Eye Problems: Chest, Heart & Stroke Scotland

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Eye Problems

For many people reporting a visual problem to their GP gives the first indication that they may have suffered a stroke.

It is the pathway that carries information from the eye to the back of the brain that is damaged by stroke, not the eye itself.

This damage may be temporary or permanent. Unfortunately it is difficult to predict who will recover from their visual problems.

Effects On Vision

There are 3 main ways that vision can be affected determined by the area and extent of the stroke

visual field loss
eye movement disorders
blurred or double vision

Speak to your GP or optician in the first instance. You may need to be referred to an eye specialist

an ophthalmologist specialises in the diagnosis and treatment of eye disease
an orthoptist specialises in the assessment of eye disorders such as muscle balance and visual fields

There may be local visual impairment services available for you to be referred on to. Aids or techniques may help you cope more effectively.

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Visual Field Loss

Visual field loss—hemianopia—is an inability to see either to the right or to the left of the centre of the field of vision.

About ⅓ of people with a stroke have some visual field loss making it the most common problem associated with vision. Unfortunately less than ½ of those severely affected show an improvement.

Awareness

However, the person may or may not be aware of this loss.

It is important for the individuals and carers to be aware of the problem as there are obvious dangers, for example if crossing the road, the individual may not be aware of cars coming from one side.

Treatment

Loss of visual field has to be specially measured.

Some orthoptists and agencies that assist people with visual disabilities offer training to compensate. Getting into the habit of turning head and eyes, minimises the effect on day-to-day activities.

Help With Reading

If visual field loss makes reading difficult, there are strategies to help

place a ruler under each line as you read or ask for a typoscope (a piece of card with a pillar-box slit) that allows you to read only one line of text at a time
draw a line down the vertical margin on left-hand side of the page with a marker pen or hold a coloured ruler vertically on the paper to take your eye to the start of each line. This helps with left visual field problems.

Eye Movement Disorders

A stroke may cause a wide variety of eye movement disorders

disturbance of rapid eye movements (saccades), which normally allow you to look from one object of interest to another. This may lead to difficulties with activities such as reading, sewing, playing cards etc.
disruption of slow eye movements (smooth pursuit) results in an inability to follow slow moving objects accurately. Compensatory fast jerky movements may replace slow eye movements making it difficult to keep visual attention on one object of interest. Lift the head rather than move the eyes to counteract this.
Sometimes the damage will repair itself. Recognising these problems helps to explain difficulties in carrying out certain activities.

Double Vision

Double vision—diplopia—is common when a stroke affects the back of the brain. People don't realise how horrible it can be to see two of everything. It can make you feel dizzy, sick and can make you lose your balance.

Double vision has dangers, for example making a cup of tea, you can miss the teapot with the boiling water as you see two teapots.

Treatment

traditionally, treatment was a patch to one eye but this can cause loss of 3D perception, making tasks more difficult
more sophisticated ‘frosted’ patches can be stuck onto one lens of the individual’s glasses to allow peripheral vision only
a prism can also be laid onto the glasses' lens. This has the effect of moving the images seen by the eye so that they join up, restoring 3D perception. They don’t work in every case, but when they do, they are very successful.

Reduced Vision

We often experience a reduction in vision as we age. A stroke may be associated with a pre-existing health problem such as high blood pressure (hypertension) or diabetes. Some reduction in vision may be directly the result of the high blood pressure or the diabetes rather than the stroke.

After suffering a stroke the combination of the stroke and reduced vision from high blood pressure or diabetes is extremely debilitating. Examination is required by a specialist so that the cause of the reduced vision can be established and the appropriate treatment prescribed.