Hemianopsia

(Hemianopia; Hemiopia; Bitemporal Hemianopsia; Homonymous Hemianopsia; Left Homonymous Hemianopsia; Right Homonymous Hemianopsia; Superior Hemianopsia; Inferior Hemianopsia)
  • Definition

    Hemianopsia is the loss of half of the visual field. A person with hemianopsia only sees a portion of the visual field from each eye. Hemianopsia is classified by where the missing visual field is located:
    • Outer half of each visual field (bitemporal)
    • The same half of each visual field (homonymous)
    • Right half of each visual field (right homonymous)
    • Left half of each visual field (left homonymous)
    • Upper half of each visual field (superior)
    • Lower half of each visual field (inferior)
    Vision loss can range from mild to severe. The likelihood that it will improve depends on the cause, the area of the brain affected, and/or how badly the optic nerves or other portions of the visual pathways were damaged.
  • Causes

    Hemianopsia is caused by conditions that affect the brain or optic nerves.
    The most common causes are:
    Other less common causes that have been reported include:
    • Neurodegenerative disorders
    • Infections
    • Toxin exposures
    • Transient events, such as seizures or migraines
    The Optic Nerve
    IMAGE
    An injury or illness that puts pressure on the optic nerve can cause hemianopsia.
    Copyright © Nucleus Medical Media, Inc.
  • Risk Factors

    Having one of the above conditions puts you at risk for hemianopsia.
  • Symptoms

    Tell your doctor if you have any of these, especially if you have a condition that can lead to hemianopsia:
    • Sensation that something is wrong with your vision
    • Bumping into objects
    • Difficulty reading
    • Difficulty driving (eg, changing lanes when there is an oncoming car or sideswiping objects)
    • Visual hallucinations, such as lights or shapes
    If you have any of these symptoms, do not assume it is due to hemianopsia. These symptoms may be caused by other conditions.
  • Diagnosis

    Your doctor will ask about your symptoms and medical history and do a physical exam. Your doctor may refer you to a neurologist, a doctor who treats brain conditions. You may also need to see an ophthalmologist, a doctor who specializes in eye care.
    Tests may include:
    • Visual field test—This is a test that makes a map of your field of vision. It is used to check whether there is damage to any area of vision. You will focus on a target in front of you and respond to lights that flash above, below, and to the right and left of the target.
    • Magnetic resonance imaging (MRI) scan —This is a test that uses magnetic waves to make pictures of structures inside the brain. It will show if there is damage to your brain in an area that affects vision.
  • Treatment

    Talk with your doctor about the best treatment plan for you. Treatment focuses on treating the underlying condition and learning to live with your hemianopsia in daily life. Your hemianopsia may improve over time, depending on the cause. Treatment options include the following:
    Visual Aids
    These may be used to help increase your visual field. They must be fitted by an eye care professional. Prisms may be attached to glasses. A prism is a clear plastic sheet that fits the lenses of your glasses. You may have a permanent prism mounted into the lens. It shifts the location of an image so that it is within your field of vision. You will be trained on how to use the prism to make up for your visual field defect. Mirrors or inverted telescopes can also be used to increase your visual field.
    Reading Strategies
    You may be taught strategies that will make reading easier. Reading can be difficult if you have hemianopsia because you may have trouble finding the beginning or end of a word or line of text.
    You may want to use a ruler or sticky note to mark the beginning or end of the text. For example, if you have right homonymous hemianopsia, use a sticky note to mark the end of a line of text. You will know that you have not reached the end of the line until you see the sticky note.
    Some people with hemianopsia benefit from turning a text and reading it vertically (up and down), rather than horizontally (side to side).
    Lifestyle Changes
    Other changes can help you deal with hemianopsia in daily life:
    • Make frequent head turns a habit. This will help you capture things outside your field of vision.
    • When walking with others, place them on the affected side. For example, if you have a left homonymous hemianopsia, they should stay on your left side. This will prevent you from bumping into objects outside of your field of vision.
    • In a theater, sit toward the affected side (eg, on the right if you have right homonymous hemianopsia). That way, more of the action will be within your field of vision.
    • Talk to your doctor about whether you can drive. Some rehabilitation centers have driving simulators that measure your ability to drive safely.
  • Prevention

    To help reduce your chances of getting hemianopsia, take steps to reduce your chances of having a condition that causes hemianopsia:
    • Use caution in situations where a brain injury could occur (eg, wear helmets when appropriate, reduce falling hazards, etc.).
    • If you are at risk for stroke, talk to your doctor about ways to decrease your risk.
  • RESOURCES

    American Academy of Ophthalmology http://www.aao.org/

    Lighthouse International http://www.lighthouse.org/

    CANADIAN RESOURCES

    Canadian Ophthalmological Society http://www.eyesite.ca/

    Canadian Stroke Network http://www.canadianstrokenetwork.ca/

    References

    Bashir K, Elble RJ, Ghobrial M, et al. Hemianopsia in dementia with lewy bodies. Arch Neurol . 1998 Aug;55(8):1132-5.

    Bitemporal hemianopsia. Saint John’s Health Center: Brain Tumor Center website. Available at: http://www.brain-tumor.org/124%5FBitemporal%5FHemianopsia.html. Accessed June 9, 2011.

    Hemianopsia. Texas School for the Blind and Visually Impaired website. Available at: http://www.tsbvi.edu/instructional-resources/986-hemianopsia. Updated February 2010. Accessed June 9, 2011.

    Homonymous hemianopia. North American Neuro-Ophthalmology Society. Available at: http://www.nanosweb.org/files/public/Homonymous%5Fhemianopia.pdf. Accessed June 9, 2011.

    Kedar S, Zhang X, Lynn MJ. Pediatric homonymous hemianopia. J AAPOS . 2006 Jun;10(3):249-52.

    Mitchell JP, Yancy A, Louis LS, et al. Reversible hyperglycemic homonymous hemianopia. J Natl Med Assoc . 2009 Apr;101(4):373-6.

    One-side neglect: improving awareness to speed recovery. American Heart and Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/EmotionalBehavioralChallenges/One-side-Neglect-Improving-Awareness-to-Speed-Recovery%5FUCM%5F309735%5FArticle.jsp. Accessed June 9, 2011.

    Seeing after stroke: vision changes are common, some are reversible. National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=SS%5FMAG%5Fsp2010%5Frehab. Accessed June 9, 2011.

    Stroke related eye conditions. Royal National Institute of Blind People website. Available at: http://www.rnib.org.uk/eyehealth/eyeconditions/eyeconditionsoz/Pages/stroke.aspx. Updated May 2011. Accessed June 9, 2011.

    What is hemianopia? Lighthouse international website. Available at: http://www.lighthouse.org/about-low-vision-blindness/vision-disorders/hemianopia/. Accessed June 9, 2011.

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