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Peripheral Vision Loss: How to Treat or Halt the Effects
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Under normal circumstances, your field of vision includes the scenery and objects you are looking at directly plus the colors, shapes and movements of things on both sides of you. The ability to see objects not directly in your line of sight is known as peripheral vision – that is, an ability to see out of the corner of your eyes or outside the center of your stare.
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Ophthalmologists refer to losing this ability as peripheral vision loss (PVL). The average field of vision allows you to see up to 170 degrees, with periphery vision accounting for 100 degrees of the horizontal visual field. A compromised periphery vision affects your ability to see or sense motion.
It means you are likely to have trouble running, driving and walking without running into things. You are also likely to have increased difficulty with your night vision.
Peripheral vision is crucial for everyday life but especially for senior citizens. One study found that peripheral visual impairment increased the risk of falling for people older than 60. Out of those who fell, 49 percent had impaired peripheral vision, compared to 39 percent who didn’t fall.
You can lose your peripheral vision to a variety of health conditions, some unrelated to eye issues. Some of the common chronic eye conditions associated with PVL include:
- Glaucoma
- Stickler syndrome
- Retinitis pigmentosa
- Diabetic retinopathy
- Retinal artery occlusion
Peripheral Vision Loss Can Indicate Several Issues
You may be used to managing your central vision with glasses and contact lenses, but your peripheral vision (the indirect vision at the edges of your eyes) is very important too. Unfortunately, you may not notice if you begin losing peripheral vision until you have lost a significant amount of your ability to see movement, objects, or colors in that area.
Advanced peripheral vision loss leads to tunnel vision, which is defined as 90 degrees around your vision when you look straight ahead. The average, healthy eye has a range of 160 degrees around your central viewpoint. With tunnel vision, you may feel like you view the world through a narrow tunnel. Some severe forms of eye disease can limit vision so much that you have only 5 degrees around your central point of view.
There are several potential causes of peripheral vision loss. Some are acute and temporary, and others are chronic diseases. Sometimes, peripheral vision loss indicates a medical emergency.
Unusual Medical Causes of Peripheral Vision Loss
Progressive eye diseases are a common underlying reason for peripheral vision loss, but there are other potential causes of this issue.
- Migraines: If you struggle with migraines, especially migraines with an ocular component, you may experience tunnel vision in addition to other migraine symptoms. Tunnel vision lasts as long as the migraine lasts. If you have never experienced a migraine before and suddenly experience tunnel vison along with head pain, nausea, light sensitivity, or other symptoms, see a doctor. Your physician can help determine if an ocular migraine, or other type of migraine, might be the cause.
- Congenital peripheral vision loss: A baby may show signs of peripheral vision loss. Your child’s first eye exam should occur when they are 6 months old. This may take place at a pediatrician’s office, and if a problem is suspected, you may be referred to a pediatric optometrist or ophthalmologist. This professional will be able to diagnose if congenital peripheral vision loss is a problem for your child.
- Strokes: A stroke that affects the area of the brain that processes your vision may lead to peripheral vision loss. As with migraine tunnel vision, this can occur suddenly. However, it will not end in a few minutes or hours. If you experience sudden loss of vision with no other symptoms, go to the hospital immediately.
- Tumors: Like strokes, tumors can impact parts of the brain or nerves that involve peripheral vision. These require expert medical diagnoses to understand and treat appropriately.
For the most part, peripheral vision loss is a progressive condition associated with chronic eye diseases that put pressure on the eye, damage the optic nerve, and damage the retina, especially the macula.
Chronis Eye Diseases Associated With Peripheral Vision Loss
If you have progressive peripheral vision loss, you are most likely to have one of three chronic eye diseases.
Diabetic retinopathy
This disease is associated with all forms of diabetes: type 1, type 2, and gestational diabetes. High blood sugar due to insulin problems begins to damage the blood vessels around the retina, choking the oxygen supply to the back of the eye.
Symptoms of diabetic retinopathy include:
Seeing a larger number of “floaters” in your central vision.
- Blurry vision.
- Vision that changes from fuzzy to clear sometimes.
- Seeing dark areas, or completely blank areas, in your vision field.
- Struggling with vision at night.
- Colors appearing washed out or pale.
Controlling your blood sugar slows the progress of diabetic retinopathy. Getting regular vision exams, about once a year, will also help your physician and ophthalmologist monitor any vision changes or loss that could indicate diabetic retinopathy.
You may receive anti-VEGF drugs, which lessen the swelling of the macula by reducing blood leakage. You could also receive steroids to lower swelling and inflammation, which reduces damage to the blood vessels and decreases swelling in the retina.
Laser surgery is increasingly being used to seal off leaking blood vessels in the early stages of diabetic retinopathy. This reduces swelling in the retina because less fluid leaks into the area. You may need more than one treatment, but your eye doctor may recommend one and then monitor your symptoms.
If you have severe diabetic retinopathy, you may need a vitrectomy. The vitreous humor or gel-like substance that keeps your eyes in shape needs to be removed because it is too full of blood. This is done surgically.
Because your retina, and specifically your macula, become damaged over the course of diabetic retinopathy, you could lose central vision as well as peripheral vision. Tunnel vision is a common symptom of late-stage diabetic retinopathy.
Glaucoma
There are several types of glaucoma, all of which involve damage to the optic nerve. Typically, this damage comes from high fluid pressure in the vitreous humor of your eye.
In a rare form of glaucoma, your eye pressure will appear within a normal range, but it will still be too high for the sensitive nerves behind your retina. As the optic nerve becomes damaged, your peripheral vision will fade out, and you will eventually develop tunnel vision.
Angle-closure glaucoma is the sudden onset of tunnel vision, and it often comes with other symptoms like confusion, dizziness, and nausea. This is considered a medical emergency, so get to a hospital or call 911.
Primary open-angle glaucoma is the most common type of this disease, with diagnosable high fluid pressure in the eye putting pressure on the retina and optic nerve, leading to ongoing damage over years. Without treatment, you will eventually go blind. However, treatment can slow the disease’s progression significantly, helping you to preserve your sight for as long as possible.
Treatments for glaucoma include:
- Eye Drops. Daily prescription eye drops can lower the fluid pressure in your eye by reducing how much aqueous humor your eye makes or by improving the flow of fluid through drainage tissues in your eye.
- Laser surgery. Two types of laser surgery can immediately improve the flow of fluid out of your eye. Trabeculoplasty allows drainage angles to work better by opening them up. Iridotomy involves a laser cutting small holes in the iris of your eye, which serve as secondary drains for fluid.
- Incisional surgery. Sometimes, more serious surgeries are needed to create a permanent solution to your eye’s draining issues. If you do not respond well to eye drops or laser surgery, your doctor may recommend trabeculectomy, which creates a small pocket between the sclera (white part of your eye) and conjunctiva (thin clear film over the sclera), called a This pocket collects aqueous humor from inside your eye, reducing fluid pressure in the orb but allowing the humor to be naturally absorbed by your eye tissues. A glaucoma drainage device may be required to force a new path for internal fluid to escape if a bleb is not a good solution.
If you need treatment for glaucoma, eye drops or surgery can slow the progression of this disease for decades, allowing you to have good vision for much of your life. People who develop glaucoma are typically at least 40 years old.
Retinitis Pigmentosa
This is a term for a group of problems affecting the retina. When damaged, this area at the back of your eye can cause peripheral vision loss, central vision loss, or both. This is a genetic condition, so if someone in your family has retinitis pigmentosa, you are more likely to develop it. Symptoms of this condition include:
- Loss of night vision.
- Gradual loss of peripheral vision, developing into tunnel vision.
- Loss of central vision.
- Colors seeming muted or difficulty seeing colors.
Genetic testing can help you understand your risks. Getting regular eye exams, informing your optometrist or ophthalmologist that you have a risk for this condition, and getting regular visual field testing are the best methods for monitoring whether you develop this condition and its advancement.
Since it is a genetic condition, there are no treatments to slow its progression. Medical studies have shown that vitamin A, some types of surgery, and some types of eye drops may ease symptoms. However, these are small studies and not conclusive.
Treatment to Manage Symptoms & Slow Peripheral Vision Loss
If you have a chronic eye disease associated with peripheral vision loss, follow your ophthalmologist’s instructions to manage the condition. You can slow the progression of some diseases, but once you have a chronic illness, you cannot cure it or regain lost vision. This means it’s critical to catch these diseases early, so you can best mitigate vision loss.
If you have recently started experiencing any degree of peripheral vision loss, see an ophthalmologist immediately. Since most people don’t notice this loss until it is substantial, it’s best to see an eye doctor regularly to monitor the overall health of your eyes.
Prevention
You should see an ophthalmologist at the first sign of PVL because it’s impossible to reverse complete vision loss. Try these tips to prevent or maintain eye health:
- Healthy diet
- Avoid smoking
- Watch your weight
- Use sunglasses when outside
- Avoid prolonged exposure to screens
- Watch blood sugar levels to prevent diabetes
- Make regular ophthalmologist visits or as instructed
If you have migraines, glaucoma, or other conditions that worsen PVL, it helps to continue taking medication as instructed to stop the condition from worsening.
References
- Peripheral Vision Loss. (December 2019). Encyclopedia.
- What Is Diabetic Retinopathy? (October 2019). American Academy of Ophthalmology (AAO).
- What Is Glaucoma? (August 2019). American Academy of Ophthalmology (AAO).
- What Is Retinitis Pigmentosa? (October 2019). American Academy of Ophthalmology (AAO).
- Diabetic Retinopathy. (August 2019). National Eye Institute.
- Glaucoma. (March 2016). Cleveland Clinic.
- Retinitis Pigmentosa. (August 2019). National Eye Institute.
- Taking Good Care of Your Eyes. University of Rochester Medical Center.
- 6 Simple Ways to Take Better Care of Your Eyes. (April 2018). Self.
- Eye Care. (February 2017). Medline Plus, U.S. National Library of Medicine.
- Making Eye Health a Population Health Imperative: Vision for Tomorrow. Chapter 3 – The Impact of Vision Loss. (2016). National Academy of Sciences.
- Central and Peripheral Visual Impairment and the Risk of Falls and Falls with Injury. (December 2009). National Center for Biotechnology Information.
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