Visual Changes

You may experience a variety of changes in your vision after your stroke. These changes can include:

Blurry vision, double vision, loss of visual field, dizziness, and difficulties understanding what you see.

Scroll down to explore the information and videos below.

Our vision videos were provided by Kimberly Downs, OTD, MOTR/L. Kim has specialized in neurological rehabilitation for over 25 years with experience in low vision and visual rehabilitation. Kim has earned a Doctorate in Occupational Therapy with a specialty in Remedial Vision Rehabilitation from Salus University, also known as the Pennsylvania College of Optometry.

Thank you for your contribution, Kim!

Understanding Eye Care Professionals

Ophthalmologist:

Specializes in conditions of the eye and can perform advanced vision care such as eye surgery. If the ophthalmologist does not specialize in visual disorders after a stroke, you may be referred to a neurological ophthalmologist. An ophthalmologist typically does not prescribe vision therapy.

Neurological Ophthalmologist:

Specializes in diagnosing visual disorders caused by a neurological dysfunction or injury. Prescribes glasses including prism glasses to compensate for changes in eye muscle function or visual field loss. A neurological ophthalmologist typically does not prescribe vision therapy.

Optometrist:

Has an advanced degree in optometry. This doctor can perform routine eye health exams and prescribe corrective lenses. An optometrist may or may not have experience with neurological disorders or prescribing prism lenses.

Neurological Optometrist:

An eye care professional who has earned a doctorate in optometry and advanced training in visual issues. This doctor prescribes glasses (including prism lenses) and visual rehabilitation (including visual exercises).

Occupational Therapist: Many occupational therapists specializing in neurological care can help you understand your vision changes and how they impact function. Occupational therapists teach strategies to help improve your daily function despite visual changes.

Some occupational therapists have advanced training in remedial visual rehabilitation and can help you with visual exercises once you have been properly diagnosed by your eye doctor. Occupational therapists can also have experience or advanced training in low vision which helps people to adapt to visual loss using adaptive tools and techniques such as increasing contrast, lighting, magnification, and organization.

Occupational therapists strive to work with eye doctors to achieve the best outcome possible. If you are having problems finding the support your need, please contact us at StrokeOT, Inc.

Blurry or Double Vision

Blurry or double vision can be a common occurrence after a stroke. A leading cause of this type of dysfunction can be decreased control of the eye muscles. When the eyes struggle to coordinate and focus on a target, the brain will see a blurry or double image.

This type of visual change can affect the quality of your near and distance vision causing functional problems such as increased difficulty with reading, eating, reaching, driving, walking, and balance.

Covering one eye is often the first strategy used to help decrease double vision. This can be achieved with an eye patch to opaque tape over one lens of your eyeglasses. Once you are medically stable, you can seek a healthcare professional specializing in visual rehabilitation to see if you are a candidate for exercises to improve your oculomotor (eye muscle) skills.

If your double vision is not improving, you may also be a candidate for a prism lens to be placed in your eyeglasses. The purpose of a prism lens is to shift the incoming image to align with where your eye prefers to rest. Prism lenses can help decrease visual strain and improve function but can have other side effects such as dizziness and distortion. For these reasons, you should speak with your eye care professional to make an educated decision on either prism lenses are a good fit for you.

Below is an example of a convergence exercise used to help the eyes work together. Please remember that it is best to consult a doctor or a therapist who specializes in your condition to receive specific recommendations for your unique condition. If you continue to scroll down the page, there are additional exercises and recommendations for reading and computer use.

Convergence Exercise: Using your eyes together

Loss of Visual Field

Your visual field is everything you can see. Visual field loss means you cannot see a section of your field of vision. Each eye has its own visual field with sections: center, top, bottom, left, and right. Visual field loss due to stroke can affect one or both eyes.

Some people 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 or homonymous hemianopia.

Hemianopia can interfere with your ability to see your environment fully. This causes difficulties such as bumping into obstacles while walking, attending to items on a desk or table when eating or working, or seeing a full line of print when reading or using a computer.

Visual field loss can sometimes improve with neurological healing. However, if your visual field loss is not improving you can work with an occupational therapist to use compensatory techniques. These techniques can improve your ability to overcome the missing field using your existing field and head movement.

Some people can also learn to use a type of prism lens that shifts the visual field, to help increase visibility to the affected side. These lenses should be obtained with caution since they can affect balance and can cause dizziness. If you are prescribed prism lenses for visual field loss you should have therapy with an occupational therapist who understands the lens and can teach you how to use the lens safely and effectively.

Scroll down to learn exercises and strategies to help with attention to an impaired visual field. Please remember, that it is best to consult a doctor or a therapist who specializes in your condition to receive specific recommendations for your unique condition.

Uncontrolled Eye Movement or Nystagmus

Uncontrolled eye movement or nystagmus can impact many areas of function, affecting your ability to fixate your eyes on a target. Many people with this impairment suffer from dizziness, decreased balance, and increased difficulty visually attending to their environment near and far.

Difficulties can include walking, watching a sporting event, being a passenger in a car, or using a computer.

These issues can improve with neurological healing. If symptoms do not improve, some exercises and techniques can be learned to help minimize your symptoms and improve your function. These techniques can be taught to you by an occupational therapist, physical therapist, or neurological optometrist who has advanced training in visual-vestibular skills.

The below sections contain exercises and adaptive strategies to help you improve your level of function. Please remember, that it is best to consult a doctor or a therapist who specializes in your condition to receive specific recommendations for your unique condition.