"There is more to us than we know. If we can be made
to see it, perhaps for the rest of our lives we will be
unwilling to settle for less."
- Kurt Hahn
Rehabilitation of the homonymous hemianopsia patient consists of several types of treatments.
Saccadic Eye Movement Training: Saccadic eye movement training also referred to as Scanning therapy, teaches the patient to move their eyes to search into the area of field that is missing. A significant portion of patients may not only lose visual field, but may suffer damage to areas in the brain that help us perform saccadic eye movements required to search for objects in the area of loss. Thus some patients do not automatically scan into the blind area without therapy and those who can scan may not develop adequate scanning without training. Initially nearly all homonymous hemianopsia patients should obtain some degree of saccadic eye movement therapy.
Training Hemianoptic Reading Skills: Training of saccadic eye movements may help improve reading, however, often more specific therapies and strategies are required particularly in patients with right homonymous hemianopsia. Here specific strategies to read by looking at the end of long words and use of boundary marking of the end of the line of text may be trained.
Optical Visual Field Expander: Today, we have several forms of visual field expanders that can be prescribed in prescription eyewear to aid those patients who continue to struggle with the loss of visual field, and for those who may undertake higher functional activities like returning to work or driving where appropriate. These include the EP Horizontal Lens which was developed at Harvard’s Schepens Eye Research Institute, the Gottlieb Visual Field Awareness System, and the Chadwick Hemianopsia Lens.
An exception to prescribing a visual field awareness system may be patients with exotropias (eye turning out) with anomalous correspondence. These patients have a natural expanded visual field from the eye drifting out and thus may not require further optical field expansion.
Not every patient will require a visual field expander, and those with potential to benefit, should be fit by a doctor with experience in vision rehabilitation of hemianopsia.
Vision Restoration Therapy: VRT is a new treatment that attempts to restore visual field by extensive stimulation along the boarder of the visual field loss. It is based on the concept of neuroplasticity, the ability for the brain to alter itself in response to stimulation. This is still a controversial area. Not all scientists agree on the effectiveness of the treatment. Recent studies using technologies to better control patient fixation have questioned the improvements reported in the original studies. Additional studies may help us learn if this treatment has a role in the therapy of hemianopsia patients.
Treatment of Associated Problems: Homonymous hemianopsia can occur in rare cases without other associated vision problems, but more often we see it associated with a cluster of deficits in areas such as eye movements, focusing, visual neglect, ocular convergence and various reading problems. Additionally, non-visual disorders related to memory, speech, cognition, emotion and paralysis may occur. Each of these problems may require specific treatments or strategies for rehabilitation by specialists in those areas.
We will discuss these options further in the next few sections.
Please contact us if you have any questions.
The Low Vision Centers of Indiana
Richard L. Windsor, O.D., F.A.A.O., D.P.N.A.P.
Craig Allen Ford, O.D., F.A.A.O.
Laura K. Windsor, O.D., F.A.A.O.
Indianapolis (317) 844-0919
Fort Wayne (260) 432-0575
Hartford City (765) 348-2020