Visual Changes After Stroke or Brain Injury

Understanding Visual Changes After a Stroke or Brain Injury

Visual impairments are common after a stroke or brain injury, with many survivors experiencing difficulties that affect daily activities and quality of life. Up to 70% of your brain is associated with vision in some way, so it makes sense that an injury to your brain can cause vision changes. These changes are often not identified or misdiagnosed, especially early in recovery. This can be seen as cognitive changes or depression, as it can limit what you want to do throughout your day.

Your brain is very powerful even stroke survivors can have a hard time identifying changes. Some people report things suddenly jump out at them, some bump into objects and don’t understand why, some people feel like someone is pushing them to the side and others say things just feel “off” especially when they move their head or body. Any of these can be a sign of vision issues and should be evaluated.

How does your vision work?

Most people know visual information is taken in through your eyes and processed by your brain, but what does that look like? A picture is taken by your retina (the area in the back of the eye) and transmitted through a nerve to the back of your brain. Most vision processing happens in your occipital lobe (the farthest point from your eyes) and then this information is brought back to the front of your brain for you to understand what you see. With the long pathway your vision needs to take, it makes sense that most strokes or brain injuries will impact your vision in some way.

One misunderstanding most people have regarding their vision is seeing things on the right or left side. Many people think that your left eye sees things to the left side of your body and the right eye sees the right side. Although this is partially true, there is a larger portion of your vision that is seen by both eyes. Each eye will see about 120 degrees. This includes the peripheral vision (out to the side) and the central vision. If you close your left eye, your vision does not stop at your nose, you can see things to the right side. Because of this, there is a large portion of your vision that overlaps in both eyes.

To make things more complicated, your brain takes half of the image it sees in each eye, and passes the information to the opposite side of the brain. The information your eyes take in from the right side of your body is put together and is processed on the left side of your brain. The type of vision issues you see will depend on where on this pathway the injury happened. If it is before this crossing over, it may look similar to if the person is closing one eye. If it is after the crossing over, you may lose vision on half of one or both eyes.

Common Vision Problems Experienced by Stroke Survivors

Stroke survivors may face a range of vision issues, including blurred vision, double vision, visual field loss, and difficulty with depth perception, all of which can affect their independence. We take in most of our information about our environment from our eyes. Our vision helps us find things in our environment, move around safely and help us plan what we are doing next. We process vision faster than any other sense, helping us live safely in our environment.

There are multiple common vision issues after a stroke or brain injury 

• Field Cut

  • This is the most common visual change after a stroke. A field cut happens when there is a change in the information the brain takes in. This is basically a blind spot in your vision. This can impact one or both eyes, can impact up to half of your visual field and may or may not include your central vision.

  • Wouldn’t someone know if they had a visual field cut? Actually, most people don’t unless it is specifically tested. Your brain is very powerful and if you have had a full visual field your brain knows there should be something there. Because of this, your brain takes its best guess regarding what should be in that visual field. It uses information it has gathered in the past to fill in the space. Sometimes it is right, sometimes it isn’t. This is why some people with field cuts will say things “jump out of nowhere” or trip over things they say were not there.

  • People with visual field cuts need to learn more about where their specific cut is so they understand what portions of their vision they may not be able to trust. Learning to move your eyes into this area can be a helpful strategy to help your brain get all of the information.

• Inattention or Visual Neglect

  • Inattention or neglect are terms related to how your brain is using the information from your eyes. With inattention or neglect your brain is seeing the whole image, but choosing to not pay attention to part of the picture. In some cases, people will even have a hard time turning their head or eyes in one direction. Many times, this can look similar to a field cut in that things are jumping out at them but it is more inconsistent and visual field testing is normal. Many times other attention issues are noticed too, like having a hard time paying attention in busy environments or following a conversation.

• Blurred or Double Vision

  • For clear vision, your eyes need to work together. There are small muscles attached to your eyes that help your eyes move together so your brain is seeing one image. After a brain injury, sometimes the muscles of your eyes are affected and can be weak or not work (just like some people have weakness in their arm or leg). If one muscle is weak, your brain is seeing two images and doesn’t know how to mesh the pictures together. This is how you get double vision. Sometimes the misalignment is minor, causing people to report blurry vision instead.

• Eye Movement Issues

  • Like we talked about above, your eyes have small muscles attached to them to help them move. Sometimes an injury will cause these muscles to not work as smooth as they did before. Sometimes eyes will “jump” more often or struggle to move in certain directions. This can be frustrating for someone as it may seem like your whole world is moving when you are sitting still.

How Occupational Therapy Addresses Visual Impairments After Stroke

At Neuro Connections in Madison, WI, our occupational therapy team incorporates vision rehabilitation techniques to help stroke survivors adapt and compensate for visual changes, improving their overall functionality. Vision changes can be subtle and sometimes hard to identify. We use evidence-based strategies to help identify what is happening with your vision, and provide recommendations to help improve your vision or compensate for changes to your vision. It is important to note, vision is a complex process and it may take multiple providers to help determine how to improve your vision.

Who is involved with vision assessment and treatment?

There are multiple providers who may be involved with vision changes. It is important to get to the right professional at the right time to get back to feeling like yourself.

Occupational Therapist

Occupational therapists are looking at how a person is functioning in a holistic way. We are not only looking at your vision, but how is that interacting with all of the things you want to do throughout your day. In occupational therapy, we may discuss exercises to help improve the vision you have, assess your environment to make things safer and easier and understand how your vision may impact other areas of your life. Occupational therapists are key in helping you determine what is the biggest barrier to you doing what you love and helping you overcome these challenges.

Optometrist

An optometrist is the professional that checks the clarity of your vision and can prescribe glasses. Optometrists are a great place to start for clear vision, but they typically don’t look at things like visual fields, eye alignment or common challenges with vision after stroke or brain injury. Having clear vision is an important first step to any other vision assessment.  

Neuro Optometrist

Neuro Optometrists are similar to the optometrist described above, but they have additional training in eye exercises that may be beneficial after a neurologic event. Their focus is primarily on exercises and special glasses that may help.

Neuro Ophthalmologist

Neuro Ophthalmologists are medical doctors who determine if surgery would be beneficial for eye issues. They typically see people with double vision to determine if surgery to the eye muscles would be helpful. Surgery is typically not helpful for people with visual field cuts, inattention, or eye movement issues.

Orthoptists

Orthoptists work closely with Neuro Ophthalmology and Optometry to determine if prisms would be helpful. Prisms are either a stick-on addition to glasses or ground into glasses to help move the visual field over. This can be helpful for double vision.  

Intervention for Visual Changes Is Crucial for Stroke Recovery

Addressing visual changes early in recovery is vital, and at Neuro Connections in Madison, we prioritize timely assessments and treatments to optimize outcomes and improve long-term quality of life for stroke survivors. Vision changes are sometimes mistaken for cognitive issues or lack of effort. We know how important vision is to your daily life and can help assess and improve your vision to get you back to the things that are most important to you. Vision issues can be debilitating but you do not need to figure out how to fix it on your own. If you or a loved one is experiencing vision changes after a neurologic diagnosis, call today for a free consultation to see how occupational therapy can help!