Generally people with visual field loss have a greater awareness and understanding of their defect than those with visual neglect. As a result, treatment options for visual field loss tend to be more effective than those available for visual neglect. Insight is key to a patient compensating for the field loss or neglect, so treatment should be combined with education to increase awareness for both the person and their carers/family and encourage self-management.
Reading is commonly affected in both visual field loss and neglect as the ability to smoothly follow a line of text is disrupted. Targeted treatment strategies are important to include.
Trials and ongoing research
Research into the most effective treatments for visual field loss and visual neglect is ongoing. At present, there is limited high quality evidence on which to base practice, but some useful sources of information are:
Cochrane Reviews:
- *Neglect: Cognitive rehabilitation for spatial neglect following stroke | Cochrane
- Field loss: Interventions for visual field defects in people with stroke | Cochrane
- Eye movement: Interventions for eye movement disorders in people with stroke | Cochrane
*an update of this review should be published in 2021.
National Clinical Guidelines for Stroke:
Royal College of Physicians (2016): Stroke guidelines
Visual field loss
Scanning
Encourage patients to regularly scan towards their affected side.
Engage patients in games or activities that involve use of the full visual field:
- computer games which require eye movements across the whole screen
- kitchen tasks which require scanning of the workspace
Teach the use of search strategies to find objects.
Gradually widen size of activity to prompt head turning.
Practice strategies that encourage automatic head turning in daily living tasks.
Adapting the patient’s living environment
Make sure people and activities are visible within the area of unaffected vision.
Position patients so staff and other patients are mainly on the side of intact vision:
- Encourage visitors to sit to the patients’ unaffected side
- Furniture should be visible in the person’s intact visual field
- Reduce the amount of visual stimulation when engaging in activities
Reading assistance
Line markers: these draw attention to either the start or end of the text (depending on which lies in the affected visual field) and also help locate the next line more easily:
- ‘L’ shaped markers can be bought or made from plastic or card
- a bright ruler or strip of card can be placed vertically at the left or right of the reading passage
- ruling a thick red line down the side of newspaper columns
Vertical Reading: try turning the page 90 degrees so the patient reads either downwards or upwards (and the whole line remains visible).
‘Steady eye strategy’ for right visual field loss. The patient keeps their head and eyes stationary while sliding the text from their right to left (similar to viewing the paper in an old fashioned typewriter!)
Visual neglect
Scanning
Patients should be encouraged to regularly scan towards their affected side. This will likely require repeated prompting:
Engage patients in meaningful games or activities that involve use of both sides of the environment
- games such as Connect Four or Word searches
- activities such as gardening or meal preparation
Adapting the patient’s living environment
This is to work around the lack of awareness on one side.
- Approach patients from their non-neglected side and encourage attention towards midline and the affected side
- Educate people to sit to the patients non-neglected side, especially if there is more than one person
- Reduce environmental clutter, by removing unnecessary items
- Video feedback of person performing a task so they can develop insight into their performance errors (as opposed to mirror feedback where the person still may not attend to the mirror image of neglect their affected side) Soderback 1992; Tham & Tegner 1997 (for full references see Additional Information box below)
Reading assistance
Patients with neglect will often miss the start of reading passages and struggle to find the next line. It may help to use:
- a bright ruler or strip of card positioned to the neglected side of the text. Reinforce its use with frequent reminders.
Page last reviewed: 29 Jul 2021
