An Eye Test For Early Diagnosis Of Parkinsons Disease
Currently, our best methods for diagnosing Parkinsons disease rely on spotting physical symptoms, such as a hand tremor. Unfortunately these symptoms only present when disease has already advanced to affect a large proportion of dopamine-producing cells. If we could detect disease earlier, we could treat it earlier and potentially slow the progression of disease. A recent study published by Eduardo Maria Normando and coworkers in the journal Acta Pathologica Communications suggests that we may be able to see changes in the retinas of the eyes of patients long before they develop symptoms.
In this way, the retina could be a biomarker for Parkinsons, showing early changes of disease. The authors used a chemical called rotenone to reproduce certain features of Parkinsons disease in rats. After 60 days of rotenone exposure, the experimenters found that large numbers of dopamine-producing cells in the rat brain were affected. Crucially, the researchers were able to use non-invasive retinal scans to see changes in the rats retinas a full 40 days earlier . This suggests that we may be able to pick-up changes in human retinas well before patients develop Parkinsons disease. It may even open the way to earlier treatment to prevent disease.
Image credit: Paul Boxley
Eye Exam Could Lead To Early Parkinson’s Disease Diagnosis
- Date:
- Radiological Society of North America
- Summary:
- 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.
There Are Many Types Of Professionals Who Can Help
While there are no proven ways to prevent most ocular conditions from developing, routine visits with an eye care professional can lead to early recognition and treatment of eye issues before they harm your quality of life. Between you, your neurologist, and an ophthalmologist, most visual complaints can be handled. However, when symptoms remain unchanged and unexplained, consultation with a neuro-ophthalmologist is probably warranted.
A neuro-ophthalmologist is either a neurologist or an ophthalmologist with fellowship training in neuro-ophthalmology. Neuro-ophthalmologists have a unique appreciation for the intersection of the eyes and the brain and perform comprehensive testing in the office to determine where a visual or eye movement problem could originate. Once the location of the disturbance is identified, diagnostic testing , treatments, and therapies can be customized depending on the individual and their concerns.
While your eye care professional may not be aware of common ocular symptoms that people living with Parkinsons experience, explaining the kinds of situations and triggers that bring on eye symptoms is usually enough for your physician to know where to look during the examination . Keeping a journal or diary of symptoms can also be helpful for both you and your physician.
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Things You Need To Know
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Parkinsons Detectable Through Eye Exam
It’s neither an avant-garde brain scan nor invasive test that could revolutionize detection of Parkinson’s disease among asymptomatic patients, but routine imaging found in the office of a doctor of optometry.
New research published Aug. 18 in the journal Acta Neuropathologica Communications details how the in vivo diagnostic imaging afforded by optical coherence tomography may help detect miniscule retinal changes associated with Parkinson’s long before the first symptoms become evident.
Categorized by bodily tremors, bradykinesia and impaired coordination, Parkinson’s affects nearly 1 million Americans, but its cause is unknown. Onset begins subtly when dopaminergic cell death accumulates proteins called Lewy Bodies in the brain. However, outward symptoms only present once 70% of dopaminergic cells die, making early detection equally crucial and difficult.
Therefore, scientists at University College London investigated retinal ganglion cell apoptosis as a surrogate marker for changes in the brain. Mimicking Parkinson’s cell death in rodent models, researchers used longitudinal in vivo imaging with detection of apoptosing retinal cells and OCT to measure cell death before and after administration of the anti-diabetic drug, rosiglitazone.
Researchers found that this nerve-cell-protecting drug helped reduced retinal cell death, further suggesting that rosiglitazone may have potential as a Parkinson’s treatment option.
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Testing For Parkinsons Disease
There is no lab or imaging test that is recommended or definitive for Parkinsons disease. However, in 2011, the U.S. Food and Drug Administration approved an imaging scan called the DaTscan. This technique allows doctors to see detailed pictures of the brains dopamine system.
A DaTscan involves an injection of a small amount of a radioactive drug and a machine called a single-photon emission computed tomography scanner, similar to an MRI.
The drug binds to dopamine transmitters in the brain, showing where in the brain dopaminergic neurons are.
The results of a DaTscan cant show that you have Parkinsons, but they can help your doctor confirm a diagnosis or rule out a Parkinsons mimic.
Knowing That It Is Msa And Not Parkinsons Is Important
Over the years MSA Coalition Board Members have heard the frustration about a slow diagnosis after the initial diagnosis of Parkinsons.While MSA is fatal, knowing the correct diagnosis, is still important.
Multiple system atrophy affects multiple systems in the body.As a result, while there are not MSA specific treatments, treating the various symptoms from sleep disorders, urinary and bowel issues, blood pressure control, etc. can vastly improve quality of life. The earlier an MSA patient is diagnosed, the earlier doctors can establish a plan of action to improve symptoms that can be very disabling. Another factor is that Parkinsons medications typically stop working in MSA patients.
An early diagnosis also allows patients and their families to spend quality time together while they are still able.It also provides time to prepare for end-of-life issues, such as preparing wills and living wills.
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A Decade Of Unnecessary Parkinsons Drugs Is Likely To Have Remodelled My Brain
A key issue is that I no longer have a convenient label for my symptoms. I had pre-existing joint and gastro issues that have worsened immeasurably during the past decade. My ability to concentrate, to function, to move, to be all worsened beyond comprehension. I have been told that nearly a decade of unnecessary Parkinsons drugs is likely to have remodelled my brain, through its innate neuroplasticity, so that it now considers the symptomatic side effects of those drugs normal for me. Just as hitting a tennis ball every day for 10 years will build up your ball-hitting skills, so the brain can be driven by drugs and their side effects into behaviours that it then reconfigures and learns as normal.
Writhing and contorting
Actually weaning myself off Stalevo a Parkinsons medication used to increase dopamine levels in the brain which I was taking eight times a day, was pretty terrifying. I was initially advised to drop one daily dose per week. By the second week I was writhing and contorting involuntarily not something I had ever done before. I was then asked to drop one daily dose per month. I took my last Stalevo dose on 25 October 2015.
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Diagnosis Of Parkinsons Disease
A number of disorders can cause symptoms similar to those of Parkinsons disease. People with Parkinsons-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinsons, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinsons. Since many other diseases have similar features but require different treatments, it is important to make an exact diagnosis as soon as possible.
There are currently no blood or laboratory tests to diagnose nongenetic cases of Parkinsons disease. Diagnosis is based on a persons medical history and a neurological examination. Improvement after initiating medication is another important hallmark of Parkinsons disease.
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Revolutionary Righteye Vision System Is Now Fda
The diagnosis of Parkinsons Disease has always been based on the results of a range of neurological tests, and unfortunately, misdiagnosis is common. In fact, up to 60% of patients with Parkinsons disease are misdiagnosed at least once, and up to one-third are misdiagnosed twice! Now, RightEye LLC, an award-winning company for healthcare technology, may be able to significantly improve the situation for patients.
The FDAs Breakthrough Device Program recently granted RightEye LLC the first and only designation for a device that uses objective eye movement measurements to help evaluate for Parkinsons disease. With this recognition, the availability of RightEye to eye doctors across the US is expected to increase dramatically. At EYEcenter Optometric, we are pleased to offer this progressive technology in our eye care offices in Citrus Heights, Gold River, Rocklin, and Folsom, California .
Blood Vessels In The Eye May Diagnose Parkinson’s Disease
Ingrid Hein
An eye exam may be all that is needed to diagnose Parkinson’s disease, new research shows.
Maximillian Diaz
Using an advanced machine-learning algorithm and fundus eye images, which depict the small blood vessels and more at the back of the eye, investigators are able to classify patients with Parkinson’s disease compared against a control group. “We discovered that micro blood vessels decreased in both size and number in patients with Parkinson’s,” Maximillian Diaz, a PhD student at the University of Florida in Gainesville, told Medscape.
The simple eye examination may offer a way to diagnose Parkinson’s early in the disease progression.
Diaz said the test could be incorporated to a patient’s annual physical examination not only to look for Parkinson’s but also for other neurological diseases. A team in his lab is also looking at whether the same technique can diagnose Alzheimer’s disease.
The beauty of this is that “the technique is simple,” he said. “What surprised us is that we can do this with fundus images, which can be taken in a clinical setting with a lens that attaches to your smartphone.”
“It’s affordable and portable and it takes less than a minute,” he added.
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Symptoms Of Parkinsons Disease
Parkinsons disease has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Stiffness of the limbs and trunk
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Other symptoms may include depression and other emotional changes difficulty swallowing, chewing, and speaking urinary problems or constipationskin problems and sleep disruptions.
Symptoms of Parkinsons and the rate of progression differ among individuals. Sometimes people dismiss early symptoms of Parkinsons as the effects of normal aging. In most cases, there are no medical tests to definitively detect the disease, so it can be difficult to diagnose accurately.
Early symptoms of Parkinsons disease are subtle and occur gradually. For example, affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinsons. They may see that the persons face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinsons often develop a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have trouble initiating or continuing movement.
Urgent Need For A Simple Diagnostic Test
Dr Arthur Roach, Director of Research at Parkinson’s UK, comments:
“Currently there is no brain scan or blood test that can definitively diagnose Parkinson’s leaving an urgent need for a simple and accurate way of detecting the condition, particularly in its early stages.
“Although the research is yet to be tested on people with Parkinson’s, a simple non-invasive test such as an eye test could be a significant step forward in the search for treatments that can tackle the underlying causes of the condition rather than masking its symptoms.
“This research complements a Parkinson’s UK funded study already underway, which aims to identify Parkinson’s bio-markers, which are measurable changes in people with the condition.
“Having a biomarker for Parkinson’s would help diagnose Parkinson’s earlier, when people are most likely to benefit from the new treatments aimed at slowing progression.”
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Visual And Stereo Screening And Stereo Acuity Tests
Visual acuity was tested using the Snellen chart. Corrected visual acuity was recorded for each eye followed by binocular vision. Contrast sensitivity was performed using the Pelli-Robson test. People with abnormal visual acuity and contrast sensitivity were excluded as these abnormalities may represent optic nerve or retina pathologies, as well as media opacities and macular disease that may skew the stereo perception results. Screening stereopsis was performed with 2D pictures demonstrating the depth estimation from image structure, which was based on whole scene structures that do not rely on specific objects . With 2D images, study participants were asked to estimate the depth relationship in each picture. Using three pictures, we show two or three objects of uniform size that are distributed in depth . The closest object will project to a retinal image with the largest angular size. The other farther objects projected to retinal images are relatively smaller. The study participants were asked to provide a cue to the depth judging the relative sizes of the objects. If the mistakes were made, the participants will be excluded from further assessment. None misjudged depth with the 2D pictures. In addition, the standard and widely used Titmus stereotest was utilized. These tests can reveal stereo perception difficulties as well as compare and validate the results from the 3D monitor active shutter system.
Parkinson’s Could Potentially Be Detected By An Eye Test
Researchers may have discovered a method of detecting changes in the eye which could identify Parkinson’s disease before its symptoms develop.
Scientists at University College London say their early animal tests could lead to a cheap and non-invasive way to spot the disease.
Parkinson’s affects 1 in 500 people and is the second most common neurodegenerative disease worldwide.
The charity Parkinson’s UK welcomed the research as a “significant step”.
The researchers examined rats and found that changes could be seen at the back of their eyes before visible symptoms occurred.
Professor Francesca Cordeiro who led the research said it was a “potentially revolutionary breakthrough in the early diagnosis and treatment of one of the world’s most debilitating diseases”.
“These tests mean we might be able to intervene much earlier and more effectively treat people with this devastating condition.”
Symptoms of Parkinson’s include tremors and muscle stiffness, slowness of movement and a reduced quality of life.
These symptoms usually only emerge after brain cells have been damaged.
But there is currently no brain scan, or blood test, that can definitively diagnose Parkinson’s disease.
Parkinson’s does not directly cause people to die, but symptoms do get worse over time.
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Caregiving For People Living With Parkinsons
Caring for a loved one with PD can be a challenging job, especially as the disease progresses. Former caregivers of a loved one with PD suggest doing the following : Get prepared, Take care of yourself, Get help , Work to maintain a good relationship with your loved one, and Encourage the person with PD for whom you care, to stay active.
Preparing for caregiving starts with education. Reading this fact sheet is a good start. More resources are available to you in theResources section of this fact sheet. Early Parkinsonâs disease usually requires more emotional support and less hands-on care. It is a good time for family members/caregivers to educate themselves about the disease.
Eye Exam Could Detect Neurological Disease Parkinsons
Examining the eyes of animals has revealed a test for very early Parkinsons Disease. This research may translate into an eye test for humans. If so, it offers hope to the 1 in 500 people worldwide who will develop Parkinsons by allowing treatment to slow the condition in its earliest stages.
Parkinsons disease is the second most common neurodegenerative disease. Symptoms include muscle tremors, stiffness, and slow movement. It is not fatal by itself, but it reduces the quality of life. There is currently no definitive test, and doctors cannot diagnose this neurological disease until it has already damaged the brain. By then, efforts to slow the diseases progression have less of an impact than if treatment started earlier.
Early indicators can tell scientists that a health condition is developing before symptoms manifest. Death of cells in the substantia nigra, a part of the midbrain, and the increase in abnormal clusters of a protein within nerve cells are what cause Parkinsons.
Researchers have discovered that some of these indicators appear in the retina as well, and do so before other symptoms are noticeable. This gives medical professionals a way for early diagnosis of Parkinsons via retinal examination.
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