Post-Stroke Visual Field Loss: Functional Assessment and Safer Mobility

Clinical framework

Post-stroke visual field loss can affect obstacle detection, reading, navigation and confidence during mobility. It is distinct from spatial neglect, although the two can coexist and produce overlapping functional problems.

A bedside observation does not establish the visual diagnosis. Formal visual assessment may be needed to characterize the deficit and guide compensation.

Assessment and differential

• Ask about collisions, missing objects on one side, reading difficulty, navigation and changes noticed by family. Observe scanning during transfers, walking and functional tasks with appropriate guarding.
• Consider visual field loss, spatial neglect, ocular-motor dysfunction, reduced acuity, attention or cognitive impairment and environmental factors. Do not label every missed obstacle as neglect.
• Document functional performance, assistance, near misses and a patient-selected task. Coordinate with occupational therapy, ophthalmology or orthoptics as locally available.

Rehabilitation strategies

• Prioritize safety: reduce clutter, improve lighting, position important objects deliberately and provide suitable supervision or mobility aids while assessment is ongoing.
• When appropriate and guided by the assessment, practice systematic visual scanning and head/eye movement during meaningful tasks, then gradually add environmental complexity.
• Use repeated functional practice with feedback and monitor whether the strategy transfers beyond the treatment room. Tailor instructions to attention, fatigue, cognition and the person's learning needs.

Progression and precautions

• Progress from predictable, low-distraction tasks to busier environments only when performance is safe and consistent. Reassess collisions, scanning, mobility assistance and confidence.
• New sudden visual loss or a new acute neurological change requires urgent medical assessment rather than routine rehabilitation.
• Avoid assuming compensatory scanning restores the visual field itself. Explain that strategies may improve function but require practice and individualized review.

Clinical pearl

Separate the impairment from its functional consequences: identify the likely visual-perceptual issue, protect mobility, arrange appropriate assessment and measure whether compensatory strategies improve real-world performance.