| Visual field loss | |
|---|---|
| Re-assessment | Many patients will recover from visual field loss, so a repeated visual field assessment is essential to determine the extent of recovery or persistence. Most recovery occurs in the first 3 months and is most marked in the first month post-stroke (Zhang et al – see Additional Information box). A detailed field assessment by automated perimetry would be useful at re-assessment, to allow an accurate assessment of the remaining visual field. Follow-up visual field testing is available from 2 main providers: the area eye service and local opticians. The patient should be advised who to see, when to see them and how that appointment will be made. This will vary for each hospital – do you know what your stroke team or hospital eye service recommend? |
| Patient response | If the visual field loss persists, patients may be aware of this and try to compensate with increased eye and head movements towards the side of field loss. |
| Treatment | This should continue after discharge, using a combination of scanning training, environmental modification and reading aids, tailored to the size and position of visual field loss and the patient’s needs and abilities. Other treatments available include prisms applied to glasses to help enlarge the area seen, and visual restitution therapy, aiming to decease the area of visual loss, provided under therapist supervision. |
| Implications | Persistent symptoms have implications for driving, leisure, work and rehabilitation. These areas are covered in previous STARs advancing module 10: Resuming daily activities after stroke. It covers-
|
| Visual neglect | |
|---|---|
| Re-assessment | A lot of patients recover from visual neglect within the first 3 months post stroke (and some even later), so repeated neglect assessment is important – it is acceptable to use the same tests as used initially. |
| Patient response | If symptoms persist, the patient will have limited awareness of their condition, and will develop fewer spontaneous coping strategies than those with visual field loss. This tends to make rehabilitation more difficult and families and carers may struggle with the person’s inability to understand the cause of their problems. Caregivers should encourage stroke survivors to slow down, think and give themselves time to pay attention to their affected side, to improve their safety. |
| Treatment | Continue to encourage patients to explore and scan to their neglected side. The emphasis in follow-up will increasingly be on adaptive treatment approaches, where the patient and clinician identify ways to alter a given task to facilitate performance. Examples are:
|
| Implications | Persistent symptoms have implications for many aspects of everyday life. These areas are covered in the STARs advancing module 10: Resuming daily activities. It covers
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Page last reviewed: 29 Jul 2021
