Vision Changes After Stroke

Vision Changes Post Stroke

This presentation will cover:

  • Identifying common visual changes post-stroke
  • Identifying common age-related visual changes 
  • Identifying adaptive vision strategies 

Mary Warren’s Visual Hierarchy

  • Visual Acuity  — How well you can see with your eyes
  • Visual Fields  — The space we can see with our eyes 
  • Oculomotor Skills — Moving our eyes in various directions
  • Visual Attention — Maintaining focus on a fixed spot
  • Visual Scanning — Moving your eyes in a coordinated fashion 
  • Pattern Recognition — Understanding and following patterns
  • Visual Memory — Recognition of shapes and forms 
  • Visual Cognition — Functional use of visual skills

Visual Changes

Common visual changes post-stroke

  • Approximately 65% of stroke survivors experience vision changes/problems (American Stroke Association, n.d.)
  • Neglect — Don’t visually respond to and aren’t aware of things on their affected side 
  • Field cuts  — Loss of some of the area we see with our eyes
  • Eye movement disorders
    • Eye turning (strabismus)
    • Eye tracking control  issues (oculomotor dysfunction)
    • Rapid eye jiggling (nystagmus)

Common age-related visual changes

  • Losing the ability to see items close to you
  • Increased time needed to adjust to lighting changes 
  • Difficulty distinguishing colors
  • Age related macular degeneration — Loss of central vision
  • Diabetic retinopathy 
  • Cataracts — Cloudy areas in vision
  • Glaucoma  — Can lead to vision loss 
  • Dry eye 

These can result in “low vision”

What is “low vision”?

  • Eyesight that cannot be fixed with glasses, contact lenses, medication, or surgery
  • Examples of having low vision may include…
    • Trouble reading 
    • Can’t see well enough to do daily tasks such as cooking
    • Difficulty recognizing faces of familiar people

Things to do to help keep our eyes healthy

  • Get your eyes checked regularly
  • Protect your eyes from sunlight—wear sunglasses and/or a hat when outside 
  • Follow a healthy, nutritious diet 
  • Monitor blood pressure 
  • Stop smoking
  • Control Diabetes as well as possible (if you have it)



  • Hang/organize clothes by color
  • Use small boxes within drawers as dividers to help organize items
  • Place high contrast tape on back of only one shoe in each pair to tell right from left 


  • Use high contrast items such as a dark bathmat to distinguish from the tub
  • Add large print labels to your shower items 
  • Use a magnified mirror for shaving or makeup


  • Use a high contrast cutting board (i.e. light cutting board on dark counters, vice versa)
  • Keep items in fridge and cabinet in an order that feels natural to you 
  • Use utensils/plates/cups with high contrast 
  • Mark appliance dials with “bump dots” to identify commonly used buttons easier
  • Mark oven dials with high contrast tape to help see them easier
  • Use the microwave if you feel unsafe using the stove

Reading & Writing:

  • Line isolator—’Magna Typoscope’
  • Bright tape at the edge of page to help you scan to the edge of the page
  • E-readers to adjust font size 
  • Magnifying glass for reading
  • Use paper with bold lines when writing 
  • Use bold pens when writing 
  • Use large print address books, calendars, checks, etc. 

Managing Money:

  • Organize important papers in different colored trays or folders with labels 
  • Pay bills online to allow for enlarged font 
  • Use large-print checks, magnifiers, etc.
  • Find a system to fold paper money in different ways to help identify them
  • Ask cashiers to verbally tell you what value of coin/paper money they are giving back to you

Managing Medications:

  • Label prescription bottles with large-print labels or different colored tape 
  • Mark bottle caps in large print with identifiers (i.e. write ‘BP’ on blood pressure meds)

Other Strategies:

  • Scanning (head turns)
  • Dark colored light switches and electrical outlets to increase contrast against walls, or add tape around them
  • Motion lights that turn on when you enter a room
  • Nightlights 
  • Clocks with large numbers and phones with large font 
  • Colored tape on edge of stairs to identify where they start 
  • Make grocery list according to where items are found in the store to consolidate 
  • Remove clutter from home 

Who is there to help with visual changes?

  • Doctor
  • Optometrist 
  • OT can provide adaptive strategies
  • Proper diagnosis and rehabilitation can help recover and improve performance in daily activities (American Stroke Association, n.d.)