Submissions from Readers

double vision

by Diane Takesh
(Oxford NJ)

Question:My sister had a stroke and is now seeing double and it is making her sick to her stomach. Her doctors told her there is nothing she can do for this. I don't believe that.


How likely is it that she will recover doing exercises? Is there other treatments for vision problems after a stroke? Her right eye is turned inward toward her nose.

Answer: I would first have your sister visit a neuro-opthamologist or neuro-optometrist who specializes in working with disorders of the eye from neurologic injury. They may be able to help your sister's eyes and/or refer her to a therapist specializing in vision therapy. You could also look around in your area for vision therapy specialists.

If the affected eye muscles have been severely weakened, it will be difficult for that eye to move at the same speed as the other eye, and it becomes difficult to coordinate eye movements together. There are various exercises for diplopia or double vision. I have listed some exercises on the following webpage, www.stroke-rehab.com/eye-exercises.html. You can also find numerous other exercises on other websites and by searching eye exercises or double vision on YouTube. You can check with the MD to make sure any exercises you find are safe and appropriate.

I like to have patients work on coordinating eye movements together as well as patching the stronger eye and working the weak eye on its own. If the double vision is causing nausea and safety issues when moving around, patching one eye can stop the double vision though this is only a temporary solution and a neuropthamologist or neuro-optometrist may have better solutions such as glasses with prisms or spot patches. You can read about this at http://www.nora.cc/for-patients-mainmenu-34/management-of-double-vision-mainmenu-73/the-phyisiology-of-double-vision.html. Spot patches are discussed at the bottom of that page, and this website has other information that may be of interest to you.

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great post
by: Anonymous

nice information to read. Very great post.

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Mini Stroke and Visual Field Loss

by Fred E.
(Los Angeles, CA)

Question: My 88 year old mother had a small stroke 40 days ago and has lost the vision on the right side of her visual field. She has also lost most of her short term memory. She has no numbness or weakness on either side. Her speech is very clear. No slurring, complete sentences and thoughts. She lives in Eugene Oregon and currently resides in assisted living. She takes herself to the bathroom and uses a walker. She is also on oxygen 1.5 litres. How should we rehab her for the best stroke recovery in Eugene? Thanks.



Answer: I don't know if it's the case with your mother, but stroke patients that do not present with problems such as limb paralysis or impaired speech often do not receive adequate rehabilitation or therapy. Stroke patients whose main deficit is hemianopsia may receive very little or no therapy for the condition because it is often overlooked.

Hemianopsia is the term for when a stroke victim loses 1/2 of their visual field. It can spontaneously improve in the first three to six months following a stroke, however, many do not resolve. Compensation techniques can be used for hemianopsia as well as visual aids. I recommend contacting an opthamologist experienced with hemianopsia as well as finding an outpatient facility with an occupational therapist that specializes in vision training (you will need a MD order for the occupational therapy treatment). When you call the opthamologist or therapy clinic, specifically ask if the professional has experience with treating hemianopsia and their background with treating visual deficits in stroke.

Some of the techniques and equipment used to deal with hemianopsia include:

Saccade training or scanning therapy - This involves training the patient to search or scan into the area of visual field that is missing. Some various activities include head/eye shifts, Dynavision, computerized trainers, descriptive walking, last letter cancellation, puzzles, and search strategies.

Boundary marking - training the patient to search for a marker at the end of a line of text.

Optical devices - special lens that can be used in eyewear such as Gottlieb Visual Field Awareness System, EP Horizontal Lens, and Chadwick Hemianopsia Lens

Visual Restoration Therapy - computer-based treatment that attempts to stimulate existing visual neurons to rewire and make new connections. It is based on the premise of neuroplasticity. Some controversy has surrounded this technique, but it is approved by the FDA.

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Vision Testing After Stroke

by Margie B.
(Hoopeston, Il)

Question:If a person is non verbal, how can they effectively be evaluated for an eye exam? My brother has expressed to me that there may be some vision problems when he sits at our table and looks outside. The expression I am getting from him is that maybe things pass by quickly, and not clear. He had a large stroke 2 months ago, his age is 52.

Answer: Opthalmologists will have training with performing eye exams on individuals who are unable to communicate effectively. I would call before setting an appointment and see if any opthamologists in your area have experience with individuals who have aphasia or have experienced stroke. The more experience the opthamologist has in this area, the easier the exam will be to perform. Specifically a neuro-opthamologist would be the best fit for your brother's examination.

You can go to http://www.aao.org/find_eyemd.cfm and enter the subspecialty of neuro-opthamology to find an eye M.D. that would meet your needs. If you can't find one in the specific city you live in, enter your state and see if there is a city close to you that has a neuro-opthamologist. If not, you can still call a general opthamologist in your area to see if they have experience with vision testing after stroke.

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Try finding a doc with VEP
by: Anonymous

For patients with communication difficulties, the Diospys NOVA VEP device is perfect for assessing the entire vision system. Check out www.diopsys.com - they have a "Find a Doctor" sectiont that may help.

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Eye Does Not Close Fully

Question: What exercises must be done if the eye sticks out a little bit out stroke and does not close fully?

Answer: I would recommend seeing an eye doctor for recommendations. An eye that won't close is prone to dryness and possibly getting debris in the eye. The eye doctor may recommend eye drops or a patch. You could also try some of the exercises that one does when they have Bell's Palsy which paralyzes one side of the face often leaving the eyelid half open. Some of the exercises used to help with eye closure can be viewed toward the bottom of this page:

http://bellspalsy.org.uk/exercises1.pdf

I recommend visiting a physical therapist who is trained in working with facial muscles so that they can train you to do exercises. You can also read more about vision and eye problems after stroke from this UK document:

http://www.stroke.org.uk/sites/default/files/F37_Visual%20problems%20after%20stroke_0.pdf



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How to use a computer after a stroke causes severe left neglect issues

by John Camoriano
(Arizona)

My father had a right parietal stroke and now has left neglect. His biggest loss is the inability to use his computer like he once did. Using an excel spread sheet is tough because sometimes he sees the column in the sheet and other times he does not see all the columns.

Are there any tools for a patient to regain use of the computer or to decrease issues related to its use?

Answer: First, I would have a neuro optometrist or neuro-opthamologist examine your father for visual deficits. If there are any visual deficits, they may prescribe special eyewear with prisms or other adaptive lens that can increase the visual field. This is not done by just any eye doctor. You have to see someone who specializes in working with vision impairments from stroke. You could try techniques used with low vision patients such as larger computer text, magnifiers, or screen readers. I would recommend doing a search for computer adaptations for individuals with low vision and see if anything comes up. You can also move the screen further to the right and mark the left side of the computer with a bright colored piece of tape so that your father knows that he has not scanned all the way to the left until he sees that piece of tape.

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