becoming disoriented in crowded environments. Prism lenses can help reduce the problems caused by visual field loss and lower the risk of bumping into objects or falling.

Specialized prisms can be used to create a larger field of vision, increasing the patient's ability to read text and move in their environment. Prism lenses can also be used to treat binocular vision dysfunction, which is a common problem that develops after a stroke. Binocular vision dysfunction occurs due to a small eye misalignment that is not detected during a regular eye exam. Prism lenses can help realign the eyes and improve symptoms such as discomfort, dizziness, headaches, eye strain, anxiety, and pain.

The use of prism lenses for stroke patients with visual field loss and binocular vision dysfunction has been supported by research. One study found that prism adaptation training improved functional tasks such as obstacle avoidance while walking in ambulatory subjects. Another study found that prism adaptation training improved both subjective straight-ahead pointing and performance in a line cancellation task. These studies suggest that prism lenses can be an effective tool to improve the visual problems experienced by stroke patients.

Frequently asked questions