Visual Problems After Stroke
Call the Stroke Helpline: 0303 3033 100or email: info@stroke.org.ukVisual problems after strokeAbout two thirds of people have vision problems after a stroke. Thisguide explains the different types of vision problems and how they canbe treated, and gives sources of further information and support.The impact of vision problemsAssessing visionA stroke can affect your vision in severaldifferent ways. If you have vision loss after astroke, it can make a lot of daily activitiesdifficult, from getting around in andoutside the home, to reading, shopping andwatching television.You should have your vision assessed beforeleaving hospital, and any sight problemsYou may need support for returning towork, such as help with travel or new waysof doing your job.Sight loss is linked to an increased riskof emotional problems like anxiety anddepression. If this happens to you, itcan affect your ability to take part inrehabilitation.Sometimes the practical and emotionaldifficulties that sight loss causes are notapparent in hospital, and you may onlybecome aware of them when you returnhome.The costs of printing this guide have been paid for by VisionExpress. The Stroke Association retains independenteditorial control over all content.For more information visit stroke.org.ukshould be treated. When you have anassessment, the healthcare team shouldensure you have your glasses or other aidsyou may use with you. If you notice newvision problems after you go home, visit yourGP or local optician, who can refer you for anassessment.If you had sight problems before yourstroke, it is important to carry on withany treatment like eye drops, and keephaving regular sight checks. This includesconditions like cataracts, age-relatedmacular degeneration, diabetic retinopathyor glaucoma. Your vision, and the effectsof a stroke, can change over time, so it’simportant to get advice if you notice anychanges in your sight.How can a stroke affect myvision?Like the other effects of stroke, visionproblems can improve over time, as thebrain recovers. How you are affecteddepends on exactly where the strokeoccurred in your brain. There are four main1
Visual problems after strokeareas of visual problem, and you may haveone or more:How do I know if I have visual fieldloss? visual field lossYou may not be aware of the missing area ofvision. People with hemianopia often havedifficulty reading, and may bump into thingson the affected side. You might only noticethe field loss if you look in a mirror and canonly see one side of your face. When reading,it can be difficult to locate the start of aline if you have left-sided field loss. If youhave right-sided field loss, it’s harder to seeahead along the line of text. It can be difficultto get around, particularly in unfamiliar orcrowded places. eye movement problems visual processing problems other sight problems.Visual field lossYour visual field is everything you cansee – including straight ahead (central vision)and out to the side (peripheral vision).Visual field loss means that you are unable tosee a section of your field of vision, usuallybecause the vision areas of your brain havebeen damaged by the stroke. The eyesthemselves work normally, but the brain can’tprocess the images from one area of vision.Where the visual field loss happens dependson where the stroke occurred in your brain.It almost always affects the same side ofthe visual field in both eyes (this is called‘homonymous’ visual field loss). How muchvisual field is lost varies between people.The most common type is homonymoushemianopia, which means losing the left orright visual field of both eyes. A less commontype is scotoma, when there is a small patchof vision loss, often near the centre of vision.Often people think that the vision in one eyehas been affected, but it is actually one sideof the visual field of both eyes.If just one eye is affected, often with centralvision loss, it may be due to damage to theblood supply to the eye itself (see Retinalvessel occlusion at the end of this section).2How is it treated?An eye specialist can assess your eyeproblems and advise you on what will workbest for you. The missing area of visioncan’t be restored, but you can get help tomake the most of your vision. The techniquethat seems to help most is visual scanningtraining. Using special lenses and optical aidsmay help some people.Visual scanning trainingThis encourages you to look to your leftand right sides in a systematic way. It iscommonly used to help you be more awareof your visual field loss, and reminds youto look into your blind side. Eyesearch andReadright are free online therapies designedto improve the speed and accuracy of eyescanning and reading (see Other sourcesof help and information for further details).Other options include using line guideswhen reading, having good lighting,and using edge markers on books andnewspapers.Call the Stroke Helpline on 0303 3033 100
Visual problems after strokeWidening your field of view with optical aidsThis involves using a plastic prism on yourglasses. The prism is worn on either oneor both lenses). It creates an image of partof the side of visual field loss (your blindside) and reflects it over to your good side.This acts as a prompt or cue for you to looktowards your blind side, or may help you tonotice things on that side.Vision restorative treatmentThere are some treatments availableprivately that aim to restore part of the lostarea of visual field, using computer-basedtherapy. Research has not yet shown if visionrestorative therapies can improve eyesight.They are not available through the NHS, andit’s a good idea to consult your stroke nurseor eye specialist before choosing this kind oftreatment.Making the most of your sightAsk your orthoptist or optometrist (optician)about low vision aids such as magnifiers. Aneye health specialist or GP can give you areferral to the local low vision service, whereyou can get low vision aids and advice.You may be given magnifiers for use withnear objects and reading, or telescopes fordistance. You can try anti-glare glasses oroverlays, to reduce excessive glare. You cantry using brighter lighting, and using coloursto make household objects easier to find.You might need someone to help you getaround in the early days and weeks afterthe stroke. With support, and by learningtechniques like visual scanning, peoplecan regain confidence and become moreindependent.For more information visit stroke.org.ukVisual hallucinationsSometimes people with visual field loss seethings that aren’t there in their blind area,known as visual hallucinations. This mightbe the only time that someone notices thearea of visual field loss. Medication can helpsome people, and reassurance or self-helpstrategies can assist a person living withthe condition. RNIB has information aboutcoping with hallucinations.Retinal vessel occlusionOccasionally, a loss of central vision is due to atype of stroke affecting the retina, the lightsensitive area of nerves at the back of theeye. This is called a retinal vessel occlusion. Ithappens when there is a blockage in one of theblood vessels to your eye. The main sign of ablockage in a retinal artery (the vessel carryingblood to the retina) is sudden loss of sight, butyou may be aware of some brief periods ofsight loss before having permanent vision loss.It’s possible to treat a blockage in a retinalartery if you are seen at a hospital within fourhours. However, the retina is very sensitive toloss of blood supply, and it may not be possibleto avoid permanent sight loss. If you notice anysudden loss of vision, you should visit your localhospital emergency department straight away.With a blockage in a retinal vein (vessel carryingblood away from the retina), your sight canbecome dim or blurry over a few days.If you have retinal vessel occlusion, you willbe given tests and checks for the main riskfactors for stroke such as high blood pressure,diabetes and high cholesterol. You shouldbe advised on taking steps to improve yourhealth such as stopping smoking, reducingwaist size and eating healthily.3
Visual problems after strokeEye movement problemsA stroke can lead to a variety of problemswith the fine nerve control that is neededto move your eyes. We have listed the mainones below.Impaired eye movementsThese may affect your eyes’ ability to movefrom looking at one object to another orto follow a moving object, like someonewalking past. These problems can makereading more difficult and can also affectyour general mobility. For example if youare unable to look around quickly, walkingoutside is likely to be more challenging.Inability to move both eyes togetherIf the nerve control to your eye muscles isaffected, one of your eyes may not movecorrectly. This may cause you to have blurredvision or double vision (diplopia). This issometimes called a squint or strabismus.Eyes move constantly, or wobbleThis can make it hard to focus on objects, orcause double vision. This condition is callednystagmus.Impaired depth perception anddifficulty locating objectsFor example, when making a cup of tea, youmay misjudge the position of the cup, andpour water over its edge rather than into it.How are these problems treated?There are a number of treatment options.Exercises can help if you have difficultymoving your eyes to look at objects held4close to your face. Prisms can improvedouble vision or allow you to see thingsto one side if you are unable to look inthat direction. Like glasses, prisms areprescribed for each individual after a sighttest.A patch over one eye can also be used toavoid double vision. This makes it easier tosee, but using only use one eye (monocularvision) can also cause some difficulty. Youcan work with an optometrist or orthoptistto choose which option works bestfor you.Visual processing problemsSome vision problems after stroke are dueto the brain having difficulty processing theinformation received from the eyes andother senses. This can happen in many ways,for example difficulty recognising objectsor people by sight, or recognising colours. Itcan cause difficulty when you try to reach forobjects or make it harder to see more thanone object at the same time.Visual neglectThe commonest type of visual processingproblem is visual neglect, which meansthat you are unaware of your surroundingsto one side. You may not realise thatyou are missing things around you. Forexample, you may be unaware of objectsand people on your affected side, and mayignore people or bump into things withoutrealising they are there. Visual neglectcan reduce your ability to look, listen ormake movements towards part of yourenvironment.Neglect is more common in people whohave had a stroke on the right side of theCall the Stroke Helpline on 0303 3033 100
Visual problems after strokebrain, which affects their awareness ofthe left side. The person is not aware thatthey are missing part of their vision. Whenneglect is severe it may be impossible todraw someone’s attention round to theiraffected side.Visual field loss and neglect can occurtogether, which can make it hard to usestrategies like visual scanning or patches.How are visual processing problemstreated?Many people recover well from visualneglect. If you have neglect you mightbe able to learn scanning and awarenessstrategies. If you have problems suchas difficulty recognising colours, faces,objects, complex scenes or text, you maybe taught to use your other senses (forexample touch or hearing) to process theinformation in a different way and to helpyou to improve your awareness of theaffected side.Other sight problemsDry eyesIf you have weakness in your facial musclesand eyelid muscles, you may have difficultyclosing the eyelids fully, or your eyes couldstay open when you are asleep. This can leadto a dry eye and irritation. It is importantthat this is treated early with lubricationdrops or ointment to prevent more seriouseye complications such as ulcers. Taping thelid closed at night is also very important ifthe eye does not always close fully.Light sensitivityYou could also become more sensitive tolight (photophobia) and may benefit fromtinted glasses or sunglasses.Accessing an eye specialistAfter a stroke, you should be referred to anorthoptist or ophthalmologist specialisingin stroke and brain injury. They can assessyou and arrange treatment for poor vision,double vision or visual field loss. Ideallythis assessment should happen beforeyou leave hospital, as visual problems canaffect daily life and rehabilitation of otherproblems after stroke. You might have a fullvision assessment in an outpatient clinic.You may be referred to a low vision clinicwhere you can have an assessment andadvice on using magnifiers or other visualaids. You can ask your GP or local opticianfor a referral.If you have sight problems, there is a widerange of specialist equipment and householditems available to help. These includeclocks and watches with large numbers,big button telephones and large printFor more information visit stroke.org.uk5
Visual problems after strokebooks and calendars. Contact the RoyalNational Institute of Blind People (RNIB) orthe Disabled Living Foundation for moreinformation (see Other sources of help andinformation at the end of this guide).Eye health professionals An orthoptist can assess and treat arange of eye problems, particularly eyemovements. An ophthalmologist is a medical doctorwho specialises in diagnosing andtreating diseases of the eye. Only anophthalmologist can certify peoplepartially sighted. An optometrist (optician) tests sight,prescribes and dispenses glasses orcontact lenses and can screen you foreye disease. Support workers and eye clinic liaisonofficers (ECLOs) can give additionalsupport. They can provide you andyour family or carer with information onpractical aids and emotional support.ECLOs provide a bridge between theeye care professionals in hospital andother organisations that can provideyou with support at home. Visual rehabilitation officers help youmake use of your remaining visionand other skills to increase yourindependence.6DrivingOne of the most common queries after astroke is whether you can return to driving.The DVLA (DVA in Northern Ireland) statesthat after a stroke or TIA you cannot drivea car for one month, but you may return todriving after this time if there are no lastingeffects. The rules are different for lorrydrivers, who must inform the DVLA/DVAafter a stroke or TIA.The DVLA/DVA state that you cannot drivewith: double vision blurred vision visual field loss, particularly centralvision.If you have vision problems after a strokeyou should get a proper visual assessmentbefore attempting to return to driving, evenif you think your vision has recovered. Thiscan take place in a hospital eye department.You should be given clear information aboutyour condition and offered treatment if it isappropriate, which may help improve yourvision to the level needed for driving.If you have visual problems in the longerterm after stroke, you can get furtheradvice about adapting to the effects andto see whether returning to driving may bean option. For more general informationabout driving see our guide F02, Driving afterstroke.Call the Stroke Helpline on 0303 3033 100
Visual problems after strokeEmployment and sight lossIf you are having problems with your workbecause of your vision, you can ask youremployer to make reasonable adjustmentsto help you. You can get information onyour rights at work and how to return toemployment after a stroke in our guideF45, A complete guide to work and stroke, andThe Royal National Institute of Blind People(RNIB) has advice and resources on sight lossand work.Should I register my sight loss?If you are assessed as being partially sightedor blind, you can choose to register yoursight loss. This can make it easier to getpractical help from social services, as well asentitling you to concessions such as counciltax reduction, the Disabled Person’s Railcardand local travel schemes. It can also helpwhen claiming certain state benefits.If your ophthalmologist recognises thatyou are severely sight impaired (blind) orsight impaired (partially sighted), they willissue you with a certificate. In England andWales this certificate is called the Certificateof Vision Impairment (CVI). In Scotlandit is called BP1, in Northern Ireland it iscalled A655.To register your sight loss, contact yourlocal social services department and theywill add you to the register. RNIB has moreinformation on the benefits of registeringyour sight loss and how to do it (see Othersources of help and information).For more information visit stroke.org.ukTips for coping with visionproblems If you have double vision, try closingone eye or using a patch when readingor watching television. If you have lost your vision to one side,it is important to move your eyes andhead towards the weaker side, forexample on entering a room. The moreyou scan and move your eyes and headto that side, the quicker you will detectobjects on that side and reduce yourrisk of bumping into objects or tripping. When reading, use rulers and markersto highlight the beginning and end ofsentences and to help you keep yourposition along a line of text. Make sure your lighting is good andwhere possible, have it positioned toyour side and not behind you, as thiscauses shadows. Reduce the number of objects that areon your surfaces at home, particularlyin the kitchen. If there is too muchclutter, it can be more difficult to pickout individual items. Vision problems are not always obviousfor other people to see. You might findit helpful to explain your sight problemsto friends, family and colleagues tohelp them understand the support youneed. If you lack confidence in going out andabout, a visual rehabilitation officercan help you to learn strategies forsafe travel on foot and using publictransport.7
Visual problems after strokeWhere to get help andinformationFrom the Stroke AssociationTalk to usOur Stroke Helpline is for anyone affected bya stroke, including family, friends and carers.The Helpline can give you information andsupport on any aspect of stroke.Call us on 0303 3033 100, from atextphone 18001 0303 3033 100 or emailinfo@stroke.org.uk.Read our publicationsWe publish detailed information about a widerange of stroke topics including reducingyour risk of a stroke and rehabilitation. Readonline at stroke.org.uk or call the Helpline toask for printed copies.Other sources of help andinformationOrganisations offering information,support and equipmentRoyal National Institute of Blind People(RNIB)Website: www.rnib.org.ukHelpline: 0303 123 9999Provides information about all aspectsof visual impairment, including low visionaids and the process of being registered aspartially sighted or blind. Offers an emotionalsupport service and over 100 social groupsthat meet weekly. They can also providedetails of transcription services. Merged withAction for Blind People in April 2017.Other services include Big Print – a weeklylarge print newspaper which includesTV and radio listings, a national library8service – a specialist library includingaudiobooks for people with sight loss, andInsight radio – a station for people with visualproblems with a wide range of programmes.Disabled Living Foundation (DLF)Website: www.dlf.org.ukHelpline: 0300 999 0004Provides information about aids andequipment for people with disabilities, aswell as advice on everyday tasks such asshopping and eating.Eye SearchWebsite: www.eyesearch.ucl.ac.ukA website from University College LondonInstitute of Neurology. Provides free onlinetherapy for people with visual searchproblems.Nystagmus NetworkWebsite: www.nystagmusnet.orgProduces publications including Adults withacquired nystagmus. You can get in contactwith the charity using their online form,which can also be used to request a call back.Partially Sighted SocietyWebsite: www.partsight.org.ukTel: 01302 965 195Offers a catalogue of resources including:easy-to-see and talking clocks, watchesand timers; large-print games, crosswordbooks, calendars and diaries; bold-linedstationery; and magnifying screens for TVsand computer monitors.Read RightWebsite: www.readright.ucl.ac.ukA website from the University CollegeLondon Institute of Neurology. Provides freetherapy you can download to help peoplewith difficulty reading because they have lostvision to one side.Call the Stroke Helpline on 0303 3033 100
Visual problems after strokeVisionaryWebsite: www.visionary.org.ukHelpline: 020 8090 9264Email: visionary@visionary.org.ukUK network of local charities for blind andpartially sighted people.Audio booksCalibreWebsite: www.calibre.org.ukTel: 01296 432339Free postal lending library of unabridgedbooks. Membership is open to children andadults who are blind or partially sighted, orhave dyslexia.Listening BooksWebsite: www.listening-books.org.ukTel: 020 7407 9417A postal audio library service. Annualmembership starts from 20. This feemay be paid by social services or your localauthority.PlaybackWebsite: www.play-back.comTel: 0141 334 2983Provides a free service recording text toaudio for people with visual problems. Alsohas a wide range of publications in audioformat that you can borrow.RNIB NewsagentWebsite: www.rnib.org.uk/newsagentHelpline: 0303 123 9999A service run by RNIB that providesaudio versions of more than 200 nationalnewspapers and magazines in variousdifferent formats including CD and onlinedownload. Call the Helpline for a free sample.For more information visit stroke.org.ukProfessional bodiesBritish and Irish Orthoptic SocietyWebsite: www.orthoptics.org.ukTel: 020 3853 9797Provides information on the eye problemsthat occur following brain injury, includingstroke. They have a stroke specialist interestgroup and support research on visualimpairment following stroke.College of OptometristsWebsite: www.college-optometrists.orgTel: 020 7839 6000Professional body for optometrists in the UK.Royal College of OphthalmologistsWebsite: www.rcophth.ac.ukTel: 020 3770 5327Professional body for eye doctors. Offersa range of information on eye conditions.Driving organisationsDriver and Vehicle Licensing Agency(DVLA) England, Scotland, WalesWebsite: www.dvla.gov.ukTel: 0300 790 6806Produces online information for drivers witha medical condition.Driver and Vehicle Agency (DVA) NorthernIrelandWebsite: www.nidirect.gov.uk/motoringThe driver, vehicle and vehicle operatorlicensing authority in Northern Ireland.9
Visual problems after strokeGlossaryDepth perception the ability to see theworld in three dimensionsHemianopia loss of vision on one sideHomonymous hemianopia losing half ofthe field of vision in both eyesMonocular vision vision with one eye onlyNystagmus a condition where the eyesmove constantlyOphthalmologist a medical doctorspecialising in diagnosing and treatingdiseases of the eyeOptometrist (optician) a specialist whotests sight, prescribes glasses and contactlenses and screens people for eye disease10Orthoptist an eye care specialist whoassesses and treats a range of visualproblems, particularly eye movementproblemsPeripheral vision the field of vision out toboth sidesPrism a plastic membrane which is appliedto a person’s glasses and which moves theposition of objects when they are seenthrough the prismRetinal vessel occlusion a blockage in ablood vessel to the eyeVisual field the whole of your visionVisual scanning training which encouragesyou to look in a systematic way to the rightand left sidesCall the Stroke Helpline on 0303 3033 100
Visual problems after strokeKeeping in touchAt the Stroke Association, we understand thatthe impact of a stroke can turn everythingupside down in an instant, not just for thestroke survivor but for their loved ones too.We are proud to be the leading stroke charityin the UK, changing the world for peopleaffected by stroke. As you may know, ourvital work covers many areas, includingproviding support and information tostroke survivors and their families, fundingresearch into stroke treatment and care, andcampaigning to raise awareness of stroke.We are determined to conquer stroke, butwe cannot do it alone.Keep in touch and find out more aboutour work. This includes groundbreakingresearch developments, other servicesthat might benefit you and opportunitiesto get involved with appeals, campaigns orvolunteering for the Stroke Association.To keep in touch, either fill out our onlinecontact form at stroke.org.uk/signupor complete your details below and sendthem to our freepost address:Freepost RSZL-SAUL-GRBKKeeping in touchLife After Stroke CentreChurch LaneBromsgroveWorcestershire B61 8RAYour contact detailsI am a: stroke survivor carer family/friendotherFirst il:Telephone number:For more information visit stroke.org.ukI would like to receive Stroke News: online (we’ll email you to let you knowwhen an online copy is available) by post (we’ll send you a free copy) I’m happy for the Stroke Associationto keep in touch with news updatesand ways to get involvedI’m happy to be contacted by:(please tick all that apply) post telephone emailYou can change or stop the way wecontact you at any time by callingour friendly Supporter Care teamon 0300 330 0740, or by emailingsupportercare@stroke.org.uk.11
Visual problems after strokeAbout our informationWe want to provide the best information forpeople affected by stroke. That’s why weask stroke survivors and their families, aswell as medical experts, to help us put ourpublications together.How did we do?To tell us what you think of this guide,or to request a list of the sources weused to create it, email us atfeedback@stroke.org.uk.Accessible formatsVisit our website if you need this informationin audio, large print or braille.Always get individual advicePlease be aware that this information isnot intended as a substitute for specialistprofessional advice tailored to your situation.We strive to ensure that the content weprovide is accurate and up-to-date, butinformation can change over time. So far asis permitted by law, the Stroke Associationdoes not accept any liability in relation to theuse of the information in this publication,or any third-party information or websitesincluded or referred to. Stroke Association 2017Version 2. Published November 2017To be reviewed: April 2020Item code: A01F37We rely on your support to fund life-saving research and vital services for peopleaffected by stroke. Join the fight against stroke now at stroke.org.uk/fundraisingTogether we can conquer stroke.The Stroke Association is registered as a charity in England and Wales (No 211015) and in Scotland (SC037789).Also registered in Northern Ireland (XT33805), Isle of Man (No 945) and Jersey (NPO 369).For more information visit stroke.org.uk12
Visual problems after stroke 2 a te troe eine on 0303 3033 100 areas of visual problem, and you may have one or more: visual field loss eye movement problems visual processing problems other sight problems. Visual field loss
exercises focusing on strengthening particular parts of the body. Every stroke is unique. Every person’s needs are different. This new guide is a much needed and overdue tool box of practical and easily followed exercise regimes for those recovering from a stroke as well as the families and whānau who support them in theirFile Size: 1MBPage Count: 51Explore further10 Stroke Recovery Exercises For Your Whole Bodywww.rehabmart.comAfter Stroke: 3 Exercises for a Weak Leg. (Strengthening .www.youtube.comStroke Exercises.pdf - Stroke Exercises for Your Body .www.coursehero.com35 Fun Rehab Activities for Stroke Patients - Saebowww.saebo.comPost-Stroke Exercises for Left Arm and Shoulder SportsRecwww.sportsrec.comRecommended to you b
State Advisory Council for Heart Disease and Stroke . o Ms. Aycock gave a thorough presentation on Maryland Stroke Centers and the actions of MIEMMS to work toward the goal, “to address system changes in stroke prevention and coordination of the delivery of care to the acute stroke patient”. Information on the standards of Primary Stroke Centers, Comprehensive Stroke Centers, and base .
Post-stroke fatigue does not always improve with rest and is not necessarily related to recent activity. So it is not like typical tiredness. You might experience post-stroke fatigue after a mild or more severe stroke. Here are some useful definitions of fatigue after stroke. If either of these apply to you, you may have post-stroke fatigue: 1.
Canadian Stroke Best Practices Framework for Optimal Stroke Services Delivery 6 Optimal Stroke Services Delivery in Stroke Rehabilitation 7 . S. TROKE . R. EHABILITATION . B. EST . P. RACTICES . W. RITING . G. . 5.7 Assessment and Management of Dysphagia and Malnutrition Following Stroke 6 3 . 5.8 Rehabilitation of Visual Perception Deficits .
hours, days and weeks after a stroke When a stroke happens. 2 Stroke Association n tro n 3 The Stroke Association is registered as a charity in England and Wales (No 211015) and in Scotland . There are two
stroke back massage reduce anxiety after stroke [43]. Cognitive behaviour therapy is highly effective for anxi-ety in older and working age people [44,45], but remains to be evaluated in stroke survivors. Relaxation training is, as yet, unproven in a stroke sample. Supportive and
NE Ohio Resource List for Stroke Survivors & Persons with Aphasia or Head Injury Compiled by the Members of the Cleveland Stroke Club This list is available online at: www.clevelandstrokeclub.org Updated: 03/24/2019 Caregivers and Stroke Survivors who participate in the Cleveland Stroke Club and other area stroke
-Textbook: Ladefoged (2006), A Course in Phonetics, (available in Thai version) -Website (for interactive learning): UCLA.-Supplementary reading and interactive lessons: Academic websites around the world, e.g., U. of Arizona, USA, Macquarie U., Australia, Otago U., New Zealand, Stuttgart U., Germany, etc. A. Tumtavitikul, SWU, Aug. 2009-Lectures: on-campus, in classroom environments via .
