Thursday, September 22, 2022

Eyesight And Parkinson’s Disease

Eye Exercises And Parkinsons Disease

More Than Meets the Eye: Vision Symptoms of Parkinson’s Disease

In this regards, I also recommend the work of Dr Eric Cobb of Zhealth Education. Dr Cobb gives a lot of free information on his blog about vision health and provides powerful, but quick exercises to practice daily, as well as running a commercial vision gym for pro-athletes. Importantly, Dr Cobb shows us just how unexpectedly important the eyes and vision are in direct connection to movement and stress reduction: hence eye exercise has very profound relevance for people with PD. I also recommend stimulation of the cranial nerves which are responsible for the muscles that move the eyes:

Patients With Parkinson Disease At Increased Risk Of Vision Eye Issues Study Shows

Patients with Parkinson disease were found to be more likely to experience vision and eye issues, such as blurry vision, dry eyes, trouble with depth perception, and problems adjusting to rapid changes in light, compared with people without the disorder, according to study findings.

Patients with Parkinson disease were found to be more likely to experience vision and eye issues, such as blurry vision, dry eyes, trouble with depth perception, and problems adjusting to rapid changes in light, compared with people without the disorder, according to study findings published in Neurology.

In patients with PD , irregular eyesight can prove a chief issue, as ophthalmologic disorders combined with postural and gait instability from the disorder may increase the risk of falls and fall-related injuries, noted the study authors.

Risk of vision impairment is potentially common for PwP because PD is linked with retinal dopamine depletion and decreased dopaminergic innervation of the visual cortex, which can lead to visual problems such as diminished oculomotor control, contrast sensitivity, color vision, and visuospatial construction. PwP are also at increased risk for seborrheic blepharitis and keratoconjunctivitis sicca .

In PwP with ophthalmologic symptoms, 68% reported that it interfered with daily activities, compared with 35% of controls .

Reference

Eye Tests Predict Parkinsons

19 January 2021

Simple vision tests can predict which people with Parkinsons disease will develop cognitive impairment and possible dementia 18 months later, according to a new study by UCL researchers.

The study, published in Movement Disorders, adds to evidence that vision changes precede the cognitive decline that occurs in many, but not all, people with Parkinsons.

In another new study published today in Communications Biology, the same research team found that structural and functional connections of brain regions become decoupled throughout the entire brain in people with Parkinsons disease, particularly among people with vision problems.

The two studies together show how losses and changes to the brains wiring underlie the cognitive impairment experienced by many people with Parkinsons disease.

Lead author Dr Angeliki Zarkali said: We have found that people with Parkinsons disease who have visual problems are more likely to get dementia, and that appears to be explained by underlying changes to their brain wiring.

Vision tests might provide us with a window of opportunity to predict Parkinsons dementia before it begins, which may help us find ways to stop the cognitive decline before its too late.

For the Movement Disorders paper, published earlier this month, the researchers studied 77 people with Parkinsons disease and found that simple vision tests predicted who would go on to get dementia after a year and a half.

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Ocular And Visual Disorders In Parkinsons Disease: Common But Frequently Overlooked

This literature search covering 50 years reviews the range of ocular and visual disorders in patients with PD and classifies these according to anatomical structures of the visual pathway. It discusses six common disorders in more detail, reviews the effects of PD-related pharmacological and surgical treatments on visual function, and offers practical recommendations for clinical management.

Involuntary Closure Of The Eyelids

Parkinson

Eyelid apraxia occurs when the muscles that open the eyelids have trouble opening. This often happens during speech. Sometimes the eyelids might close completely and stop you being able to see properly. In mild cases of eyelid apraxia, simply rubbing the eyelids might help. Sometimes, injections of botulinum toxin are used to treat eyelid apraxia. Speak to your specialist for advice.

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Leaky Blood Brain Barrier And Parkinson’s Disease

we discussed how leakage issues with epithelial cell membranes, a special form of protective and moisturizing tissue, are prevalent in PD. The malfunctions of these epithelial layers are due, for example, to chronic dehydration, nutritional deficits, infection. Places where epithelial layers occur include in the skin, the gut lining, the blood brain barrier, the mouth and sinuses – all of which are implicated in the major and common symptoms of PD.

Such epithelial layers also occur in the eye. For example the retina-blood barrier, which has functions including, but not limited to, light absorption, nutrient transport from blood to eye, secretion and immune response. These retinal cells, like those in the Substantia Nigra, are meloncytes – they are black. The Conjunctiva also contain epithelial cells, lining the inside of the eyelids and covering the white of the eye. Conjunctiva help lubricate the eye with mucous and tears, with immune surveillance, and protection of the eye against microbes. Given that problems with epithelial layers are common in PD, it is highly probable that malfunctions of the eye’s epithelial cells are also widespread in PwP. Indeed, dry eyes, bloodshot eyes and eye strain problems are very common, for example.

Involuntary Eye Closure & Eyelid Drooping

Its not uncommon for seniors with Parkinsons disease to experience involuntary eye closure . Eyelids may also droop due to muscle weakness or nerve damage caused by the disease. Both of these issues can narrow the field of vision and contribute to difficulty with navigation and coordination. Vision problems of this nature also increase the risk of falling for seniors with PD. Under certain circumstances, Botox injections may be recommended to address issues with eyelid drooping.

If your loved one is living with vision problems and needs assistance with daily tasks, help is available. Seniors can face a variety of challenges as they age, many of which can be mitigated with the help of professional in-home caregivers who provide high-quality elderly home care.Trust Home Care Assistance to help your elderly loved one age in place safely and comfortably.

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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.

Blurred Vision And Difficulty Focussing

Vision in Parkinson’s Disease – Keynote from 2021 UF Parkinson’s Disease Symposium

Some Parkinsons medications, in particular anticholinergics, can cause blurred vision and difficulty focussing. You may find your vision is blurred if you start taking anticholinergics and that this goes away when your body gets used to the new drug. This can also happen if you have been taking anticholinergics for some time but your dose is altered. If necessary your doctor may adjust your medication regime.

Talk with your doctor if blurred vision does not improve – or worsens – over time, so that your medication can be adjusted if necessary. If you wear reading glasses, a slight adjustment may also help. Your optician or optometrist should be able to help with this.

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Who Treats Vision Problems

Talk to your family doctor or neurologist about any vision changes at your next appointment. They will most likely refer you to an eye specialist:

  • Optometrist: a health care professional who examines the eyes, consults on vision problems and prescribes glasses and contact lenses. Some also provide care for people with certain eye disorders.
  • Ophthalmologist: a specialized eye doctor who examines, diagnoses and treats eye disorders and injuries.

Occupational therapists may also be able to help you manage your vision problems at home and at work by suggesting strategies, equipment and ways to adapt your environment.

Difficulty Reading & Other Pd

The quick eye movements that allow the eyes to shift to a new vision target can slow down as Parkinsons disease progresses. Should this happen, it can be difficult for seniors with PD to follow words on a page as they go from one line to the next while reading. Older adults with Parkinsons may also experience other vision problems involving: The ability to follow moving targets in a side-to-side direction Blinking to change eye positionLevodopa, the most common PD drug, may help The ability to see a target coming right at the eyes Difficulty voluntarily opening/closing eyes possible solutions include doing eyelid crunches or having Botox injections

There are a variety of age-related health conditions that can make it more challenging for seniors to live independently. However, many of the challenges they face can be easier to manage if their families opt for professional home care services. Rhode Island families can rely on expertly trained caregivers to keep their loved ones safe and comfortable while aging in place. Trust your loved ones care to the professionals at Home Care Assistance. To create a customized home care plan for your loved one, call 284-0979 today.

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Vision In Parkinson’s Disease

Research team

Parkinsons disease is a common, debilitating neurological condition. As well as causing tremor and slowness of movement, dementia is a common symptom, affecting around half of all patients within 10 years of diagnosis. Our work is funded by a Wellcome Career Development Fellowship and aims to identify patients at highest risk of dementia in Parkinsons disease and to understand the brain mechanisms that cause these cognitive changes.

In a large cohort of patients with Parkinsons disease we are running a multimodal longitudinal study that uses advanced neuroimaging techniques alongside detailed neuropsychology, retinal imaging, visual measures, plasma markers and genetics to gain insights into markers of cognitive change in Parkinsons disease.

For example, we have shown that thinning of specific layers in the retina is related to higher risk of dementia in Parkinsons disease and that levels of brain tissue iron are higher in the hippocampi linked with poorer cognitive function in Parkinsons disease.

Ultimately, our aim is to refine these techniques to develop robust markers of cognitive involvement in Parkinsons disease that can be used in clinical trials to slow down the process of dementia in Parkinsons disease.

Saccadic And Smooth Pursuit Eye Movements

Vision problems may be common in people with Parkinson

EOG recordings have been made before and after apomorphine treatment in patients with early-stage disease and have confirmed that smooth pursuit movements are affected during the initial stages of the disease . In addition, patients with PD often have difficulty in sustaining repetitive actions and hence, smooth pursuit movements exhibit a reduction in response magnitude and a progressive decline of response with stimulus repetition.

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Types Of Eye Movements

There are three kinds of eye movements that can change with PD:

  • Saccadic rapid eye movements direct us to gaze at a specific object or to read lines of print.
  • Pursuit eye movements allow us to follow an object as it moves.
  • Vergence eye movements allow us to move our eyes in different directions2

Changes to these eye movements due to Parkinsons can also result in different kinds of visual difficulties. The inability to control eye movements can lead to involuntary blinking, double vision and other motor issues that can affect visual acuity.

Dry eyes can be treated with drops or ointments, warm wet compresses, but are not generally cured. The blink reflex can be impacted by PD. This manifests as either a slowing of the reflex, appearing as inappropriate staring, dry or burning eyes and by reduced vision. Blepaharospasm and apraxia are two common eyelid motion issues. Blephararospasms are eyelid spasms that cannot be controlled, cause eyelids to squeeze, and can be relieved with Botox injections. Apraxia is a condition that makes it difficult to open eyes. There are specialized lid crutches and cosmetic tape that can be applied to hold the eyelids open.2

Smell And Vision Difficulties

Only two paragraphs about the loss of smell in Parkinsons precede nearly a dozen eye problems and vision difficulties for people with Parkinsons and useful tips for coping with them. Of note is a paragraph suggesting that those with glaucoma may have problems with anticholinergic medication and levodopa.

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How Does Parkinson’s Cause Vision Issues

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

There Are Many Types Of Professionals Who Can Help

Eye Test May Reveal Parkinson√Ęs Disease Earlier

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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Ocular And Visual Manifestations Of Parkinsons Disease: A Teaching Case Report

Jolinda Tam, OD, and Pauline F. Ilsen, OD, FAAO

Abstract

Parkinsons disease is a common neurodegenerative condition affecting the elderly population. It is pathologically characterized by decreased dopamine levels from damage to the substantia nigra, which results in the classic motor deficits. It is less commonly known that individuals with PD are at increased risk for ocular and visual problems, including dry eyes, diplopia, contrast sensitivity loss, impairment in color vision, glaucoma-like defects, impairment of visuospatial functions, and visual hallucinations. This teaching case report incorporates a case of PD and discusses the ocular and visual manifestations, differentials, management and current research on the disease.

Key Words: Parkinsons disease, dry eyes, diplopia, contrast sensitivity loss, visual hallucination

Background

Though the motor impairments of PD are well-established, the ocular and visual manifestations are not widely recognized.3,5-8 With a rise in the aging population, it is of great importance that eyecare providers are aware of these findings so they can better care for patients with PD.1 Furthermore, greater dependence is placed on vision to guide patients in daily activities when they have motor dysfunctions.3,6,8

Case Description

Figure 1. HVF 24-2 SITA Fast testing of the right eye.

Education Guidelines

Learning objectives

  • Recognize that PD affects the ocular and visual system in addition to systemic motor function
  • 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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    Ways Parkinsons Disease Affects The Eyes

    According to the Mayo Clinic, Parkinsons Disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement. There many other prevalent symptoms and complications of Parkinsons and the eyes are no exception.

    Diplopia

    Diplopia is the medical term given to double vision. Unfortunately, it can be a common occurrence in patients with Parkinsons Disease. It may occur in up to 30% of PD patients. The exact mechanism for the cause of the double vision in not fully understood. The double vision may occur in straight-ahead gaze or in a particular direction of gaze . Another very common source of double vision in PD is convergence insufficiency, which is when the eyes are unable to converge normally for up close visual activities like reading. This would produce double vision when only reading.

    Double vision may be helped with PD medications if the person is not actively being treated. Interestingly, some PD medications themselves may cause double vision. If the double vision is consistent, the optometrist may be able to prescribe prism in the patients glasses to help compensate for the misalignment causing the double vision. If the double vision is due to convergence insufficiency, a separate pair of reading glasses with prism compensation may be best.

    Dry Eyes

    Blepharospasm

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