How can vision therapy help with vision loss after a stroke?

Question

Hello doctor,

My uncle, aged 78, had a brain stroke 20 days ago, which caused some vision loss. At the time of the stroke, his vision was significantly affected. Over the past 20 days, his vision has improved somewhat, but there is still partial loss. He can now see at middle distances but continues to struggle with far and near vision. Before the stroke, he had full vision.

A neurologist and ophthalmologist were consulted, and the ophthalmologist advised tests, including an OCT (optical coherence tomography) macula and RNFL (retinal nerve fiber layer), as well as an MRI (magnetic resonance imaging) brain and MR angiography (MRA).

Medications prescribed since the stroke include:

Clopidogrel (75 mg).
Aspirin (150 mg).
Atorvastatin (40 mg).
Homocheck (multivitamin with folic acid, vitamin B6, and vitamin B12).
Citicoline (500 mg).
Cilnidipine (10 mg).

Please review the attached reports and provide an update:

Based on the findings, is there any chance of restoring complete vision to pre-stroke levels in the next 5–6 months?
Are any additional medications or treatments needed to restore vision quickly?
Do the OCT macula and RNFL reports indicate any abnormalities?
Is vision therapy recommended for faster recovery? If yes, when should therapy begin, how long should it continue, and can you suggest reliable sources for therapy?
Would adding eye vitamin supplements, such as "Tab Isite" (which contains lutein, zeaxanthin, and antioxidants), improve recovery speed?
How long should he continue "refresh tears" (Carboxy Methylcellulose eye drops), and will this help restore vision?
Could his eyeglass prescription change as part of his recovery? If so, when should he recheck his vision?
What diet recommendations would you suggest for brain and eye recovery?
Are there any other remedies or therapies that could help restore vision more effectively?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

The OCT (optical coherence tomography) macula and RNFL (retinal nerve fiber layer) reports appear normal, indicating no significant structural damage to the retina.
The vision loss is due to white matter infarcts in the occipital lobe, the area of the brain responsible for processing vision. The improvement you have seen so far is likely due to collateral blood flow aiding recovery.
Full recovery of vision cannot be guaranteed, but there is a high likelihood of significant improvement over the next several months. Keep a positive outlook.
The current medications, including clopidogrel, aspirin, atorvastatin, and citicoline, are appropriate for stroke management and neuroprotection. No additional medications are required for vision restoration.
Vision therapy is not necessary at this stage. Focus on monitoring progress with optometric evaluations every two months. If improvement slows, consult a neuro-ophthalmologist for further guidance.
Antioxidant supplements like "Tab Isite" (Isotretinoin) can help reduce oxidative stress and promote retinal health. Use them for two months.
Refresh tears (Carboxy Methylcellulose) is a lubricant that soothes dry eyes but does not contribute to vision restoration. Continue using it as needed (SOS).
Eyeglass prescriptions may change as vision improves. A recheck in 2–3 months is recommended for updated refraction and vision assessment.
A brain- and eye-friendly diet includes foods rich in omega-3 fatty acids (salmon, walnuts), antioxidants (berries, spinach, carrots), and B vitamins (whole grains, eggs). Staying hydrated and limiting salt intake is also crucial.

Continue with regular follow-ups with the neurologist and ophthalmologist. Additional therapies may not be necessary if steady progress is observed.

Revert with the answer to assist further.

Thank you and take care.

Answer 2

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

Based on the MRI (magnetic resonance imaging) and MR angiography findings, the vision loss appears to be due to white matter infarcts in the occipital lobe. While 100 percent vision restoration cannot be guaranteed, steady improvement is expected over the next 6–8 months, provided the infarct heals and blood flow improves through collateral circulation.

Vision therapy is not necessary at this point. Improvement will occur naturally as the brain recovers. If progress slows after 3–4 months, you may consult a neuro-ophthalmologist about possible therapies.
Antioxidant supplements like "Tab Isite" (Isotretinoin) are beneficial for promoting retinal and neural health. They may aid recovery when used for 2–3 months.
Homocheck already includes important vitamins like folic acid, vitamin B6, and vitamin B12. No additional supplements are needed unless tests show deficiencies (for example, vitamin D or omega-3).
Refresh tears (Carboxymethylcellulose) is a lubricant that helps relieve dry eye symptoms but does not directly restore vision. Continue using the drops as needed (SOS).
Changes in eyeglass prescriptions are likely during recovery. A re-evaluation of his vision and refraction is recommended in 2–3 months to ensure he has the most appropriate prescription.
A diet for brain and eye health includes:

Omega-3 fatty acids: Fatty fish (salmon, mackerel), flaxseeds, and walnuts.
Antioxidants: Leafy greens (spinach, kale), carrots, berries (blueberries, strawberries).
B vitamins: Whole grains, eggs, and lean meats.
Hydration: Adequate water intake.
Limit sodium, sugar, and unhealthy fats.

No additional remedies or therapies are required at this stage, but regular follow-ups with his neurologist and ophthalmologist are crucial. Gentle mental exercises and brain-stimulation activities like puzzles may also support recovery.

I hope this helps.

Thank you and take care.

Regards.