How is homonymous hemianopsia treated?

Treatment by a low-vision specialist deals with two main areas: improving reading ability and navigating the environment.

Strategies to improve reading ability:

  • Use a straight edge to direct the eyes to the next line of text.
  • Work on willingly increasing the size of small eye movements as words are read along the line of text. The goal is to capture each word in the field of vision and to recognize it as a whole before reading it.
  • Place your hand at the edge of a page to make it easy to determine the margin of a page.
  • Hold the text at a 45- to 90-degree angle so that reading is done vertically rather than horizontally. People with a right hemianopsia should read down, while those with a left hemianopsia should read up. In each case, this will keep the next line of text within the available field of vision.

Strategies to improve navigating the environment:

  • When moving through the environment, learn to direct the eyes toward the good visual field.
  • When walking into a new environment, pause and move your head from one side to another. Observe where objects and people are located. Think about painting a picture of what you see in your brain. Practicing this, particularly in the 6 months after vision loss, can help train your brain to do this automatically.
  • When looking for objects in the blind field consciously make large eye movements to that side and then let the eyes come back to the object.
  • When walking, let a partner walk on the blind side and provide his or her arm for guidance.
  • When in group situations, situate people in the good field of vision as much as possible.
  • When in a theater, sit far over to the blind side so that the action takes place in the normal visual field.
  • Play real-life (not computer-based) card games and do crossword puzzles to regain coordination between vision and touch.
  • Do word search or picture search puzzles to improve eye scanning at near distances.

Other treatments:

  • Prisms on glasses may help to expand the area for central vision. A prism can displace images of objects into the field of vision.
  • Some makers of computer-assisted programs claim to promote recovery of the entire field of vision. However, there are no proven studies showing such programs are effective. In addition, they are very expensive.
  • Driving a motor vehicle is hazardous for many people with homonymous hemianopsia, particularly if other neurological problems are present. Practice on a driving simulator offers a chance to regain driving skills and allows an instructor to determine if the patient is able to drive again.

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