What is Quadrantanopia?

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer

Quadrantanopia, also known as quadrantopsia, is the loss of vision in one quarter of the visual field. It occurs when the visual pathways between the eyes and brain are damaged, typically by a stroke, tumor or head injury. Visual field testing diagnoses it. It may resolve within a few months, and treatment focuses on compensatory strategies like head movements. [1]

What the research says

• Scanning training may improve quality of life, but it does not restore the lost field. A Cochrane review of 20 trials (732 randomised participants) of interventions for visual field defects after stroke found low-quality evidence that scanning (compensatory) training improved quality of life on the VFQ-25 questionnaire (mean difference 9.36, 95% CI 3.10 to 15.62; 2 studies, 96 participants), with no effect on visual field measures. There was not enough evidence to judge restitution therapy or prisms (Pollock et al., Cochrane Database of Systematic Reviews, 2019). [4]

• Rehabilitation can improve reading speed. A meta-analysis of 9 randomised trials found that rehabilitative interventions significantly improved reading disorders caused by homonymous visual field defects (standardised mean difference 0.30, 95% CI 0.08 to 0.51). Reading training alone showed a similar benefit (standardised mean difference 0.35, 95% CI 0.05 to 0.66) (Maeyama et al., Acta Neurologica Belgica, 2024). [5]

• Many people with quadrantanopia can still drive safely, but it needs individual assessment. In an on-road study of 22 drivers with hemianopia, 8 with quadrantanopia and 30 with normal visual fields, all drivers with normal fields were rated safe, as were 88% (7 of 8) of drivers with quadrantanopia and 73% (16 of 22) of drivers with hemianopia. Slower visual processing, reduced contrast sensitivity and lower visual field sensitivity were linked to unsafe driving (Wood et al., Investigative Ophthalmology & Visual Science, 2009). [3]

Key Takeaways

What is quadrantanopia, and how does it affect vision?

Quadrantanopia is a specific type of visual field deficit where the entire area you can see—your visual field—is missing a one-fourth section. To understand this, imagine your vision divided into a grid of four equal parts: top-left, top-right, bottom-left, and bottom-right. In quadrantanopia, one of these sections appears to be completely blacked out or missing. [1]

This condition is distinct from hemianopia, which is the loss of exactly half of the visual field. The suffix "-anopia" refers to the absence of vision, while "quadrant" specifies the exact portion affected. It is almost always a neurological issue rather than a problem with the eyes themselves.

The Different Types of Vision Loss

Medical professionals categorize quadrantanopia based on which part of the visual field is affected and whether it impacts one or both eyes:

• Superior Quadrantanopia: Vision loss in the upper quadrants. This is famously nicknamed "pie in the sky" because the missing section is in the upper field of view. [1]

• Inferior Quadrantanopia: Vision loss in the lower quadrants, often called "pie on the floor." [1]

• Homonymous Quadrantanopia: The same quadrant is affected in both eyes (e.g., both eyes lose the top-right corner). [1]

• Binasal vs. Bitemporal: Binasal affects the quadrants closest to the nose, while bitemporal affects the quadrants closest to the temples. [1]

What are the symptoms and causes of quadrantanopia?

The most obvious sign of quadrantanopia is the sudden realization that a portion of your sight is missing. However, because the brain often tries to compensate for vision loss, the symptoms can sometimes be subtle at first.

Common Signs to Watch For

Individuals with this condition often experience:

• Blind Spots: A specific area of the vision that appears dark or simply "not there."

• Compensatory Movements: Frequently moving the head or eyes to try and see into the missing quadrant.

• Accidents: Bumping into furniture, tripping over low objects (in inferior types), or failing to see objects that appear suddenly from the side.

• Reading Difficulty: Losing one's place while reading or failing to see the beginning or end of a line of text.

Why Does It Happen?

Quadrantanopia is caused by a disturbance in the visual pathways—the complex network of nerves that carry electrical signals from the eyes to the brain's visual cortex. When these pathways are damaged, the brain cannot process the information from a specific section of the visual field.

The most frequent causes include:

1. Stroke: A disruption of blood flow to the brain is the leading cause of visual field loss.

2. Traumatic Brain Injury (TBI): Blows to the head from accidents or falls can damage the optic radiations.

3. Brain Tumors: A growing mass can put pressure on the visual pathways, gradually cutting off sight in a specific quadrant.

4. Contralateral Damage: Interestingly, damage to the right side of the brain typically causes vision loss on the left side of the visual field, and vice versa.

How is quadrantanopia diagnosed and managed?

If you experience any sudden change in your vision, call 911 or go to the emergency room right away, because it can be a sign of stroke.

Diagnostic Testing

To confirm a diagnosis, specialists use precise tools to map your sight:

• Visual Field Testing: Also known as perimetry, this is the gold standard for diagnosis. You look into a machine and signal when you see flashes of light in different areas of your vision.

• Electrophysiology: Tests like visual evoked potentials measure how the brain responds to signals from the eyes, while an electroretinogram checks the retina, helping to pinpoint where the pathway is broken.

• Medical History: A review of recent health events, such as a suspected stroke or head injury, provides vital context.

Treatment and Visual Rehabilitation

While there is no surgical "fix" for the damaged nerves, the brain is remarkably adaptable. Many people find their vision improves spontaneously within the first three to six months after the initial injury. [1]

For those with permanent loss, visual rehabilitation is the primary treatment:

• Scanning Techniques: Learning to scan your environment by moving your head quickly and systematically toward the blind spot. [1]

• Reading Aids: Using bright markers to denote the start of a line or using line guides to stay focused. [1]

• Computer-Based Stimulation: Specialized software designed to stimulate the edges of the blind spots to encourage the brain to process information more effectively. [1]

Can quadrantanopia be prevented, and what is the outlook?

The outlook for quadrantanopia varies based on the underlying cause. While the vision loss itself is not always preventable, the primary causes—stroke and head injuries—can often be managed through lifestyle changes.

Reducing Your Risk

• Stroke Prevention: Maintaining a healthy diet low in saturated fats, staying physically active, and quitting smoking can significantly lower your risk of the vascular issues that lead to vision loss. [1]

• Head Safety: Always wear seatbelts while driving and use helmets during contact sports or cycling. [1]

• Home Safety: Arrange furniture to prevent falls and ensure all stairways are well-lit, especially for those who already have minor vision issues. [1]

Living with Vision Loss

Most people with quadrantanopia are still able to perform daily tasks, though some activities, like driving, may require specialized testing to ensure safety. Accessing low-vision resources and support groups can provide practical tips for navigating a world that feels "one-fourth" smaller.

Conclusion

Quadrantanopia is a challenging condition that highlights the delicate connection between the eyes and the brain. Whether it manifests as a "pie in the sky" or "pie on the floor" deficit, understanding the cause and seeking early diagnosis is essential for the best possible recovery. With the right rehabilitation strategies and a focus on safety, individuals can successfully adapt to these visual changes and maintain a high quality of life.

Understanding complex visual deficits is easier with clear diagrams. Use Rinnit's infographic templates to create professional medical illustrations that explain visual field loss, brain anatomy, and rehabilitation techniques for patients and students alike.

Frequently Asked Questions

What is quadrantanopia?

It is the loss of vision in one-fourth of your visual field.

Is it the same as being blind?

No, it is a partial loss of vision in a specific area, not total blindness.

What is the difference between quadrantanopia and hemianopia?

Quadrantanopia is loss of one-fourth of the vision; hemianopia is loss of one-half.

What does "pie in the sky" mean?

It is a nickname for superior quadrantanopia, where the top quadrant of vision is missing.

What does "pie on the floor" mean?

It refers to inferior quadrantanopia, where the bottom quadrant of vision is missing.

Can a stroke cause this?

Yes, stroke is one of the most common causes of visual field deficits.

What is homonymous quadrantanopia?

When the same quadrant is affected in both eyes.

What causes the "blacked out" area?

Damage to the visual pathways in the brain prevents the processing of light from that area.

Is the eye itself damaged?

Usually no; the problem lies in the brain or the nerves connecting the eye to the brain.

Can a brain tumor cause vision loss?

Yes, by pressing against the optic nerves or visual cortex.

What is contralateral damage?

When damage to one side of the brain causes vision loss on the opposite side of the visual field.

What are the symptoms of quadrantanopia?

Blind spots, bumping into things, and needing to move the head to see clearly.

Do people with this condition trip often?

Yes, especially those with inferior (lower) vision loss.

Can it affect reading?

Yes, it can make it hard to find the beginning or end of a sentence.

How is it diagnosed?

Through a visual field test (perimetry).

What is perimetry?

A test where you look into a bowl-shaped machine to map your field of vision.

Is there a cure for quadrantanopia?

There is no direct cure, but it can improve spontaneously.

How long does spontaneous recovery take?

Usually within three to six months.

What is visual rehabilitation?

A series of exercises and techniques to help you compensate for vision loss.

What are scanning techniques?

Moving your head and eyes systematically to cover blind spots.

Can I still drive with quadrantanopia?

It depends on local laws and passing a specialized driving safety test.

Are there glasses for this?

Prisms in glasses can sometimes help shift the visual field, but they don't "fix" the loss.

What is an electroretinogram?

A test that measures the electrical response of the eye's light-sensitive cells.

Can head injuries cause this?

Yes, traumatic brain injuries (TBI) are a frequent cause.

Is it permanent?

It can be, but many people experience at least partial recovery.

How can I prevent a stroke?

By eating well, exercising, and managing blood pressure.

Are helmets important?

Yes, they help prevent the TBIs that can lead to vision loss.

Should I get regular eye exams?

Yes, to monitor any changes and ensure overall eye health.

Can children have quadrantanopia?

Yes, if they experience a brain injury or have a congenital condition.

What is quadrantopsia?

It is simply another name for quadrantanopia.

Does it affect color vision?

Usually not, as it is a field-of-vision issue, not a color-processing issue.

Can stress cause this?

No, it is caused by physical damage to the brain or nerves.

What should I do if my vision changes suddenly?

Seek emergency medical care immediately.

Can I use a computer?

Yes, though you may need to adjust the screen or use software aids.

Are there support groups?

Yes, many organizations for stroke and TBI survivors offer vision-specific support.

What is the optic radiation?

The part of the visual pathway that often gets damaged in quadrantanopia.

Does it affect both eyes?

In homonymous cases, yes, it affects the same area in both eyes.

What is bitemporal vision loss?

Loss of the outer (temple-side) quadrants of the vision.

What is binasal vision loss?

Loss of the inner (nose-side) quadrants of the vision.

Can it be caused by a car accident?

Yes, due to the potential for head trauma.

Is it painful?

The vision loss itself is not painful, though the cause (like a TBI) might be.

Does it cause headaches?

Sometimes, due to the strain of trying to compensate for the blind spot.

Can I still work?

Many people continue to work, often with workplace accommodations.

What are line guides?

Tools used to help people with vision loss stay on the correct line while reading.

Can the brain "rewire" itself?

Yes, through a process called neuroplasticity, the brain can learn to use other areas to process information.

Is it a rare condition?

It is relatively common among stroke and TBI survivors.

Can high blood pressure cause this?

Indirectly, by increasing the risk of stroke.

How often should I do rehab exercises?

As recommended by your specialist, usually daily.

Can I use a magnifying glass?

It may help with detail, but it doesn't fix the missing quadrant.

Where can I learn more?

Consult with a neuro-ophthalmologist or visit the Cleveland Clinic website.

Related Reading

Visual Field Test: Types, What to Expect and What Results Mean explains the test used to map and confirm vision loss.

Understanding the Occipital Lobe: The Brain's Visual Processing Hub describes the brain area where many visual field losses begin.

Optic Chiasm: Anatomy, Function, and Visual Health explains where the optic nerves cross and how damage affects vision.

Stroke: Symptoms, Causes, Diagnosis, and Treatment — A Complete Guide covers stroke, a common cause of sudden visual field loss.

References

1. Cleveland Clinic. Quadrantanopia: What It Is, Causes & Types. Cleveland Clinic Health Library. Last updated March 19, 2023. https://my.clevelandclinic.org/health/diseases/24849-quadrantanopia

2. Monserrate AE, De Jesus O. Homonymous Superior Quadrantanopia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; updated August 23, 2023. PMID 32644408. https://www.ncbi.nlm.nih.gov/books/NBK558982/

3. Wood JM, McGwin G, Elgin J, et al. On-road driving performance by persons with hemianopia and quadrantanopia. Invest Ophthalmol Vis Sci. 2009;50(2):577-585. PMID 18936138. https://doi.org/10.1167/iovs.08-2506

4. Pollock A, Hazelton C, Rowe FJ, et al. Interventions for visual field defects in people with stroke. Cochrane Database Syst Rev. 2019;5(5):CD008388. PMID 31120142. https://doi.org/10.1002/14651858.CD008388.pub3

5. Maeyama T, Okada H, Sakai S. The effects of rehabilitative interventions on reading disorders caused by homonymous visual field defects: a meta-analysis focusing on improvement in reading speed. Acta Neurol Belg. 2024;124(1):123-140. PMID 37572263. https://doi.org/10.1007/s13760-023-02327-6

Disclaimer

This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.