Two very different problems after stroke can look alike from the outside — missing things on one side. Knowing which one you're dealing with changes what helps.
Hemianopia is a loss of sight: the same half of the visual field is missing in both eyes because the visual pathway was damaged. The person usually knows something is wrong — they bump into door frames, lose their place reading, get startled by things appearing from one side.
Visual neglect (also called spatial neglect or inattention) is a loss of attention: the eyes may work, but the brain doesn't attend to one side of space — most often the left side, after a right-hemisphere stroke. The hallmark is that the person often doesn't realise: food left on half the plate, one side of the face unshaved, drawings with the left half missing, with no sense that anything is absent.
The same stroke can cause both, which is one reason assessment by professionals matters — the combination behaves differently from either alone, and untangling them takes formal testing.
Visual fields are measured directly (confrontation testing, perimetry). Neglect is assessed with tasks like cancellation (crossing out targets scattered on a page), line bisection (marking the middle of a line — people with left neglect mark it far to the right), clock drawing and copying. An orthoptist, occupational therapist or neuropsychologist can run these; the pattern of results distinguishes a field cut from an attention problem.
With hemianopia, the person knows to compensate, so scanning strategies and reading aids can be practised deliberately. With neglect, the first hurdle is awareness itself — therapy often has to build the habit of looking to the neglected side before any scanning strategy can stick, using prompts, anchors and structured cueing. The evidence base for neglect treatments is genuinely limited: a Cochrane review of cognitive rehabilitation for neglect (Bowen and colleagues, 2013) found insufficient evidence to say which approaches work best, though scanning-based training with prompts remains a mainstay of clinical practice. Neglect also tends to affect everyday independence more, which makes professional involvement more important, not less.
For hemianopia: systematic scanning toward the blind side, anchoring the edge of a page when reading, good lighting, and placing important things on the seeing side while practising attention to the other. For neglect: a bright anchor at the edge of the neglected side, routines that always start by finding that anchor, family members prompting from the neglected side gently, and structured practice set up by an occupational therapist. In both cases: check with your team before adopting techniques — these are general descriptions, not a personalised plan.
Stroke Sight's exercises — Anchor & Scan, Visual Search Grid, Line Bisection and others — are used for scanning practice in both conditions. Whether and how they fit your situation is a question for your team; the app is a wellness tool for practice support, not a treatment. Free demo, no account.
See Stroke Sight →This guide is general information, not medical advice, and does not diagnose or treat any condition. Always follow the guidance of your own care team. Stroke Sight and ReWrite are wellness support tools, not medical devices.