Loss of Peripheral Vision

Peripheral vision, also called side vision, allows you to see objects outside your direct line of sight. Loss of peripheral vision—sometimes called "tunnel vision"—can significantly impact daily activities like driving, walking in crowds, and navigating around obstacles.

What Peripheral Vision Loss Feels Like

People with peripheral vision loss may experience:

• Bumping into objects or people on one side
• Difficulty navigating through doorways or crowds
• Being startled by people or objects "appearing" from the side
• Problems driving, especially changing lanes or merging
• Need to turn head frequently to see what's beside you
• Feeling like looking through a tunnel
• Missing objects that aren't directly in front of you
• Difficulty with sports requiring awareness of surroundings

Many people don't realize they've lost peripheral vision because the brain compensates by filling in gaps.

Patterns of Peripheral Vision Loss

The pattern of vision loss provides important diagnostic clues:

One Eye Affected

• Suggests problem with that eye or its optic nerve
• Causes include glaucoma, ischemic optic neuropathy, optic neuritis, retinal detachment

Same Side Affected in Both Eyes (Homonymous)

• Suggests problem in the brain beyond the optic chiasm
• Homonymous hemianopia—loss of left or right half of vision in both eyes
• Usually caused by stroke, tumor, or brain injury

Both Outer Sides Affected (Bitemporal)

• Bitemporal hemianopia—loss of temporal (outer) vision in both eyes
• Suggests problem at the optic chiasm (where optic nerves cross)
• Often caused by pituitary tumors or other masses

Upper or Lower Half Affected

• Altitudinal defect—loss of upper or lower half of vision
• Suggests optic nerve or retinal problem
• Common in ischemic optic neuropathy

Common Causes

Eye Conditions

• Glaucoma—most common cause; damages optic nerve gradually
• Retinal detachment—separation of retina creating shadow
• Retinitis pigmentosa—inherited retinal degeneration
• Diabetic retinopathy—advanced disease with retinal damage

Optic Nerve Conditions

• Ischemic optic neuropathy—sudden blood flow loss to optic nerve
• Optic neuritis—inflammation of optic nerve
• Papilledema—optic nerve swelling from increased brain pressure
• Compressive optic neuropathy—tumor pressing on optic nerve

Brain Conditions

• Stroke—affecting visual pathways or occipital cortex
• Brain tumors—compressing visual pathways
• Pituitary tumors—pressing on optic chiasm
• Traumatic brain injury—damaging visual pathways
• Multiple sclerosis—demyelination affecting visual pathways

When to Seek Care

How Peripheral Vision Loss Is Diagnosed

Visual Field Testing

The key test for documenting peripheral vision loss:

• Humphrey visual field—automated test mapping sensitivity across visual field
• Goldmann perimetry—manual testing for detailed assessment
• Confrontation visual fields—quick screening in clinic

Eye Examination

• Dilated fundus exam—examining optic nerve and retina
• Intraocular pressure—checking for glaucoma
• Optical coherence tomography (OCT)—imaging optic nerve fiber layer
• Gonioscopy—examining drainage angle in glaucoma

If Neurological Cause Suspected

• MRI of brain and orbits—evaluating optic nerves, chiasm, and brain
• MRA or CTA—imaging blood vessels
• Blood tests—checking for inflammation, vascular risk factors

Treatment Options

Treatment depends on the underlying cause:

For Glaucoma

• Eye drops—to lower intraocular pressure
• Laser treatment—selective laser trabeculoplasty (SLT)
• Surgery—trabeculectomy, tube shunts, or minimally invasive procedures
• Goal is to prevent further loss; lost vision usually doesn't return

For Stroke or Brain Lesions

• Acute stroke treatment—if within treatment window
• Rehabilitation—visual training, scanning techniques
• Prism glasses—sometimes helpful to expand field awareness
• Treatment of underlying cause (tumor removal, etc.)

For Optic Nerve Conditions

• Treatment specific to cause—steroids for inflammation, surgery for compression
• Management of papilledema—treating elevated intracranial pressure

Adaptation Strategies

• Visual scanning training—learning to look toward the blind side
• Mobility training—safe navigation techniques
• Driving evaluation—determining if safe to drive
• Home modifications—improving safety

Impact on Daily Life

Driving

• Most states have visual field requirements for driving
• You may need formal evaluation by a certified driver rehabilitation specialist
• Some people with peripheral vision loss can continue driving with adaptations
• Discuss driving restrictions with your doctor

Safety

• Increased fall risk—use handrails, clear obstacles
• Difficulty in crowds—move cautiously, sit with back to wall
• Sports modifications—may need to avoid activities requiring side vision
• Home lighting—ensure adequate illumination

Frequently Asked Questions

Can peripheral vision be restored?

Generally, once peripheral vision is lost from conditions like glaucoma or stroke, it doesn't return. However, treatment can prevent further loss, and rehabilitation can help you adapt.

Why didn't I notice my peripheral vision loss?

The brain is remarkably good at compensating. It "fills in" missing areas, so gradual peripheral vision loss often goes unnoticed until significant. This is why regular eye exams including visual field testing are important.

Is peripheral vision loss the same as tunnel vision?

"Tunnel vision" typically refers to severe loss of peripheral vision, leaving only central vision. Peripheral vision loss can range from mild (small defects) to severe (tunnel vision).

Can I still drive with peripheral vision loss?

It depends on the severity and location of the loss. Most states require a minimum visual field (often 120-140 degrees). A formal driving evaluation can determine if you can drive safely.

How fast does glaucoma cause vision loss?

Untreated glaucoma typically progresses slowly over years, but can cause significant vision loss if uncontrolled. With proper treatment, most people with glaucoma maintain functional vision throughout their lives.

References