Visual field loss in children

What is a visual field loss?

The visual field is the whole of what your child sees. Vision is best in the centre of the visual field, getting more blurred at the edge. Visual field loss is where certain areas of an object or scene are missing. Visual field loss may affect the periphery or the central areas of vision, or both.

Some types of visual field loss in children

Homonymous Hemianopia, where half of the visual field is missing: either the right side or the left side of each eye.
Quadrantanopia, where a quarter of the visual field is missing; upper left, upper right, lower left or lower right.
Lower (or less commonly upper) field loss, where the lower (or upper) half of the visual field of each eye is missing.
Bi-temporal hemianopia, where the outer visual field of each eye is missing. This is rare in children and will not be mentioned further.

What causes a visual field loss?

Visual field loss may be caused by damage to any part of the visual pathway. This includes the retina (the light sensitive film in the eye), the optic nerve (the connection between the eye and the brain) and the occipital lobe (the special ‘vision’ part of the brain).

This leaflet is mostly concerned with loss of visual field caused by damage to the brain, either before your child was born, around the time of their birth or after birth. Causes of this include infection, poor blood supply, difficulty breathing, hydrocephalus (a buildup of fluid in the brain), head trauma or brain tumours. Visual field loss is common in children with cerebral palsy.

The images from each eye mix together and go to both sides of the brain. The images from the left side of the visual field go to the right side of the brain. Similarly the images from the right side of the visual field go to the left side of the brain. This is opposite to what you might think.

Damage to the right side of the visual pathway may cause a left visual field loss.
Damage to the left side of the visual pathway may cause a right visual field loss.
Damage to the top part of the visual pathway may cause lower visual field loss.
Damage to the lower visual pathway may cause upper visual field.

What are the signs of a visual field loss?

You may already be aware that your child has difficulty seeing objects in certain areas of their visual field. Similarly your child’s therapist or teacher may have some concerns.

Your child may:

Not respond to a feeding spoon when brought towards them from a certain position.
Leave food on a certain part of their plate.
Startle when approached from a certain side.
Have difficulty locating toys on the floor or in a certain area of a table/tray.
Lack confidence in unfamiliar surroundings.
Trip over objects on the floor or bump into objects on one side.
Have difficulty with steps, slopes and negotiating the edge of pavements or floor boundaries.
Have difficulty with reading, writing and drawing because certain parts of the page are missing.
Adopt an unusual head position.

Are there any tests to confirm the diagnosis?

Your child is encouraged to look at a toy directly in front of them. A ball or toy will be introduced from behind them to check if your child is aware of it appearing from each quarter of their visual field. The test may have to be repeated on several occasions before we have an accurate result.

Some children can cope with more detailed testing and may be assessed with a field machine known as a perimeter.

Is there any treatment?

There is no treatment for a visual field loss. However, just being aware of the difficulty and making others aware is very important. It is good to inform relatives, teachers and therapists who may be working with your child. There are some strategies which may help your child cope.

Coping strategies for Hemianopia

Place objects in the seeing side of your child’s vision.
When feeding your child, sit on their seeing side and bring the spoon towards the mouth from that same side.
Turn the plate round partway through the meal to reveal any missed food in their non-seeing side.
When in unfamiliar surroundings, encourage your child to look around, and point out likely obstacles or interesting things for them.
Encourage use of a banister rail when going up and down stairs. Allow your child to trail their hand along the wall when walking along a corridor.
Use bright yellow tape on the edges of doorways to make them stand out and ensure that the stairway is well lit
At home try to keep the floor clear of obstacles so that your child does not bump into them.
Allow time for your child to move their head from side to side to scan when walking or using a wheelchair.
Ensure that your child is seated with their non- seeing side towards the wall in a classroom, cinema etc.

When reading

Use large, bold, well-spaced print and good lighting.
In a left hemianopia – put a line, elastic band or coloured tape down the left side of a page to help with finding the start of the next line.
In a right hemianopia – the words seem to disappear as your eyes scan across the page. It may help to hold the page at an angle or completely sideways rather than read left to right.

Coping strategies for lower visual field loss

Try to place objects in the part of your child’s vision that is working i.e. above the mid line.
When feeding your child, bring the spoon towards the mouth from slightly above the mid-line.
Turn the plate round partway through the meal to reveal any missed food on the lower half of the plate.
When in unfamiliar surroundings, encourage your child to look and move their head downwards. Point out likely obstacles.
Some children may find it helpful to push a wheeled toy in front of them as it helps them to feel the height of the ground ahead.
Your child may be more able to see their feet in the peripheral field if they wear white shoes/ trainers.
Encourage use of a banister rail when going up and down stairs. Some children benefit from a separate banister which is the correct height for them.
Use bright yellow tape on the edges of steps to enhance them and ensure that the stairway is well lit.
At home try to keep the floor clear of obstacles so that your child does not trip over them.
If reading, use large, bold, well- spaced print and good lighting.
Use a sloping desk/workstation at school.
Use a marker on the side of the page so that your child does not easily lose their place when reading down a page.

Coping strategies for upper visual field loss

This is less common than lower field loss. Try to place objects in your child’s lower field. In unfamiliar surroundings, encourage your child to look and move their head upwards. Point out likely obstacles

Coping strategies for quadrantanopia:

You may need to use a combination of the strategies mentioned under hemianopia or lower/upper field loss.

For additional advice on field loss

Our eye clinic liaison officers can talk to you during your clinic visit, at another time or by phone to help find solutions for living with vision problems in the community and advise on available support services.

Tel: 0191 282 0221 Monday – Friday, 9am-5pm

Royal National Institute of Blind people (RNIB)

Tel: 0303 123 999 Monday – Fri day, 8.45am-5.30pm

Royal National Institute of Blind people (RNIB) website

Visually Impaired Children taking Action (VICTA)

Tel: 01908 240 831

Visually Impaired Children taking Action (VICTA) website

Blind Children UK

Tel: 0860 781 1444

Blind Children UK website

Guide Dogs for the Blind Association

Tel: 0118 983555

Guide Dogs for the Blind Association website

National federation of families with visually Impaired children (LOOK)

Tel: 0121 450 7754

LOOK website

Contact details

Appointments office

To change or cancel an appointment: 0191 282 4444.

Monday to Friday 9am to 5pm (excluding Bank Holidays)

Orthoptic department

To speak to an orthoptist about treatment call 0191 282 4434

Monday to Friday 9am to 5pm (excluding Bank Holidays)

PALS (Patient Advice and Liaison Service)

For help, advice and information about NHS services. You can contact them on Freephone 0800 032 02 02, e-mail north of the Tyne PALS or text to 07815500015.

Useful websites

If you would like further information about health conditions and treatment options, you may wish to have a look at the NHS website at www.nhs.uk (Arial 12)

Squint clinic

British and Irish Orthoptic Society (BIOS)

If you would like to find accessibility information for our hospitals, please visit the Accesscable website.