Vision problems after stroke

Vision loss after a stroke can affect your daily life in many ways. You could find it more difficult to do things like reading, shopping or watching television.

You may need support for returning to work, such as help with travel or new ways of doing your job. Sight loss is linked to an increased risk of emotional problems like anxiety and depression, and this can affect your ability to take part in rehabilitation.

Sometimes the practical and emotional difficulties that sight loss causes are not apparent in hospital, and you may only become aware of them when you return home.

Assessing vision

You should have your vision assessed before leaving the hospital, and any sight problems should be treated. When you have an assessment, the healthcare team should ensure you have your glasses or other aids you may use with you.

If you notice new vision problems after you go home, tell your GP, or local optician or specialist stroke nurse. They can refer you to the hospital eye clinic for an assessment.

Reduced central vision and other visual field loss

Your visual field is everything you can see, including straight ahead (central vision) and out to the side (peripheral vision).

Visual field loss means that you are unable to see a section of your field of vision, usually because the vision areas of your brain have been damaged by the stroke. The eyes themselves work normally, but the brain can’t process the images from one area of vision. Where the visual field loss happens depends on where the stroke occurred in your brain. It almost always affects the same side of the visual field in both eyes (this is called ‘homonymous’ visual field loss). How much visual field is lost varies between people. The most common type is homonymous hemianopia, which means losing the left or right half of the visual field of both eyes. A less common type is scotoma, when there is a small patch of vision loss, often near the centre of vision.

How can a stroke affect my vision?

Like the other effects of stroke, vision problems can improve over time, as the brain recovers. How you are affected depends on exactly where the stroke occurred in your brain. There are four main areas of visual problem, and you may have one or more:

  • Reduced central vision and other visual field loss.

  • Eye movement problems.

  • Visual processing problems.

  • Other sight problems.

Eye movement problems

A stroke can lead to a variety of problems with the fine nerve control that is needed to move your eyes. We have listed the main ones below:

  • Impaired eye movements.

  • Inability to move both eyes together.

  • Eyes move constantly or wobble.

  • Impaired depth perception and difficulty locating objects.

How are these problems treated?

There are a number of treatment options. Exercises can help if you have difficulty moving your eyes to look at objects held close to your face. Prisms can improve double vision or allow you to see things to one side if you are unable to look in that direction.

Like glasses, prisms are prescribed for each individual after a sight test. A patch over one eye can also be used to avoid double vision. This makes it easier to see, but using only use one eye (monocular vision) can also cause some difficulty. You can work with an orthoptist to choose which option works best for you.

Tips for coping with vision problems

  • If you have double vision, try 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.

Information

Other resources

Stroke Association
Helpline: 0303 3033 100
Email: helpline@stroke.org.uk
Contact us for information about stroke, emotional support and details of local services and support groups.

Royal National Institute of Blind People (RNIB)
Helpline: 0303 123 9999
Provides information about all aspects of visual impairment, including low vision aids and the process of being registered as partially sighted or blind. Offers an emotional support service and over 100 social groups which meet weekly. They can also provide details of transcription services.

British and Irish Orthoptic Society
Email: bios@orthoptics.org.uk
Provides information on the eye problems that occur following brain injury, including stroke. They have a stroke specialist interest group and support research on visual impairment following stroke.

Driver and Vehicle Licensing Agency (DVLA) England, Scotland, Wales
Produces a Customer Service Guide for Drivers with Medical Conditions and an At a Glance Guide to the Current Medical Standards of Fitness to Drive.

Driver and Vehicle Agency (DVA) Northern Ireland
The driver, vehicle and vehicle operator licensing authority in Northern Ireland.

Living Made Easy
Provides information about aids and equipment for people with disabilities.

Nystagmus Network
Phone: 01427 718093
Produces publications including ‘Understanding nystagmus’, ‘Nystagmus and ‘driving in the UK’ and ‘Computers and nystagmus’.

Partially Sighted Society
Phone: 01302 965195
Email: reception@partsight.org.uk
Offers a catalogue of resources including easy-to-see and talking clocks, watches and timers; large playing cards; large print games, crossword books, calendars and diaries; large piece jigsaws, bold-lined stationery and Magnascreen for TVs and computer monitors. Also offers publications such as Visual problems and stroke, Obtaining magnifiers and Seeing things that aren’t there.

Read Right
A website from University College London Institute of Neurology. Provides free therapy you can download to help people with difficulty reading because they have lost vision to one side – a condition called hemianopia alexia.

Royal College of Ophthalmologists
The professional body for eye doctors. Offers a range of information on eye conditions.

Sight Science
Sight Science provides a programme of Neuro-eye Therapy (NeET), a type of visual restorative treatment. It involves an interactive computer-based therapy for people with visual field loss after stroke.

The College of Optometrists
The professional body for optometrists in the UK.

Visionary – linking local sight loss charities
Phone: 020 8090 9264
UK network of local charities for blind and partially sighted people, which are listed on their website.

Apps from MyTherappy
NHS approved and recommended stroke apps for survivors and carers ranging from communication, eating and drinking, healthy lifestyle, vision and more.

Audiobooks

Calibre
Email: enquiries@calibre.org.uk
Free postal lending library of unabridged books, recorded in various formats. Membership is open to children and adults who are blind, partially sighted and print disabled.

Listening books
Phone: 020 7407 9417
Email: info@listening-books.org.uk
A postal audio library service. Annual membership starts from £20. This fee may be paid by social services or your local authority.

Playback Recording Service
Email: info@play-back.org.uk
Provides a free service transcribing text to audio format for people with visual problems. Also has a wide range of publications in an audio format that you can borrow.

RNIB Newsagent
Phone: 0303 123 9999
Email: helpline@rnib.org.uk
A national charity that records more than 200 national newspapers and magazines in various different formats.

Disclaimer: The Stroke Association provides the details of other organisations for information only. Inclusion on My Stroke Guide does not constitute a recommendation or endorsement.