 | William L. Park, OD, FAAO is in private practice in Wichita, KS. He works exclusively with patients referred for low vision evaluation, low vision rehabilitation and neurological vision loss. He is a past Director of Low Vision Services, Lions Research & Rehabilitation Center, Wilmer Eye Institute-Johns Hopkins University. Dr. Park can be reached at William L. Park, OD, LLC, www.parklowvision.com, 610 N. Main, Suite 201, Wichita, KS 67203, (316) 440-1690 or drpark@parklowvision.com. |
Vision
2011-12-27 09:55:34
Vision impairment after a stroke - series
Q: My 42-year-old husband experienced a stroke seven weeks ago and was admitted and treated at a hospital, followed by further care at a rehabilitation hospital. However, he still has difficulty with compensating for double vision, loss of peripheral vision, reading, walking and performing simple tasks. He is extremely depressed, which is affecting our entire family. I feel totally helpless. What can I do?
A: First, you are not alone. Approximately 750,000 people suffer a stroke each year in the United States. The problems you express are about visual function, not necessarily visual acuity. This is due to the abruptness of loss of using both eyes and the inability of the brain to adapt. This type of vision loss can also severely affect recovery due to cognitive and motor dysfunction.
Many patients do not express their decreased capability to perform normal activities of daily living to their family, friends or occupational associates, though they may be extremely frustrated and lack an understanding of why they are unable to perform these tasks as they did in the past. They may become more withdrawn or non-social. These individuals may benefit from social work or counseling.
Double vision is common due to cranial nerve trauma as a result of a hemorrhage or a mass that leads to poor function of the muscles involved in movement of each eye. This can be corrected in many cases with prism lenses that compensate for the defect. A word of caution – these lenses may need to be changed over time and, in many cases, the double vision resolves. Loss of peripheral visual field is also not uncommon and can be resolved with prism lenses, temporally or permanently, or with vision therapy scanning techniques.
Early rehabilitation intervention is critical and should be implemented with occupational and physical therapy as soon as possible to achieve the objectives desired by both professions. That would include enhancement of mobility, prevention of falls, improved speech and language skills, scanning and reading skills, along with enhancement of activities of daily living.
If your husband is still having difficulty, you may want to talk to his neurologist, primary care physician or any other healthcare practitioner about referral for further neurological rehabilitation. An evaluation by a vision rehabilitation team, consisting of a vision rehabilitation practitioner (optometrist or an ophthalmologist), occupational and physical therapist, and orientation and mobility specialist in the same clinical environment, may dramatically and expeditiously improve visual function, while providing further patient education about resources, therapeutic interventions and environmental adaptations. The changes will enhance the patient’s overall quality of life.
Because transportation and mobility are significant factors for those rehabilitating from a stroke, the goal of my practice is to participate as part of this team in one building, on one floor, with each healthcare practitioner providing expertise and patient care in their private suite and treatment rooms.
