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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Tunnel vision from stroke

by Gail
(Wellsburg, Iowa)

Question: My husband suffered a stroke that only effected his eye sight. It left him with tunnel vision. He says he can see everything upward but out to the sides and especially below he says there is nothing.

Would occupational therapy help him in any way? The doctors never really followed up with what he was suppose to do, they just sent him home.

Answer:You can take your husband to a neuro-optometrist that deals with special vision issues like this which are due to stroke. Often special glasses with prism lenses can be made to help with the vision deficit. They may also have visual therapy available as well or at least will be able to refer you to a therapist. A neuro-optometrist is different than your regular optometrist, and to find the closest one to where you live, you can go to https://nora.cc/healthcare-locator.html. It looks like the closest two to you are in Independence and Cedar Rapids. There are not many neuro-optometrists so I would just enter your state name when you search rather than your city.

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Vision Rehab Treatment

by Audrey
(Salem, Oregon USA)

Question: What can be done regarding vision rehab in a stroke patient with homonymous hemianopsia who wants to resume driving again?

Thanks, Audrey

Answer:The patient would need to visit a neuro-optometrist (this is a specialized optometrist, not just any optometrist). The neuro-optometrist can evaluate the stroke patient's vision, determine the level of damage, prescribe special glasses that can help with the visual field, and make recommendations about what if any visual rehab is needed. To find a neuro-optometrist in your area, visit the Neuro-Optometric Rehabilitation Website at https://nora.cc or use their healthcare finder tool at https://nora.cc/healthcare-locator.html.

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Vision therapy
by: iLM

Our neurologist suggested we visit a neuro opthamalogist to determine vision weakness. He also scheduled an appointment with a driving therapist. The N.O. Found significant cataracts and following a driving evaluation, the plan was set to complete cataract surgery before moving forward with driving therapy. One eye has been completed, restored to 20/20 Our major problem is left side neglect. It was explained to us that it isn't just his left eye, but the left portion of both eyes. We tried speech therapist for cognitive, but neither therapist really understood left side neglect. I would be interested in other suggestions for LSN. my husband has directional and time management deficit.

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improve left visual field

by Ray
(Hibbing, MN, USA)

Question: I have a left visual field deficit following a hemorrhagic stroke on the right side What can I do to reduce the deficit?
Ray

Answer:If you have lost part of your visual field, you may need special glasses to help. There are glasses with prisms that might be beneficial. You would need to see a neuro-optometrist who specializes in visual problems due to neurological conditions such as stroke. This is a very specialized field. In order to find a neuro-optometrist in your area, you can visit https://nora.cc/ and select the find a provider tab. Make sure you select to find a neuro rehabilitation optometrist when doing your search.

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Optic Nerve Damage

by Omran Khalaf
(Pensacola Fl)

Question:Is it possible to improve visual field after five years of glaucoma and a stroke? My optic nerve had a considerable damage before the stroke now I can hardly see with my right eye.

Answer: I believe that damage to the optic nerve caused by injury or disease tends to be permanent. My understanding is that the cells that form the optic nerve don't regenerate or repair themselves, however, I know that there is always new discoveries and research occurring so it would be best to check with an opthalmologist or optometrist for the best answer to your question.

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Left Side Neglect Due to Right Parietal Hemorrhagic Stroke

Question: During inpatient speech therapy my husband was given written exercises to help him visually scan the left side. He has left sided neglect. Can you give me a website that I can download some written activities for him to do

Answer: I would recommend reading some of the eye exercises I have on my website at https://www.stroke-rehab.com/eye-exercises.html. On that page I recommend two websites, www.eyecanlearn.com and www.lumosity.com. There are also apps for visual neglect. One can be found at http://tactustherapy.com/app/vat/. As far as a website where you can find worksheets, you could try:

http://edhelper.com/visual_skills.htm

http://resources.sparkleboxteacherresources.ltd.uk/8000-9000/sb8600lc.pdf

http://www.printablesfree.com/categories/visual-scanning-worksheets

http://www.yourtherapysource.com/freestuff.html (look under the visual perceputal freebies section)

Many education websites have worksheets. You can google visual scanning worksheets which will will probably pull up quite a few websites for you. You could also look up visual neglect worksheets. There are also many apps available for this as well.

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