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Does Parkinson’s Disease Affect The Eyes

Eye Exam Could Lead To Early Parkinson’s Disease Diagnosis

How Parkinson’s Affects Your Vision
Radiological Society of North America
A simple eye exam combined with powerful artificial intelligence machine learning technology could provide early detection of Parkinson’s disease, according to new research.

A simple eye exam combined with powerful artificial intelligence machine learning technology could provide early detection of Parkinson’s disease, according to research being presented at the annual meeting of the Radiological Society of North America .

Parkinson’s disease is a progressive disorder of the central nervous system that affects millions of people worldwide. Diagnosis is typically based on symptoms like tremors, muscle stiffness and impaired balance — an approach that has significant limitations.

“The issue with that method is that patients usually develop symptoms only after prolonged progression with significant injury to dopamine brain neurons,” said study lead author Maximillian Diaz, a biomedical engineering Ph.D. student at the University of Florida in Gainesville, Florida. “This means that we are diagnosing patients late in the disease process.”

Disease progression is characterized by nerve cell decay that thins the walls of the retina, the layer of tissue that lines the back of the eyeball. The disease also affects the microscopic blood vessels, or microvasculature, of the retina. These characteristics present an opportunity to leverage the power of AI to examine images of the eyes for signs of Parkinson’s disease.

Visual Problems That May Occur

The main ones are:

  • Blurred vision: This causes you to squint and to re-focus your eyes too often.
  • Bright light is often experienced as harsh and painful.
  • Asthenopia: This is weakness or fatigue of the eyes, usually accompanied by headaches.
  • Trouble reading.
  • Double vision: Although less common than the above symptoms, seeing double happens more frequently among PD patients than among the general population.
  • Visual hallucinations: About one-third of persons with PD will experience varying types of visual hallucinations. Usually, the hallucinations occur in peripheral vision . Visual hallucinations are often linked to medication dosage levels and to the disease itself.
  • Difficulty estimating spatial relations: Persons with PD have a little more difficulty with spatial relationships than do other persons.
  • Abnormalities of color perception: This happens especially in the blue-green axis, and of visual contrast sensitivity have also been well-documented in PD patients.
  • Abnormalities in blinking: The frequency of blinking is decreased in PD patients.
  • Blepharospasm .

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The study enrolled 20 patients who had been newly diagnosed with Parkinsons disease, and 20 age-matched healthy subjects, to assess changes in the visual system associated with the disease. The participants underwent magnetic resonance imaging scans, which researchers used to look at changes in the white and gray matters, as well as ophthalmologic examinations.

They found that patients presented significant changes in the brain structures associated with the visual system, such as changes in the optic radiations, decreased white matter volume and reduced volume of the optic chiasm .

As a consequence, patients experienced visual alterations, such as an inability to perceive colors, decreased visual acuity, and a reduction in blinking, which often led to dry eyes.

According to Arrigo, these changes may appear more than a decade before the motor symptoms associated with Parkinsons disease, which makes them potential biomarkers to diagnose and follow this disease.

The study in depth of visual symptoms may provide sensitive markers of Parkinsons disease, Arrigo said. Visual processing metrics may prove helpful in differentiating Parkinsonism disorders, following disease progression, and monitoring patient response to drug treatment.

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Difficulty Moving The Eyes

You may have difficulties when starting to move your eyes or when trying to move them quickly. This might be more noticeable when looking at fast-moving objects, such as cars. Sometimes, instead of a smooth movement, your eyes move in a slow and jerky way. Difficulties in moving the eyes up or down are more common in progressive supranuclear palsy than Parkinson’s.

Alzheimers Disease: Multifaceted Vision Changes


When it comes to chronic conditions, we know the least about Alzheimers disease.

Researchers discovered the condition in the 1980s. Since then, theyve been working hard to understand how the problem begins and what can be done to treat it. They do know that people with the condition have changes in visual ability, but no one is quite sure why.

The Alzheimers Association says 5.7 million people lived with the condition in 2018, and that number should rise as the population ages. Most people with Alzheimers are identified due to severe memory loss and functional brain changes. They may forget words, get lost, or experience unusual emotional shifts.

People with Alzheimers disease also have vision changes, researchers say, and they can involve:

  • Peripheral vision. When the field of vision shrinks, youre only able to see the things right in front of you, unless you move your head. You may find that you run into things often, or you may fall.
  • Motion detection. You may see the world as a series of still photographs, and that can cause you to get lost in familiar spaces.
  • Color. You may struggle to identify colors, or the whole world may seem dim and gray.
  • Depth. Everything may seem flat to you, and that can make it hard for you to spot items you need, like a plate on the table.

More research can confirm this hypothesis, and right now, its a guess.

Structural Eye Changes & Color Perception Issues

Is Vision Specifically Affected In Pd Dementia

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Everyone Needs Regular Eye Exams

Even people with perfect eyesight should schedule regular eye exams as part of their preventative care routine. These exams are essential for screening for eye diseases and preserving your vision. Typically, an eye exam includes visual acuity tests , depth perception tests, eye alignment, and eye movement. Your eye physician may also use eye drops to dilate your pupils, allowing them to check for common eye problems such as diabetic retinopathy, glaucoma, and age-related macular degeneration.

These are important for people with Parkinsons to keep in mind for two reasons: first, up to half of all vision loss in the US is preventable or treatable with early detection through annual eye exams, and second, vision loss has a disproportionate impact on people with Parkinsons: it increases the risk of falls, hip fractures, depression, anxiety, hallucinations, and dementia.

The American Academy of Ophthalmology recommends that all adults over 65 receive a comprehensive eye exam every one to two years. The recommended frequency of eye exams is every two to four years for age 40-54 and every one to three years for age 55-64. If you have a history of diabetes or are at an increased risk of glaucoma , you should have an eye exam every year regardless of age.

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What Is Binocular Vision Dysfunction

Binocular vision dysfunction is any condition where your eyes dont work together properly. Some people are born with BVD and others develop BVD due to illness or injury. It is not like nearsightedness or farsightedness, which cause blurry vision. Instead, BVD causes the eye muscles to constantly shift position in order to focus. That results in eye strain, headaches, double vision, vertigo, and depth perception problems.

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Seeing Clearly with Parkinson’s Disease: Vision Changes

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Parkinsons disease is a progressive condition whereby the signals communicated between the brain and nervous system are disrupted. This causes a number of impairments, many of which relate to movement. The symptoms are often subtle at first but become quite pronounced as the condition advances. When this occurs, the eyes may be affected in a number of ways.

Eye Exam Could Lead To Early Parkinsons Disease Diagnosis

Radiological Society of North America
A simple eye exam combined with powerful artificial intelligence machine learning technology could provide early detection of Parkinsons disease, according to new research.

A simple eye exam combined with powerful artificial intelligence machine learning technology could provide early detection of Parkinsons disease, according to research being presented at the annual meeting of the Radiological Society of North America .

Parkinsons disease is a progressive disorder of the central nervous system that affects millions of people worldwide. Diagnosis is typically based on symptoms like tremors, muscle stiffness and impaired balance an approach that has significant limitations.

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Vision: More Than Meets The Eye Tricks To Aid Pd Patients


Vocal Symptoms

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Neurodegenerative Conditions: When Amd Parkinsons And Alzheimers Affect The Eyes

By John Hulleman, Ph.D.

The eyes are figuratively the windows to the soul but they also can literally be windows to the brain. Aside from traditional age- and genetics-related vision conditions, such as macular degeneration, central nervous system conditions including Parkinsons disease and Alzheimers disease can affect patients vision. These diseases can cause direct or retrograde degenerations of the optic nerve, retinal cells, and surrounding visual structures. While not often obvious, these conditions affect coordination, mobility, and visual perception, resulting in increased risks of falls and related injuries.

The UT Southwestern Department of Ophthalmology is on the leading edge of diagnostics and treatment. With a suite of advanced tools, techniques, and ongoing research studies, we collaborate with researchers in UTSW’s Peter O’Donnell Jr. Brain Institute and community physicians to translate our expertise and data into active, effective therapies to diagnose, treat, and even prevent degenerative eye conditions in patients in North Texas and around the world.

Excessive Watering Of The Eyes

People with Parkinsons can experience this for several reasons, including infrequent blinking due to impaired reflexes. Infrequent blinking stimulates the lacrimal gland resulting in excessive watering. Irritation can also be a cause and this is often eased by using eye lubricants.

If the watering does not settle your neurologist may refer you to an ophthalmic surgeon. Botulinum toxin A injections into the lacrimal gland may also help.

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Difficulty Moving The Eyes Or Difficulty In Focusing On Moving Objects

The slowness or reduced movement associated with Parkinsons may affect how you move your eyes. You might notice this more when following a fast-moving object such as a vehicle or ball. Your eyes may move slowly and jerkily. You may also experience some difficulty in reading because the eyes are slower in jumping from the end of a line to the beginning of the next.

Difficulties moving the eyes up and down are more common in a condition called Progressive Supranuclear Palsy, a form of parkinsonism. If you experience this problem, your specialist or Parkinsons nurse if you have one, will be able to give advice.

Caution! If detecting or seeing movement is difficult, particularly estimating the speed of a moving object such as a car, great care should be taken when out and about, both when driving and walking.

Colour Vision Contrast Sensitivity And Low Light Conditions

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A lack of dopamine-producing cells in the retina can cause problems with colour vision and contrast sensitivity. This means that it may be hard to distinguish between shades of the same colour, particularly blues and blue/greens. Some people also have difficulty defining images on a background of similar shades or colours and reading fine print, particularly in low light levels.

Levodopa and other Parkinsons medications may help with these problems. Your doctor will be able to advise you on this.

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Eye Changes May Identify Parkinson’s Disease

Researchers have identified changes in the eye in patients with Parkinson’s disease that can be seen with noninvasive, inexpensive imaging equipment, raising hopes that this could in future become a method for the early diagnosis of the condition.

The team led by eye specialists from Duke University Medical Center, Durham, North Carolina, report decreased retinal microvascular perfusion and structural alterations in the choroid compared with findings in cognitively healthy control individuals.

Their findings were in JAMA Ophthalmology on December 23.

Cason Robbins

“Our group has previously reported retinal changes in patients with Alzheimer’s and mild cognitive impairment and we are now extending this work to patients with Parkinson’s disease,” lead author, Cason Robbins, BS, a medical student at Duke University, told Medscape Medical News.

“It has been shown previously that Parkinson’s is associated with increased vascular disease in the brain. It could be that we are observing the same changes in the vasculature in the retina. We have seen similar changes in the retinal blood vessels in Alzheimer’s but there is more retinal thinning in Alzheimer’s disease,” Robbins commented.

“We think that in both Parkinson’s and Alzheimer’s, the changes in the retina reflect dying neurons similar to what is happening in the brain, but we can see it more easily in the eye.”

JAMA Ophthalmol. Published online December 23, 2020. Abstract, Editorial

Thinning Of Retina Linked To Loss Of Brain Cells That Control Movement

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with 38,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

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Is Vision Specifically Affected In Pd Dementia

Many of the oculo-visual features present in early and middle stage PD will become more severe if the patient develops PD dementia. However, some features appear to be particularly exacerbated in PD dementia including deficits in colour vision and changes in pupillary function . In addition, there are visual features which may be particularly characteristic of PD dementia. First, prominent visual hallucinations are significantly more frequent in PD dementia than PD . Second, severe eye movement problems are more likely to be present in PD dementia and to become more extensive with declining cognitive function . Third, defects in visuospatial orientation are likely to be greater in PD dementia especially when associated with greater cortical atrophy . Many additional visual features, already detected in PD, are likely to be present in a more severe form in PD dementia.

How Does Parkinson’s Cause Vision Issues

Dr. James Beck – How does Parkinson’s disease affect the brain?

Parkinsons is characterized by a loss of dopamine producing cells in the substantia nigra portion of the brain. The reduction of dopamine can affect the visual cortex. So Parkinsons can impair mobility of the eyes just like the limbs. There are several kinds of visual disturbances that may be experienced by people with Parkinsons. Many who experience changes in vision or eye mechanics seek out a consultation from a neuro-opthalmologist, someone who specializes in visual problems associated with neurological disease.2

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Pathological Alterations In The Retina Of Pd Patients

In recent years, the development of non-invasive studies such as imaging of the retina and electrophysiological assessments allowed the direct observation of structural and functional changes in the retina in PD patients.

Optical coherence tomography allows measurements of retinal layers in vivo, providing structural information of the retina with 1-to-10 micrometer resolution . In particular, OCT was used to analyze the peripapillary retinal nerve fiber layer and retinal thickness . Different studies have shown a significant reduction in RNFL thickness of PD patients especially in the temporal quadrant that, notably, is typically affected in mitochondrial optic neuropathies . In contrast, only a few studies failed to find differences between PD patients and healthy controls . OCT analysis reported pathological thinning of the RGC, IPL and INL, more evident in the foveal pit zone . However, also in this case, other studies failed to find significant differences in PD patients . These discrepancies can be attributed to differences in disease stage/severity, and to diverse measurement protocols and OCT equipment and analysis methods.

Electrophysiology techniques such as electroretinography and visual evoked potentials allow the analysis of selective retinal circuits and the determination of dysfunction of specific retinal cell types.

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Does Parkinsons Disease Affect Vision

By Kathy Herrfeldt 9 am on March 15, 2021

When people think about Parkinsons, they typically focus on the loss of motor skills. However, the disease can also impact vision and make it difficult to complete various tasks that dont involve motor function or mental health. Continue reading to learn how Parkinsons disease can affect a seniors vision and what family caregivers can do to help with each issue.

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Treating Parkinsons Related Binocular Vision Dysfunction

Dont just assume you have to live with these issues. The good news is that a neurovisual specialist can help improve depth perception, balance, reading difficulties, and double vision by prescribing glasses with prism lenses. These special glasses can correct subtle eye misalignments and allow the muscles around the eyes to relax, decreasing symptoms of BVD.

While a typical optical exam addresses most vision changes, a neurovisual specialist will also examine the muscles around the eyes for BVD. Dr. Sonnenberg at NeuroVisual Specialists of Florida has years of experience assessing eye alignment and muscle function of the eyes. She uses a completely non-invasive evaluation process to identify alignment problems so she can prescribe the right glasses to correct them.

Prismatic lenses move images to where your eyes are positioned. Once youre wearing them, your eyes dont have to work as hard to focus. Most people notice an improvement as soon as they start wearing the prism lenses. The best part is, they dont look any different from ordinary glasses.

For more information about BVD, prismatic lenses, and the examination process, or to schedule an appointment, contact us today!

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