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You are in: Home > Stroke Information > How Stroke Affects You > Visual Problems

Visual Problems

• How your vision can be affected by a stroke
• Help and support
• Reduced vision
• Visual field loss
• Eye movement disorders
• Double vision
• Useful websites

How your vision can be affected by a stroke

• Visual problems following a stroke are common. In fact it is often some type of sight defect that gives you the first inkling that you have suffered a stroke.

The area and extent of your stroke determine the types of visual problems you may experience.

It is the visual pathway, that carries information from the eye to the back of the brain, that is most commonly damaged by a 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.

The most common symptoms are:

• Loss of part of the visual field
• Blurred or double vision
• Difficulty reading

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Help and support

• Living with visual problems can be very frustrating and can affect your confidence and rehabilitation following your stroke. You may feel a sense of isolation which can add to any feelings of anxiety and depression you may have.

It is important to get help to identify what visual problems you have and find coping strategies to help improve your quality of life. Speak to your GP or optician (optometrist), initially, if you are concerned. 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.

An ophthalmologist (eye specialist) can examine you and assess whether you are able to register your sight impairment. If your ophthalmologist feels that you do qualify, he / she will complete a certificate of vision impairment and send it to your local social services department. You will then be contacted to find out what help and advice you need. This can include help around your home as well as developing skills to help regain some independence / control.

There may also be local visual impairment services available for you to be referred on to. Though distressing in many instances, aids or techniques are available to help you cope more effectively.

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Reduced vision

• It is common to experience a reduction in your vision as you 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 a direct result of high blood pressure or diabetes rather than your stroke.

However, the combination of your stroke and any pre existing reduced vision can be extremely debilitating. Examination is required by a specialist so that the cause of your reduced vision can be established and the correct treatment prescribed for you.

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Visual field loss

About 20–50% of people with a stroke have some visual field loss (known as 'hemianopia'). This is the most common problem associated with vision.

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

This type of visual loss is directly related to the site of the stroke in your brain. Both of your eyes will be affected, but the effect may be different in each eye.

Damage to the visual pathway, not the eye itself, results in loss of sight on one side in both eyes. So, if you have left visual field loss then you will lose some, or all, of your vision on your left side. Conversely if you have right visual field loss then you will lose some, or all, of your vision on the right side.

However, you may not be aware of this loss of vision. You may need specialised measurement of your visual field to reveal the problem.

• Awareness: it is important for you and your carer(s) to be aware of the problem as there are obvious dangers. For example, if you are crossing the road you may not be aware of cars coming from one side.
• Treatment / training : loss of visual field has to be specially measured. Some orthoptists and agencies that assist people with visual disabilities offer training on how to compensate for visual field loss. For example, you are taught to get into the habit of turning your head and eyes, and therefore minimise the effect on day–to–day activities. However, not everyone will show an improvement with this kind of training.
• Help with reading: if visual field loss makes reading difficult, there are strategies to help. For example:
  • 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.

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Eye movement disorders

A stroke may cause a wide variety of eye movement disorders:

• Disturbance of rapid eye movements (known as '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 (known as 'smooth pursuit') results in an inability to follow slow moving objects accurately. Compensatory fast jerky movements may replace slow eye movements. This may make it difficult to keep your visual attention on one object of interest. Sometimes the damage will repair itself.

Recognising these problems is important. To understand your difficulties your carer(s) also need to understand what is going on.

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Double vision

People who have never had double vision (known as 'diplopia') do not realise how horrible it is. It can make you feel dizzy, sick and it can make you lose your balance.

• Double vision is common when a stroke affects the back of your brain.

Double vision has dangers, for example when 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 of your eyes. This can cause loss of 3D perception, making tasks more difficult.
• More sophisticated 'frosted' patches can be stuck onto one lens of your glasses to allow peripheral vision only.
• A prism can also be laid onto your glasses' lens. This has the effect of moving the images seen by your eye so that they join up, restoring 3D perception. They don't work in every case, but when they do, they are very successful.

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Useful websites

RNIB Scotland

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