The leading cause of a neurological impairment in the world is cerebrovascular accident or stroke. A stroke will often result in dysfunction in the brain usually affecting one side or hemisphere of the brain. When the right or left hemisphere of the brain is affected, it may cause a loss of motor function on the opposite side of the body. This can significantly impact independence and quality of life.
Stroke and Vision
If a stroke has caused a loss of motor function, it may result in difficulty with weight bearing on the affected side. It may also cause visual field loss or a spatial neglect on the same side. The hemisphere of the brain that is affected may also result in more specific symptoms, for example a stroke in the left hemisphere may also cause difficulty with recognizing letters, numbers, and words called a receptive aphasia. It may also produce difficulty speaking which is termed an expressive aphasia. The tissue damage often caused by a stroke commonly results in Post Trauma Vision Syndrome (PTVS).
Symptoms of PTVS include:
- Double vision
- Headaches
- Blurred vision
- Dizziness or nausea
- Attention or concentration difficulties
- Staring behavior (infrequent blinking)
- Spatial disorientation
- Losing your place when reading
- Not being able to find the beginning of the next line when reading
- Visual memory problems
- Pulling away from objects when they are brought close to you
- Seeing objects as moving when they are actually stationary
- Difficulty tolerating busy/crowded environments
If you or a loved one are currently recovering from a stroke and experience any of the symptoms mentioned above, please know that we can help in your rehabilitative process. If you would like to learn more about PTVS, please click here.
Stroke and Balance
When a stroke occurs, the spatial process often becomes compromised affecting the balance between the two visual processes. This results in disrupted support for posture, balance, and movement causing vision problems. Following a stroke, those affected initially tend to lean toward the side of their hemiparesis (paralysis of one side of the body). The brain will attempt to compensate for this change by shifting the visual midline away from the affected side. This is termed Visual Midline Shift Syndrome (VMSS). When the visual midline shifts, the effect is to weight shift away from the affected side.
Symptoms of VMSS include:
- Dizziness or nausea
- Spatial disorientation
- Consistently drifting to one side of hallway or room
- Bumping into objects when walking
- Poor balance or posture (leaning forward, backward or to one side when walking, standing or seated in a wheelchair)
- Back pain or muscle rigidity
- Difficulty tolerating busy/crowded environments
Often a person receiving rehabilitative services after a stroke will improve only to a certain level and then “plateau” or not make any additional progress. This is because the visual midline will often remain deviated. If the visual midline remains compromised, the progress will often “plateau” which can feel immensely disheartening. At the Padula Institute of Vision, we commonly work with patients who have been told their progress has plateaued. We are here to help. If you would like to learn more about VMSS, please click here.
Neuro-Visual Processing Rehabilitation
Individuals who have had a stroke and experience visual dysfunction can benefit from a neuro-visual evaluation. This exam is very different from a routine eye exam. Its purpose is to provide an in-depth analysis of the relationship between the spatial visual process and the neuro-motor system using a variety of tests. If you would like to learn more about what to expect during an exam, please click here.
Treatment of visual processing symptoms often comes in the form of yoked-prism glasses which are usually prescribed for therapeutic use and should only be used under the direction of the prescribing doctor. These prisms may also be recommend for use during physical or occupational therapy. We also provide Neuro-Visual Postural Therapy ™ (NVPT) when necessary and appropriate.
For many, dysfunction of the visual process can be a primary cause of the symptoms they experience. Treatment through neuro-optometric rehabilitation becomes an interdisciplinary approach that can maximize potentials in other therapies such as physical, occupation, speech and cognitive therapies. Collaboration is often the key to successful rehabilitation.
Frequently Asked Questions
Strokes are medical emergencies that occur when blood flow to the brain is interrupted, leading to brain cell death. They are primarily categorized into two types: ischemic and hemorrhagic.
Ischemic Stroke
- What it is: An ischemic stroke happens when a blood clot blocks an artery supplying blood to the brain. This is the most common type of stroke, accounting for about 87% of all cases.
- Causes: The clot can either form in the brain artery itself (thrombotic stroke), often related to plaque buildup (atherosclerosis), or travel from another part of the body, such as the heart (embolic stroke).
- Mechanism: The blockage deprives the brain tissue downstream of oxygen and nutrients, causing damage.
Hemorrhagic Stroke
- What it is: A hemorrhagic stroke occurs when a blood vessel in the brain ruptures and bleeds into the surrounding brain tissue.
- Causes: This rupture is frequently caused by conditions that weaken blood vessels, such as long-term high blood pressure (hypertension), a ballooning of a blood vessel (aneurysm), head injury, or certain blood-thinning medications.
- Mechanism: The bleeding both deprives the area supplied by the ruptured vessel of blood, and the pooled blood puts excessive pressure on the surrounding brain tissue, damaging it.
Both types of stroke can have a profound and complex impact on vision because the areas of the brain that process visual information (the visual pathway) are highly susceptible to damage from interrupted blood flow or bleeding.
The Padula Institute of Vision, which focuses on Neuro-Optometric Rehabilitation, would address the resulting visual symptoms through specialized therapy.
Key visual impacts of stroke include:
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- Visual Field Loss (Homonymous Hemianopsia): The most common visual consequence, where the stroke damages the visual processing centers (often in the occipital lobe) resulting in a loss of the same half of the visual field in both eyes (e.g., losing the entire right half of vision).
- Oculomotor Dysfunction: Difficulty with eye movement control, leading to double vision (diplopia), eye strain, or problems with tracking objects.
- Visual Processing and Perception Deficits: The brain may struggle to interpret what the eyes see, resulting in:
- Visual Neglect: The patient ignores objects or space on one side, even if their vision is technically intact.
- Balance and Posture Issues: Distorted visual input affects spatial awareness, leading to dizziness or instability.
- Reading Difficulties: Trouble maintaining gaze on a line of text or skipping words.
The institute’s research demonstrates that when there is a visual field loss or a neglect of visual space it causes a visual midline shift, which then complicates the condition by adding balance difficulties, as well as difficulty with spatial orientation producing neglect. The Padula Institute of Vision specializes in rehabilitating these acquired visual disorders using Neuro-Optometric Rehabilitation and has discovered that we can utilize yoked prisms to realign the visual midline, thereby reducing or eliminating the balance problems and reducing risk of fall(ROF).
- Vision therapy to rebuild eye coordination, tracking, and focusing skills
- Prism lenses to expand the visual field and reduce double vision
- Neuro-Visual Postural Therapy™ (NVPT) to correct visual-postural imbalances
- Occupational therapy to adapt daily activities and improve safety
- Targeted eye patching when needed to manage double vision
Because the brain controls how we process and interpret visual information, a stroke can lead to several vision problems, depending on the area affected. Common issues include:
- Loss of part of the visual field (hemianopia)—difficulty seeing on one side
- Blurred or double vision
- Trouble focusing or tracking movement
- Visual neglect, where the brain “forgets” one side of the visual world
An ischemic stroke often results from a clot forming in or traveling to a brain artery, sometimes linked to plaque buildup (atherosclerosis).
A hemorrhagic stroke occurs when a weakened blood vessel bursts—commonly due to high blood pressure, aneurysms, injury, or certain medications that increase bleeding risk.
- A stroke occurs when blood flow to part of the brain is suddenly blocked or interrupted.
- This interruption deprives brain cells of oxygen and nutrients.
- The resulting damage can affect movement, speech, thinking, and vision.
Two main types of stroke:
- Ischemic stroke: Caused by a blockage, such as a blood clot.
- Hemorrhagic stroke: Caused by bleeding from a ruptured vessel in the brain.
The Padula Institute of Vision Rehabilitation
provides a patient-centered approach to evaluate each person’s individual imbalance in visual processing and will provide an individual direction for rehabilitation based on each person’s needs and abilities.
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