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How to Tell the Difference Between Left Visual Field Cuts vs Left Neglect

woman with left visual field cuts covering right eye and peeking out from left hand

Some patients think they have a left visual field cut when they might actually have left neglect. While both conditions have similarities, they have completely different causes and, as a result, different treatments.

To find appropriate treatment, it’s important to know the difference between left visual field cuts vs neglect. You’re about to learn the differences, along with appropriate ways to approach recovery.

Understanding Left Visual Field Cuts

Visual field cuts are exactly what their name implies: the visual field has been “cut” off, and there is blindness or reduced vision in half the visual field. Another name for this condition is hemianopsia.

The left side is most commonly affected, which is called a left visual field cut.

Here is an example of what someone with a left visual field cut may see:

family portrait with left side blacked out from left visual field cut

It’s important to recognize that left visual field cuts do not mean the eye is “broken” on the left side. Rather, the brain is having trouble processing information from your left visual field.

Each half of the brain processes visual information from the opposite side of the body. When the right hemisphere is damaged by stroke or brain injury, it can impair the brain’s ability to process information from the left side, resulting in a left visual field cut.

Now, how does this differ from left neglect?

Understanding How Neglect Differs from Field Cuts

Hemineglect is an attention disorder where a patient does not notice his or her environment, objects, or stimuli on one side. Usually it occurs on the left side, which clinicians refer to as left neglect. Other names for this condition include: one-sided neglect or hemispatial inattention.

Unlike left field cuts, which involve problems with visual processing, left neglect involves problems with attention. It’s often caused by a stroke in the right parietal lobe.

For example, if you walk up to someone with left neglect and stand on their left side, they may not notice you. They’re not being rude or aloof — they just don’t have enough attention on their left side.

To illustrate this problem, here’s what someone with left neglect would draw if they were asked to fill in the numbers on a clock:

clock with digits only on right side from left neglect

Image from Journal of Neurology

Treatment for Left Visual Field Cuts and Left Neglect

Treatment greatly differs for visual field cuts and hemineglect. Get a formal diagnosis from your doctor so that you can proceed with treatment efficiently.

Below you will see the various treatment and rehabilitation methods available for left visual field cuts and left neglect.

Rehabilitation for Left Visual Field Cuts

To treat left visual field cuts, rehabilitation focuses on helping the brain process visual information again.

Here are some methods used to improve left visual field cuts:

  • Oculomotor exercises. These exercises teach patients to move their eyes to search into left field. Ideally, this helps retrain the brain to scan the left environment and start to process information there.
  • Field expanders and prisms. A compensation strategy involves using prisms and other equipment can help shift images from the blind field. This does not address the root issue, but it can help patients see while going about their daily lives.
  • Visual restoration therapy. This incorporates exercises like saccadic eye movements to create stimulation along the border of the missing field of vision. NovaVision is a good example.

Depending on the severity of the issue, patients with hemianopia may experience spontaneous recovery where visual field cuts improve, at least partially, on their own.

Rehabilitation for Left Neglect

Treatment for left neglect focuses on helping the patient improve their attention and awareness on the left side.

Here are some rehabilitation methods used for left neglect:

  • Visual scanning training. The patient turns their head to scan their left environment. This helps train the brain to pay attention to the left environment and may reduce left neglect.
  • Limb activation treatment. By moving the left arm and leg within the neglected environment, patients can improve their awareness of the left field. It has been shown to help with hemineglect because of the link between visual attention and motor function.

Most rehabilitation techniques rely on the phenomenon of neuroplasticity to help the brain rewire itself and improve function.

Visual Field Cut vs Neglect

Although field cuts and hemineglect manifest in similar ways, they are different conditions.

Field cuts involve partial blindness where the patient cannot see on the affected side. It’s a problem with visual information processing in the brain, not a problem with the eyes.

Hemineglect involves inattention on the affected side. It’s a problem with awareness.

Patients with field cuts can benefit from vision restoration therapy while patients with hemineglect can benefit from limb activation therapy.

A useful compensation technique for both conditions is scanning, which involves turning towards the affected side to process what’s there.

Hopefully this guide has helped you identify the difference between field cuts and hemineglect, along with treatments to consider with your medical team.

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