Stroke and sight loss

Following a stroke, you might experience problems with your vision, but you are not alone. Up to two thirds of people experience some changes to their vision after stroke. It you think your vision has become worse, it is important to have an eye examination.

How can stroke affect my vision?

There are four main types of visual problem and you may experience one or more:

1. Visual field loss

There are many types of visual field loss, but the most common is a condition where you can see only the right half or the left half of the world out of each eye. Other types of visual field loss include loss of a quarter of the visual field, loss of the entire upper or lower field of vision, or patches missing in the field of vision. You may experience problems reading.

How is it treated?

It is important for an eye specialist to assess your eye problems and advise you on what will work best for you. Here are the three main options:

  • Training in compensatory strategies. This involves visual scanning training, which encourages you to look to your left and right sides in a systematic way.
  • Widening your field of view with optical aids. This involves using a plastic prism segment on a pair of glasses.
  • Visual restorative treatment. This treatment aims to help you to interpret visual information.

2. 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. These may affect both of your eyes' ability to move from looking at one object to another or to follow a moving object, like someone walking past. These problems can make reading more difficult and can also affect your general mobility.
  • Inability to move one eye up, down, sideways or inwards. If the nerve control to your eye muscles is affected, one of your eyes may not move correctly. This may cause you to have blurred vision or double vision.
  • Your eyes may move constantly. This means you see objects constantly wobbling which can be very distressing and disorientating.
  • Impaired depth perception and difficulty locating objects.  For example, when making a cup of tea, you may misjudge the position of the cup and pour water over its edge rather than into it.

How are these problems treated?

There are various treatment options. Prisms can join double vision or displace vision if you are unable to look to one side. A patch over one eye can also be used to avoid troublesome double vision. Exercises can help if you have difficulty moving your eyes to look at objects held close to your face.

3. Central vision loss

Central vision loss is the partial or complete loss of vision in one or both of your eyes. You may not be able to see anything at all, or you may only be able to see things around the edge of your vision, but not in the centre. 

How is it treated?

You may be given magnifiers (to increase the size of what you are looking at), minifiers (to help you concentrate on the remaining area of your vision) or anti-glare glasses or overlays (to reduce excessive contrast of images and glare).

4. Visual processing problems

When we look at something, our eyes receive visual information which must then be processed by our brain to find out what it means. This enables us to recognise colours, someone we know, or familiar objects, for example, but this process can be affected by stroke.

You may also experience a change in your awareness and perception of the world around you. This is called visual neglect and is the most common visual processing problem. It is more common in people who have had a stroke affecting the left side of their body.

You may be unaware of objects and people on your affected side and may ignore people or bump into things without realising they are there.

Visual hallucinations are quite common after a sudden loss of vision and can be very distressing. Identifying these and understanding their cause can be reassuring. For many people, this improves in time.

How are visual processing problems treated?

If you have problems such as difficulty recognising colours, faces, objects, complex scenes or text, it is important to use adaptive strategies. These involve using your other senses (for example touch or hearing) to process the information in a different way and to help you to relearn how to recognise things or adapt to your difficulties. Prisms, patches and mirrors have been tried to improve people's awareness of visual neglect, but with limited success.
Fortunately, many people recover well from visual neglect. However it is important that your healthcare professionals and carers work with you to help you become more aware of your affected side.

What help is available?

There are a number of specialists that can help you:

  • An orthoptist is an eye care specialist who can assess and treat a range of eye problems, particularly problems with eye movements.
  • An ophthalmologist is a medical doctor who specialises in diagnosing and treating diseases of the eye.
  • An optometrist (optician) is an eye care specialist who tests sight, prescribes and dispenses glasses or contact lenses and can screen you for eye disease.
  • Support workers, visual rehabilitation officers (VROs) and eye clinic liaison officers (ECLOs) can provide additional support. They can provide you and your carer (if you have one) with information on practical aids and emotional support.

Procedures for seeing a specialist vary across the UK. If you are in hospital, you should be referred to an orthoptist or ophthalmologist specialising in stroke and brain injury. They can assess you and arrange any treatment for poor vision, double vision or visual field loss. You may then be referred to a low vision clinic where you can receive an assessment and advice on using magnifiers or other visual aids.

If you are at home, your GP or local optician can refer you to one of these specialists. It is best to see an optician first, so they can establish if you have any other sight problems. If you wear glasses, they can make sure that they allow you the best possible vision under the circumstances. Your optician may then write to your GP who can refer you to the hospital eye department for a specialist assessment.

If you have visual problems, there is a wide range of specialist equipment and household items available to help. These include clocks and watches with large numbers, big button telephones, and large print books and calendars.

Will I be able to drive again

One of the most common queries after a stroke is whether you can return to driving. The DVLA/DVA states that after a stroke you cannot drive for one month, but you may return to driving after this time if there are no lasting effects.

The DVLA/DVA state that you cannot drive with double vision, blurred vision below a certain level or visual field loss, particularly one which interferes with central vision. It is important to have a proper assessment of your visual problems so that you receive an accurate diagnosis. 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.

Should I register my sight loss

Registering your sight loss can make it easier to get practical help from social services. You can also benefit from concessions such as the Disabled Person's Railcard and local travel schemes. If you choose to register your sight loss, an ophthalmologist can assess whether you qualify for registration as sight impaired (partially sighted) or severely sight impaired (blind).

Tips for coping with visual 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 constantly move your eyes and head towards the weaker side. 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.

The information on this page has been put together with help from the Stroke Association.

Related link

The Stroke Association produce a factsheet called Visual problems after a stroke.

 

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