Vision problems after stroke - Stroke Association
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Vision problems
after stroke
Stroke Helpline: 0303 3033 100
or email: helpline@stroke.org.uk
About two thirds of people have vision problems after a stroke.
This guide looks at the different ways your vision can be
affected, and how you can get treatment and support.
Vision loss after a stroke can affect Assessing vision
your daily life in many ways. You You should have your vision assessed
could find it more difficult do things before leaving hospital, and any sight
like reading, shopping or watching problems should be treated. When you
television. You may need support for have an assessment, the healthcare
returning to work, such as help with team should ensure you have your
travel or new ways of doing your job. glasses or other aids you may use
with you. If you notice new vision
Sight loss is linked to an increased problems after you go home, tell
risk of emotional problems like your GP, or local optician or specialist
anxiety and depression, and this stroke nurse. They can refer you to the
can affect your ability to take part in hospital eye clinic for an assessment.
rehabilitation. Sometimes the practical
and emotional difficulties that sight If you had sight problems before your
loss causes are not apparent in stroke, it is important to carry on with
hospital, and you may only become any treatment like eye drops, and
aware of them when you return home. keep having regular sight checks. This
includes conditions like cataracts,
age-related macular degeneration,
diabetic retinopathy or glaucoma. Your
vision, and the effects of a stroke, can
change over time, so it’s important to
get advice if you notice any changes in
your sight.
For more information visit stroke.org.uk 1Vision problems after stroke
Eye tests for people with Reduced central vision and
communication or cognitive other visual field loss
problems
Depending on someone’s Your visual field is everything you can
communication difficulties, some see, including straight ahead (central
opticians are able to conduct eye tests vision) and out to the side (peripheral
using pictures, symbols or numbers. vision).
If this isn’t possible, there is a tool
called a retinoscope that uses light Visual field loss means that you are
reflections to determine someone’s unable to see a section of your field of
prescription, without the need for vision, usually because the vision areas
language. See ‘Other sources of help of your brain have been damaged by
and information’ for organisations that the stroke. The eyes themselves work
can help you find an eye professional normally, but the brain can’t process
with experience in this area. the images from one area of vision.
Where the visual field loss happens
depends on where the stroke occurred
How can a stroke affect in your brain. It almost always affects
my vision? the same side of the visual field in
both eyes (this is called ‘homonymous’
Like the other effects of stroke, vision visual field loss). How much visual field
problems can improve over time, is lost varies between people. The
as the brain recovers. How you are most common type is homonymous
affected depends on exactly where the hemianopia, which means losing the
stroke occurred in your brain. There left or right half of the visual field of
are four main areas of visual problem, both eyes. A less common type is
and you may have one or more: scotoma, when there is a small patch
of vision loss, often near the centre of
• Reduced central vision and other vision.
visual field loss.
• Eye movement problems. Often people think that the vision in
• Visual processing problems. one eye has been affected, but it is
• Other sight problems. usually one side of the visual field of
both eyes.
If just one eye is affected, often with
combined central and peripheral
vision loss, it may be due to damage to
the blood supply to the eye itself (see
‘Retinal vessel occlusion’ at the end of
this section).
2 Call the Stroke Helpline on 0303 3033 100Vision problems after stroke
How do I know if I have visual Visual scanning training
field loss? This encourages you to look to your
Some people with visual field loss may left and right sides in a systematic
not be aware of the missing area of way. It is used to help you be more
vision. People with hemianopia often aware of your visual field loss and
have difficulty reading, and may bump reminds you to look into your blind
into things on the affected side. You side. Eyesearch and Readright are
might only notice the field loss if you free online therapies designed to
look in a mirror and can only see one improve the speed and accuracy of
side of your face. When reading, it eye scanning and reading (see ‘Other
can be difficult to locate the start of sources of help and information’ for
a line if you have left-sided field loss. further details). Other options include
If you have right-sided field loss, it’s using line guides when reading, having
harder to see ahead along the line of good lighting, and using edge markers
text. It can be difficult to get around, on books and newspapers.
particularly in unfamiliar or crowded
places. Widening your field of view with
optical aids
Will visual field loss recover? This involves using a plastic prism on
Visual field loss can improve, usually your glasses. The prism is worn on
within the first month after a stroke. either one or both lenses). It creates
Around 15% of people recover an image of part of the side of visual
completely and 30% have a partial field loss (your blind side) and reflects
recovery. For about half, the field it over to your good side. This acts as a
loss will be permanent but there are prompt or cue for you to look towards
techniques to help you make the most your blind side or may help you to
of your remaining vision. notice things on that side.
Techniques for better vision Vision restorative treatment
An eye specialist can assess your eye There are some treatments available
problems and advise you on what will privately that aim to restore part of
work best for you. The missing area the lost area of visual field, using
of vision can’t be restored, but you computer-based therapy. These are
can get help to make the most of your not available through the NHS, but
vision. The technique that seems to if you wish to try this treatment it’s
help most is visual scanning training. a good idea to get advice from your
Using special lenses and optical aids stroke nurse or eye specialist first.
may help some people.
For more information visit stroke.org.uk 3Vision problems after stroke
Making the most of your sight They can improve over time, and may
Ask your orthoptist or optometrist eventually stop. They can return or
(optician) about low vision aids such as get worse if your sight gets worse or
magnifiers. An eye health specialist or if you are unwell due to an infection.
GP can give you a referral to the local Hallucinations can be caused by other
low vision service, where you can get conditions affecting the brain, so if
low vision aids and advice. you start having them tell your GP,
optician or specialist stroke nurse.
You may be given magnifiers for There is no medication or treatment
use with near objects and reading, for visual hallucinations, but you
or telescopes for distance. You can can find organisations that support
try anti-glare glasses or overlays, to people with hallucinations in ‘Other
reduce excessive glare. You can try sources of information’ at the end of
using brighter lighting, and using this guide. RNIB publishes a guide to
colours to make household objects Charles Bonnet Syndrome available at
easier to find. rnib.org.uk and Esme’s Umbrella is a
campaign group raising awareness of
You might need someone to help the condition.
you get around in the early days
and weeks after the stroke. With Retinal vessel occlusion
support, and by learning techniques Retinal vessel occlusion is due to a
like visual scanning, people can blockage in one of the blood vessels
regain confidence and become more to the retina (retinal arteries). It is
independent. also called an ‘eye stroke’ but unlike a
stroke, it does not affect the brain.
Visual hallucinations
Visual hallucinations happen when the The retina is a light-sensitive area of
brain generates images in the missing nerves at the back of your eye. If the
area of vision. The images appear in blood supply is blocked, it can cause
your blind area. You might see simple sudden loss of sight. Some people
patterns, or more complex images of have brief periods of sight loss before
people and places. For some people, it having permanent vision loss.
is the only time they notice the area of
vision loss. It is also known as Charles It’s possible to treat a blockage in
Bonnet syndrome. a retinal artery if you are seen at a
hospital within four hours. However,
Visual hallucinations are caused by the retina is very sensitive to loss
sight loss, and they are not a symptom of blood supply, and it may not be
of a mental health problem. They often possible to avoid permanent sight
start after a sudden loss of vision. loss.
4 Call the Stroke Helpline on 0303 3033 100Vision problems after stroke
If you notice any sudden loss of vision, Inability to move both eyes together
you should visit your local hospital If the nerve control to your eye
emergency department straight away. muscles is affected, one of your
eyes may not move correctly. This
With a blockage in a retinal vein may cause you to have blurred
(vessel carrying blood away from the vision or double vision (diplopia).
retina), your sight can become dim or This is sometimes called a squint or
blurry over a few days. strabismus.
Retinal vessel occlusion shares many Eyes move constantly, or wobble
of the risk factors for stroke, so you This can make it hard to focus on
will be given tests and checks for objects, or cause double vision. This
conditions like high blood pressure, condition is called nystagmus.
diabetes and high cholesterol. You
should be advised on taking steps to Impaired depth perception and
improve your health such as stopping difficulty locating objects
smoking, maintaining a healthy weight For example, when making a cup of
and eating a balanced diet. tea, you may misjudge the position of
the cup, and pour water over its edge
rather than into it.
Eye movement problems
How are these problems treated?
A stroke can lead to a variety of There are a number of treatment
problems with the fine nerve control options. Exercises can help if you have
that is needed to move your eyes. We difficulty moving your eyes to look at
have listed the main ones below: objects held close to your face. Prisms
can improve double vision or allow
Impaired eye movements you to see things to one side if you are
These may affect your eyes’ ability unable to look in that direction. Like
to move from looking at one object glasses, prisms are prescribed for each
to another or to follow a moving individual after a sight test.
object, like someone walking past.
These problems can make reading A patch over one eye can also be used
more difficult and can also affect your to avoid double vision. This makes it
general mobility. For example if you easier to see, but using only use one
are unable to look around quickly, eye (monocular vision) can also cause
walking outside is likely to be more some difficulty. You can work with
challenging. an orthoptist to choose which option
works best for you.
For more information visit stroke.org.uk 5Vision problems after stroke
Visual processing problems How are visual processing
problems treated?
Some vision problems after stroke Many people recover well from
are due to the brain having difficulty visual neglect. If you have neglect
processing the information received you might be able to learn scanning
from the eyes and other senses. This and awareness strategies. If you have
can happen in many ways, for example problems such as difficulty recognising
difficulty recognising objects or people colours, faces, objects, complex
by sight, or recognising colours. It scenes or text, you may be taught to
can cause difficulty when you try to use your other senses (for example
reach for objects or make it harder to touch or hearing) to process the
see more than one object at the same information in a different way and to
time. help you to improve your awareness of
the affected side.
Visual neglect
The commonest type of visual
processing problem is visual neglect, Other sight problems
which means that you are unaware
of your surroundings to one side. You Dry eyes
may not realise that you are missing If you have weakness in your facial
things around you. For example, you muscles and eyelid muscles, you may
may be unaware of objects and people have difficulty closing the eyelids fully,
on your affected side, and may ignore or your eyes could stay open when you
people or bump into things without are asleep. This can lead to a dry eye
realising they are there. Visual neglect and irritation. It is important that this is
can reduce your ability to look, listen treated early with lubrication drops or
or make movements towards part of ointment to prevent more serious eye
your environment. complications such as ulcers. Taping
the lid closed at night is also very
Neglect is more common in people important if the eye does not always
who have had a stroke on the right close fully.
side of the brain, which affects their
awareness of the left side. The person Light sensitivity
is not aware that they are missing Light sensitivity is common after
part of their vision. When neglect is a stroke. You might be bothered
severe it may be impossible to draw by bright light, or glare from light
someone’s attention round to their coloured surfaces. Some people find
affected side. Visual field loss and that a yellow or orange tinted overlay
neglect can occur together, which can helps reduce glare.
make it harder to use strategies like
visual scanning or patches.
6 Call the Stroke Helpline on 0303 3033 100Vision problems after stroke
Eye health professionals You might have a full vision
assessment in an outpatient clinic. You
• An orthoptist can assess and treat a may be referred to a low vision clinic
range of eye problems, particularly where you can have an assessment
eye movements. and advice on using magnifiers or
• An ophthalmologist is a medical other visual aids. You can ask your GP
doctor who specialises in or local optician for a referral.
diagnosing and treating diseases
of the eye. Only a consultant If you have sight problems, there is a
ophthalmologist can certify people wide range of specialist equipment
partially as sight impaired. and household items available to help.
• An optometrist (optician) tests These include clocks and watches with
sight, prescribes and dispenses large numbers, big button telephones
glasses or contact lenses and can and large print books and calendars.
screen you for eye disease Contact the Royal National Institute
• Support workers and eye clinic of Blind People (RNIB) for more
liaison officers (ECLOs) can give information (see ‘Other sources of
additional support. They can provide help and information’ at the end of
you and your family or carer with this guide).
information on practical aids and
emotional support. ECLOs provide
a bridge between the eye care Driving
professionals in hospital and other
organisations that can provide you After a stroke or TIA, by law you
with support at home. cannot drive for one month. Whether
• Visual rehabilitation officers help you can return to driving depends on
you make use of your remaining the type of stroke you had and the
vision and other skills to increase vehicle you drive.
your independence.
If your vision was affected by the
Accessing an eye specialist stroke, you must get a proper visual
After a stroke, you should be referred assessment before attempting to
to an orthoptist or ophthalmologist return to driving, even if you think your
specialising in stroke and brain injury. vision has recovered. This can take
They can assess you and arrange place in a hospital eye department.
treatment for poor vision, double You should be given clear information
vision or visual field loss. Ideally this about your condition and offered
assessment should happen before treatment if it is appropriate, which
you leave hospital, as visual problems may help improve your vision to the
can affect daily life and rehabilitation level needed for driving.
of other problems after stroke.
For more information visit stroke.org.uk 7Vision problems after stroke
The DVLA (DVA in Northern Ireland) A consultant ophthalmologist can
state that you cannot drive with: complete the request to issue you with
a certificate and referral for support
• Double vision. services. In England and Wales this
• Blurred vision. certificate is called the Certificate of
• Visual field loss, particularly central Vision Impairment (CVI). In Scotland
vision. this is called the CVI (Scotland) form,
and in Northern Ireland it is called
For information and advice, read our A655.
guide ‘Driving after stroke’ or call our
Helpline. To register your sight loss, contact
your local social servicesor hospital
eye clinic, and they will add you to the
Employment and sight loss register. RNIB has more information
on the benefits of registering your
If you are having problems with your sight loss and how to do it (see ‘Other
work because of your vision, you can sources of help and information’).
ask your employer to make reasonable
adjustments to help you. You can get
information on your rights at work and Tips for coping with vision
how to return to employment after a problems
stroke in our guide ‘A complete guide
to work and stroke’, and The Royal • If you have double vision, try using
National Institute of Blind People a patch when reading or watching
(RNIB) has advice and resources on television.
sight loss and work. • If you have lost your vision to one
side, it is important to move your
eyes and head towards the weaker
Should I register my sight loss? side, for example on entering a
room. The more you scan and move
If you are assessed as being sighted your eyes and head to that side,
impaired (partially sighted) or the quicker you will detect objects
severely sight impaired (blind), you on that side and reduce your risk of
can choose to register your sight bumping into objects or tripping.
loss. This can make it easier to get • When reading, use rulers and
practical help from social services, as markers to highlight the beginning
well as entitling you to concessions and end of sentences and to help
such as council tax reduction, the you keep your position along a line
Disabled Person’s Railcard and local of text.
travel schemes. It can also help when
claiming certain state benefits.
8 Call the Stroke Helpline on 0303 3033 100Vision problems after stroke
• Make sure your lighting is good and My Stroke Guide
where possible, have it positioned to The Stroke Association’s online
your side and not behind you, as this tool My Stroke Guide gives you free
causes shadows. access to trusted advice, information
• Reduce the number of objects and support 24/7. My Stroke Guide
that are on your surfaces at home, connects you to our online community,
particularly in the kitchen. If there to find out how others manage their
is too much clutter, it can be more recovery.
difficult to pick out individual items.
• Vision problems are not always Log on to mystrokeguide.com today
obvious for other people to see. You
might find it helpful to explain your
sight problems to friends, family and Other sources of help and
colleagues to help them understand information
the support you need.
• If you lack confidence in going out Help with finding an optician for
and about, a visual rehabilitation people with communication or
officer can help you to learn cognitive difficulties
strategies for safe travel on foot and
using public transport. British Association of Behavioural
Optometrists (BABO)
Website: babo.co.uk/find-a-
Where to get help and behavioural-optometrist/
information
Seeability – Find an Optometrist
From the Stroke Association Website: seeability.org/find-an-
optometrist
Helpline
Our Helpline offers information and Visioncall
support for anyone affected by stroke, Website: vision-call.co.uk
including family, friends and carers.
Free online therapy for vision
Call us on 0303 3033 100, from a problems
textphone 18001 0303 3033 100 or
email helpline@stroke.org.uk. Eye Search
Website: eyesearch.ucl.ac.uk
Read our publications A website from University College
Get more information about stroke London Institute of Neurology.
online at stroke.org.uk, or call the Provides free online therapy for people
Helpline to ask for printed copies of with visual search problems due to
our guides. hemianopia and spatial neglect.
For more information visit stroke.org.uk 9Vision problems after stroke
Read Right Audio books
Website: readright.ucl.ac.uk
Free online practice-based therapy Calibre
to improve reading speeds in people Website: calibreaudio.org.uk
with hemianopia from the University Tel: 01296 432 339
College London Institute of Neurology. Free postal lending library of
unabridged books. Membership is
Organisations offering information, open to children and adults who are
support and equipment blind or partially sighted, or have
dyslexia.
Esme’s Umbrella
Website: charlesbonnetsyndrome.uk Listening Books
Helpline: 020 7391 3299 Website: listening-books.org.uk
Support and information for people Tel: 020 7407 9417
with visual hallucinations due to sight Postal audio library service with a
loss (Charles Bonnet syndrome). small annual membership fee.
Nystagmus Network Playback
Website: nystagmusnet.org Website: play-back.com
Information and support for people Tel: 0141 776 3395
with nystagmus. Provides a free service recording text
to audio for people with sight loss.
Partially Sighted Society Also has an audio publication library.
Website: partsight.org.uk
Tel: 01302 965 195 Professional bodies
Resources, products and support for
people with sight loss. British and Irish Orthoptic Society
Website: orthoptics.org.uk
Royal National Institute of Blind Tel: 020 3853 9797
People (RNIB) Provides information on the eye
Website: rnib.org.uk problems that occur following brain
Helpline: 0303 123 9999 injury, including stroke. Search the site
Information about all aspects of sight for ‘Stroke and neuro rehabilitation’
loss and an emotional support service. for useful resources.
Visionary College of Optometrists
Website: visionary.org.uk Website: college-optometrists.org
Helpline: 020 8090 9264 Tel: 020 7839 6000
Email: visionary@visionary.org.uk Professional body for optometrists in
UK network of local charities for blind the UK.
and partially sighted people.
10 Call the Stroke Helpline on 0303 3033 100Vision problems after stroke
Royal College of Ophthalmologists Optometrist (optician): a specialist
Website: rcophth.ac.uk who tests sight, prescribes glasses and
Tel: 020 3770 5327 contact lenses and screens people for
Professional body for eye doctors. eye disease.
Offers a range of information on eye
conditions. Orthoptist: an eye care specialist in
eye movement problems.
Driving licensing agencies UK
Photophobia: abnormally high
Driver and Vehicle Licensing Agency sensitivity to light.
(DVLA) England, Scotland, Wales
Website: dvla.gov.uk Prism: a plastic membrane which is
applied to a person’s glasses and
Driver and Vehicle Agency (DVA) which moves the position of objects
Northern Ireland when they are seen through the prism.
Website: nidirect.gov.uk/motoring
Ptosis: drooping of the upper eyelid.
Glossary Retinal vessel occlusion: a blockage
in a blood vessel to the eye.
Depth perception: the ability to see
the world in three dimensions. Scotoma: area of visual field loss.
Diplopia: seeing two images of a Strabismus: the two eyes do not line
single object (double vision). up together (squint).
Hemianopia: loss of vision on Visual field: the whole of your vision.
one side.
Visual neglect/inattention: the
Homonymous hemianopia: losing inability to notice things to one side.
half of the field of vision in both eyes.
Visual perception: how the images
Monocular vision: vision in only received by the brain are processed.
one eye.
Visual scanning: training which
Nystagmus: a condition where the encourages you to look in a systematic
eyes move constantly, or ‘wobble’. way to the right and left sides.
Ophthalmologist: a medical doctor
specialising in eye conditions.
For more information visit stroke.org.uk 11Vision problems after stroke
About our information
We want to provide the best information for
people affected by stroke. That’s why we
ask stroke survivors and their families, as
well as medical experts, to help us put our
publications together.
How did we do?
To tell us what you think of this guide, or to
request a list of the sources we used to create
it, email us at feedback@stroke.org.uk.
Accessible formats
Visit our website if you need this information
in audio, large print or braille.
Always get individual advice
This guide contains general information about
stroke. But if you have a problem, you should
get individual advice from a professional such
as a GP or pharmacist. Our Helpline can also
help you find support. We work very hard
to give you the latest facts, but some things
change. We don’t control the information
provided by other organisations or websites.
© Stroke Association 2020
Version 3. Published July 2020
To be reviewed: September 2022
Item code: A01F37
Every five minutes, stroke destroys lives. We need your support to help
rebuild them. Donate or find out more at stroke.org.uk.
JN 2021-089.7
The Stroke Association is registered as a charity in England and Wales (No 211015) and in Scotland (SC037789).
Also registered in the Isle of Man (No. 945) and Jersey (No. 221), and operating as a charity in Northern Ireland.
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