Vision Related Reading Problems
After Stroke or Head Injury

10 Causes of Reading Problems after TBI

Reading problems may occur from various problems after a stroke or head injury. Reading problem are a primary reason stroke and head injury patient come to eye doctors. It is crucial that the type of reading problem be diagnosed. The list below contains some of the more common causes in reading problems with introduction to how they may be treated.

 

Convergence Disorders Affecting Reading

Patients may experience reduced convergence after stroke or head injury. Our eyes must turn in together accurate as a team to present double vision and eye fatigue in reading. Prisms may aid some patients. Orthoptic therapy may aid some, but not all patients with convergence insufficiency will respond to therapy due to the variation in the extent of trauma which may be present. 

 

Loss of Accommodation (Focusing)
Affecting Reading

Young head injury patients may experience decreased focusing ability. It is often missed because at an early age doctors don't expect loss of accommodation. It happens naturally at about age 42. Individual  with reduced accommodation may benefit from bifocals.

 

Reading Problems Due to Visual Field Loss

Field loss patients often lose their place in reading. Simple techniques, like sticking a Post-it note along the side of a column of print can mark the beginning or end of the column and reduce confusion. A right hemianopsia patient may may lose his or her place at the end of a line.  The right hemi patient may leave off words at the end of a line. A left hemianopsia patient may have difficulty at the start of each line and may not return to the very beginning of the line.

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Alexias/Aphasias Affecting the Ability to Read

If the patient is unable to read do to damage to areas which process reading but can understand verbal reading, electronic machines are available such as the Kurzweil Omni 1000 and 3000 and the Zerox Expert  Reader. These machines scan all typed print, interpret it and read it aloud to the patient.   Talking books and reading radio are also very helpful.

 

Loss of Cognitive Skills May Affect 
Reading and Comprehension

Patient  may need to relearn the reading skills developed in childhood or the damage may be do severe as to preclude reading. Therapist may be able to re-establish reading over time.

 

Low Vision Causing Reading Problems

When visual acuity is impaired, high add bifocals or low vision devices may be indicated. Magnifiers, Electronic Magnification CCTVs, special and microscopic eye wear may help the patient read again.

 

Double Vision (Diplopia) Causing Disruptions to Reading

If the binocular vision problem can be treated therapy, surgery or prisms may be used to re-establish binocular vision. If the double vision is not curable, then partial translucent occlusion may block diplopia which is not responsive to prism.

 

Eye Gaze Disorders

Patients with inferior gaze paresis may not be able to look down into the bifocal, but may read with single vision reading eyewear. Clip on reading lenses may also employed.

 

Eye Movement Disorders Affecting Reading

Saccadic movement disorders may also interfere with reading. Sometimes therapy may improve function. If not responsive to therapy, there are now computer systems which can present each word directly in front of the patient. These may help patients with cerebral palsy.

 

The Combination of Two or More of the Above

In reality most of the patients we see have a combination of problems, which make it difficulty for the patient and family to understand the exact cause. We recommend a low vision examination on all head injury patient experiencing reading difficulty.

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