Why do vision problems occur after stroke?

Vision problems happen because of damage to your brain.

If the part of your brain that controls and receives information from your eyes is affected by your stroke, then this can cause problems with your vision.

If you had vision problems (such as cataracts or glaucoma) before your stroke, this can add to the way your vision is affected. 

What kind of vision problems do people have?

There are four main types of problems that you can have with your vision after a stroke:

  • Visual field loss - your visual field is everything you can see, from straight ahead to everything around it and to the sides.Visual field loss means that you are unable to see a section of your field of vision. Some people find that they lose one side of their visual field, so they can only see the right or left half of what they are looking at. This is called hemianopia. Central vision loss is when the centre of your visual field is affected. It may mean that you can’t see anything at all, or that you can only see things on the edge of where you are looking, not in the centre. 
  • Eye movement problems - sometimes a stroke can affect the way you control your eyes, causing eye movement problems. This may make moving from looking at one thing to another difficult or affect the way you judge distances between objects. It can also mean that your eye is constantly moving so that objects seem to wobble. This is called nystagmus.
  • Visual processing problems - a stroke can also affect the way your brain processes the information it receives from your eyes. This can cause a number of visual processing problems. The most common of these problems is visual neglect. It happens when your brain does not receive information about what you are seeing on one side. So you may not be aware of anything on either your right or left side. This means that you may accidentally ignore people, or you may bump into things because you don’t realise that they are there. 
  • Other sight problems - other sight problems that may occur after stroke include dry eyes or light sensitivity. 

Problems with vision can sometimes be missed, so if you think your vision may have changed after your stroke, talk to your doctor. 

Can vision problems get better?

Like other effects of stroke, vision problems can improve with time, as the brain recovers.

Having trouble with your vision can be distressing, but even if you are left with long-term problems there is a lot that can be done to help you adjust to the changes.

Are there treatments that can help?

There are different treatments for different vision problems. An orthoptist (an eye care specialist) or ophthalmologist (a medical doctor who specialises in eye diseases) can talk through the different options and advise the treatments that may be best for you.
 
Central vision and visual field loss can often be treated with optical aids. This includes magnifiers, which increases the size of what you are looking at, and minifiers, which help you to concentrate on the areas you can see. 
 
Using a plastic prism on a pair of glasses can help to widen your field of view. Prisms can sometimes help with eye movement problems as well, as can eye patches.
 
You can also learn compensation strategies to help you cope with or ‘work around’ your vision problems. If you have lost some of your visual field, for example, then with visual scanning training you can train yourself you to be more aware of your blind side and remind you to look towards it. 

Driving and vision problems

The DVLA/DVA state that you cannot drive with:

  • Double vision.
  • Blurred vision.
  • Visual field loss, particularly central vision.

If you have vision problems after a stroke you should get a proper visual assessment before attempting to return to driving, even if you think your vision has recovered. This can take place in a hospital eye department. You should be given clear information about your condition and offered treatment if it is appropriate, which may help improve your vision to the level needed for driving.

If you have visual problems in the longer term after stroke, you can get further advice about adapting to the effects and to see whether returning to driving may be an option.

Tips for coping with vision problems

  • If you have double vision, try closing one eye or using a patch when reading or watching television.
  • If you have lost your vision to one side, it is important to move your eyes and head towards the weaker side, for example on entering a room. The more you scan and move your eyes and head to that side, the quicker you will detect objects on that side and reduce your risk of bumping into objects or tripping.
  • When reading, use rulers and markers to highlight the beginning and end of sentences and to help you keep your position along a line of text.
  • Make sure your lighting is good and where possible, have it positioned to your side and not behind you, as this causes shadows.
  • Reduce the number of objects that are on your surfaces at home, particularly in the kitchen. If there is too much clutter, it can be more difficult to pick out individual items.
  • Vision problems are not always obvious for other people to see. You might find it helpful to explain your sight problems to friends, family and colleagues to help them understand the support you need.
  • If you lack confidence in going out and about, a visual rehabilitation officer can help you to learn strategies for safe travel on foot and using public transport.

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