Half My World is Gone and The Rest is Double

As a neuro-ophthalmologist I am often often asked to see patients who have had a stroke. These patients can be seen at the hospital or in our clinic depending on how recent the stroke was or how severe it was. Sometime I will even be seeing patients that never knew they had a stroke until a recent eye exam revealed this. Sometimes the stroke can cause loss of the visual field  and or double vision. It is my job to help identify the stroke and offer any possible treatment.

Strokes Causing Visual Field Loss

 

Strokes that affect the brain can cause a person to loss half their vision is both eyes. Patients often know they have lost vision in one eye but not always that the other eye is involved. This occurs because of the way the nerves or our eyes connect to the brain. If you close one of your eyes and cut straight down the middle from top to bottom that is the way the vision is divided when it goes to the brain. So the vision on the right side of the field goes to the left side of the brain on both eyes, and the vision on the left from both eyes goes to the right side of the brain. The nerves of our eyes send the signal to the back of the brain called the occipital lobe (it is behind the back part of your skull). Because of this division even if a stroke takes out half your brain you will not be blind.This can be seen in the drawing to the right.

We can often do a visual field test and determine the extent of the visual field loss. The test can even sometime tell us what part of the brain was affected.

The problem with these defects is that there is no known good treatment for it. There has been a lot of trials of different devices to help recover the lost field area. Often this includes computer programs, flashing lights, and other devices. The problem I have with it all is that there has not been any good proven articles to show this works. Yes there are articles showing it works but most are published in journals that were created by the makers of the device. So my standard to patients is to be careful when pursuing these treatments. While most will not hurt any more then your pocketbook they can give false hope. Some patients will get some improvement over time (usually over the period of a year). The best therapy for a patient is to work with physical therapy and occupational therapy to help learn to maximize use of the remaining field.

The Big Question

Usually the biggest question I get from my patients is “Can I drive?”. This is not a decision that I or any doctor fully get to make. The decision from the visual standpoint is based on the regulation of the state motor vehicle department. Unless there is a problem in the eye itself (ie. glaucoma, macular degeneration, diabetic changes) the overall visual acuity should be ok despite the stoke. Often the limiting visual problem for driving I see in stroke victims is the visual field.  In Florida the patient must have 130 degrees of continuous uninterrupted field. If the stroke causes compete loss of one side of the field, or even a large incomplete defect, there is not enough field left to qualify. If there is not enough field left I or any other doctor does not have a choice but to deny the patient to drive. This is designed to protect not only the driver but others on and around the road.

 

 Strokes Can Cause Double Vision

Patients can often present to the ER or our office complaining of double vision. As explained previously  true neurologic diplopia is from a misalignment of the eyes. Strokes that affect the brainstem can cause ocular misalignments. Be taking accurate measurements the location of the stroke can be identified prior to any imaging. Then depending on the extent and symptoms treatment can be suggested. As mentioned before this was discussed in the article on double vision.

 

Jody Abrams, MD

Oculoplastics/Neuro-ophthalmologist

Sarasota Retina Institute

Sarasota, Florida

 

 

 

Comments

  1. John Meyers says:

    I had a stroke on December10,2012. I lost the left side of my vision field. I live in N.W. Florida .Is there any one you know of or can recommend that I could see. I need someone in the area.

    • John
      I am sorry to hear about the stroke. What part of Florida do you live in specifically? I assume the panhandle area, but there are a few people up there so want to tell you someone that is near you.

      Jody Abrams, MD

    • I had a stroke nineteen months ago and loss half my left visual field in both eyes. I have recovered over half the bottom field vision on left and some on the right. My concern is that I felt fine and I adjusted well the first ten months, but last July, 2012, I began experiencing major vision changes such as blurr spots in my upper left field and in August I woke up and a blurred curtain came down in my left vision field, alone with floaters and flashes. I immediately went to my opthamologist. He dilated my eyes and gave me a thorough exam that included a vision field test. He didnt find any retina detachment and vision field test actually showed improvement. He referred me to a retinal specialist and my eyes and retinal were normal. Since then, I have been experiencing left eye pain, watery eyes, gradual reduction of space (feeling closer and closer to the ground), steady diming vision, needing more light (A sunny day looks cloudy now). I have seen a Nero ophthalmologist in my town and was told my eyes were fine, optic nerve was normal, no glacoma and have 20/20 vision with my glasses on. He said I have cateracts in both eyes but i shouldnt do anything about them yet, and my eye pain could be from migraine headaches.

      I am so afraid I am gradually going blind. I have had several MRIs, with and without contrast (results showed nothing my neurologist was concerned with). I have eye pain every day without a headache and I am losing light and depth or space quickly. It is like my brain is still adjusting and trying to find its space. Both the ophthalmologist and neuro ophthalmologist do not think I am going blind, but they never heard of symptoms like mine with the type of stroke I had. My neurologist also do not know why I am still having these progrssing symptoms so late after my stroke. I am so afraid, depressed and very anxious. I do not know where to go or where to turn. Left eye pain, losing light and dept or space are my biggest concerns. Are my symptons common for homonymous hemianopsia strokes? Could it be something simple as cateracts? I greatly welcome your help.

      • JAbramsMD says:

        Zinnia,
        Do they know why you had the stroke? Was it lack of blood from a clot, high blood pressure, or a bleed into the brain? The cause of the stroke can shed some light on what is going on. Cataracts can affect your vision and it might be that with the combination of the cataract and the homonymous hemianopsia that it makes things worse then in a normal person. The fact that eyes water and burn make me wonder about anterior surface disease like dry eyes, which can happen after a stroke. Has the visual field changed any over the last 6 months? Do you have an temple tenderness, new headaches, weight loss, or fevers? It would be odd but giant cell artierits can cause strokes and vision loss.
        If the visual fields are not changing and the vision on the eye chart is not getting worse you can feel confident that you are probably not going blind. These are great ways to monitor the ocular system. Also an OCT can be helpful to make sure the retina and optic nerve are not changing even before changes in the field are seen. I hope this helps some.

        Jody Abrams, MD
        Oculoplastics/Neuro-ophthalmology
        Sarasota Retina Institute
        Sarasota, Florida

        • Dr. Abrams,

          Thank you so much for your comments and view on my condition. I think this site is a wonderful place for patients to come and learn information on various eye diseases and to gather insight into their condition. Thank you so much!!

  2. herbert williams says:

    Dr Abrams,

    how far out do you believe stem cell is for NAION,,I was diagnosed in 06,,I was a patient of yours in Chattanooga a few years later,,we talked about this and I was just wondering your thoughts on it now
    Thank you
    Herbert

    • Jody Abrams, M.D. says:

      Hello Mr. Williams
      I still believe stem cells are the future of treating patients with NAION. From what I heard last February at our national meeting Stanford is the leader in this field and is making some great strides. I will know more at our March annual meeting. Also in February at our conference we host here in Sarasota we have a speaker and expert in the field of ocular implants that act like cameras that can be wired into the brain. This is possible another avenue that might arrive even earlier then stem cells since there is a little less government regulation.
      As soon as we know more I will be posting it on our website so suggest you sign up for our email list to not miss any announcements.
      I hope all is well otherwise for you in Chattanooga.

      Dr. Jody Abrams

      • herbert williams says:

        Dr Abrams,
        thank you so much for the reply,,I think I was told at the Chattanooga office that once I was a patient there I automatically went on the stem cell list,,,I’ve heard so much the last few years I just wanted to make sure I was remembering correctly plus with the ocular implants is there a waiting list or notification list I should be on,,,thank you again for being such a caring Dr. it means the world to those whose world has been turned upside down with no warning,,,mine was 22 days,,,(wife is typing of course) I will definitely get on the email list and will continue to check-in.
        Thank You
        Herbert

        • Jody Abrams, M.D. says:

          Mr Williams
          As soon as we get to a point where we can offer stem cells to patients safely I promise you will be seeing all kinds of information coming out here about it. We will be calling all patients we can find to offer them the chance to regain vision. The same for any of the implants. My colleagues and I want nothing more then to offer a chance of regaining sight for our patients that previously had none. Stay tuned for further updates here as I learn them. I appreciate your kind words also.

          Jody Abrams, MD

          • herbert williams says:

            Dr. Abrams,,

            thank you so much for all of your replies,,one more question if I may,,,for about six months I have had severe watering of my eyes,,basically pouring down face,,have to keep Kleenex with me at all times,, upon waking up my eyes wil be crusted over and I have to go straight and get warm cloth to open them,,it is all times of the nite or day,,six months on going so I don’t think it would be related to seasons,,eyes stay red and swollen almost continuous,,just wondering if you had any ideas of what I may do,,once again thank you so much
            Herbert Williams

  3. herbert williams says:

    Dr Abrams,,
    We just received the update about OCT would it help with ION
    thank you
    Herbert Williams

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  1. […] pull it off the tarsal plate. There are neurologic causes of droopy lids such as myasthenia gravis, brain strokes, cranial nerve 3 damage,  other neuromuscular disorders.It is important to see your eye doctor for […]

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