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Homonymous Hemianopia
What is homonymous hemianopia?
Homonymous hemianopia is referred to as a neurological vision impairment.
While we may be familiar with ocular based vision impairments such as
cataracts, retinal deterioration or glaucoma, neurological based vision issues
occur frequently and can be significantly debilitating.
Neurological vision impairment is much more complex. It occurs when the
visual processing areas of the brain or the visual pathways to these processing
areas are damaged, often through stroke or head trauma. While the eyes are
still functioning correctly the information gathered is not sent through the
brain in its entirety or the brain is not able to process the information
Each eye picks up and transmits a right and left visual field. The optic nerves
transfer information from the left visual field from each eye to the right side of
the brain and the right visual fields to the left side of the brain. This leads to a
situation where the right hemisphere of the brain processes visual information
from the left visual field and the left hemisphere processes the information
from the right. Because of the physical structure of the brain strokes generally
occur in one of the two hemispheres leaving the other intact, thus leaving half
the visual field unaffected.
The Visual Pathway
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With a homonymous hemianopia half of the visual field in both eyes is lost.
Depending on the exact location of the damage to the visual pathways, different
amounts of vision may be affected with different names (relative hemianopia,
quadrantinopia, incongruent hemianopia), however functional changes still
Those experiencing homonymous hemianopia may not be aware that their
vision has been altered. Without being aware of a problem they cannot correct
for it. Going into crowded stores may become difficult, because people seem to
suddenly appear in front of them. Anxiety leaving the home can occur and some
people may even experience panic attacks. They may frequently bump into
stationary objects on one side. Additionally, the loss of visual field can also
cause reading difficulties when words are missed.
They are likely to lose confidence in their abilities and find situations
confusing. Relatives may attribute this to the stroke or injury. It is crucial for
people with neurological vision impairment and their relatives and carers to
understand the nature of their situation before they have any chance of
adapting to their circumstances.
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© 2014 Guide Dogs SA/NT
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Guide Dogs SA, through its Neurological Vision Service, provides a specialised
program for people who have neurological vision impairment.
A key element in this service is the use of the Neurological Vision Technology
scanning system (NVT). This is a mobile device which can be used to define a
visual field loss and screen for additional associated conditions such as visual
The NVT is used as the basis of a training programme to establish a scanning
technique to assist in compensating for the reduced visual field. This technique
is then practiced in many different environments to increase independence and
safety in daily life.
Guide Dogs SA Neurological Vision Service includes:
Comprehensive assessment of functional vision loss using a range of
assessment tools
If appropriate, assessment and training by Low Vision Specialist to provide
appropriate ocular rehabilitation strategies
Assessment for specialized low vision adaptive devices
Individually designed visual scanning programs
Graduated training from simple to complex tasks within a variety of
Orientation and mobility programs transitioning clients return to work,
study, vocation or recreation, including road crossing strategies and use of
public transport
Therapy and rehabilitation provided in hospital, at home and in the
Follow up after programming to minimise any difficulties encountered.
Referrals can be made by any health professional, family member or friend on
the person’s behalf. Permission must be given by the person being referred.
Enquiries and referrals to:
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© 2014 Guide Dogs SA/NT
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Guide Dogs Association SA/NT
251 Morphett Street
Adelaide SA 5000
Telephone: 1800 757 738
Email: [email protected]
IS699 v1.1 Publish Date: 05 November 2014
© 2014 Guide Dogs SA/NT
when printed
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