Friday, February 16, 2024

Parkinson’s Disease And Vision Problems

There Are Many Types Of Professionals Who Can Help

Vision Issues in Parkinson’s

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.

Vision Problems Common In Older Parkinsons Patients In Us Study Finds

Problems with vision are more common in older people with Parkinsons disease than in others of a similar age, and are linked with poorer health outcomes, a study based on U.S. Medicare records found.

Fewer than 60% of the more than 285,000 Parkinsons patients whose data were analyzed, however, had annual eye exams.

The study, Visual Impairment Is More Common in Parkinsons Disease and Is a Risk Factor for Poor Health Outcomes, was published in Movement Disorders.

Difficulties with vision at older ages Medicare beneficiaries in the U.S. are overwhelmingly people age 65 or older are associated with a poorer quality of life, including a greater risk of falls, depression, anxiety, and dementia, the study noted.

With vision problems increasingly recognized as a nonmotor symptom of Parkinsons, researchers at the University of Pennsylvania investigated Medicare claims data from 201014, looking at the prevalence of these problems and outcomes in this patient group.

Specifically, they sought to determine the prevalence of moderate to severe visual impairment in Parkinsons patients, and how poorer vision related to disease outcomes. They also explored patterns of eye examinations given patients.

Because most causes of visual impairment are either preventable or treatable, they wrote, findings could lead to better healthcare approaches in patients at greater risk for diminished vision.

Saccadic And Smooth Pursuit Eye Movements

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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Webinar: âVision Problems in Parkinsonâs Diseaseâ? April ...

APDAUncategorizedEye Problems in Parkinsons Disease

PD patients often have a lot of difficulty with their vision, although, when I examine them in the office, the visual acuity is often normal. Problems can come from difficulty in moving the eyes and eyelids, as well problems with blinking and dryness. Most of these conditions arise from Parkinsons Disease itself, while others may be caused by the medications required to treat PD.

Many Parkinsons Disease patients complain of trouble reading. One common cause of this is called convergence insufficiency. In order to see clearly up close, normal eyes must converge or cross inwards to see a single image. If convergence is defective, a person will have double vision when trying to see close up. Sometimes placing prisms in the reading glasses can alleviate this problem. Often, however, just covering one eye may be the only way to eliminate the symptom.

Other eyelid movement problems can contribute to visual difficulty in Parkinsons Disease patients. Parkinsons Disease patients may have intermittent blepharospasm, especially when the eyelids or brows are touched. The patient involuntarily squeezes his eyes shut and may have difficulty opening them as well. This is why Parkinsons Disease patients often have difficulty during eye exams, when the doctor is holding the eyelids open for examination or to measure eye pressures.

Dr Elliott Perlman, MD Rhode Island Eye Institute 150 E. Manning St. Providence, RI 02906

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Serious Eye Problems Common In People With Parkinson’s

WEDNESDAY, March 11, 2020 — People with Parkinson’s disease often have eye problems, which can interfere with their daily activities and increase their risk for falls, researchers say.

“It is especially important for people with Parkinson’s to have the best vision possible because it can help compensate for movement problems caused by the disease, and help reduce the risk of falls,” according to the author of a new study, Dr. Carlijn Borm of Radboud University Medical Center in Nijmegen, the Netherlands.

The study included 848 people with Parkinson’s who had symptoms for an average seven years, and 250 people without the disease. The average age in both groups was 70.

Participants were asked about vision and eye problems such as blurry vision, dry eyes, trouble with depth perception and problems adjusting to rapid changes in light.

In all, 82% of people with Parkinson’s reported one or more eye problems compared to 48% of others, and people with Parkinson’s reported daily symptoms much more often, according to the report published online March 11 in the journal Neurology.

In addition, 68% of people with Parkinson’s said that eye and vision problems interfered with daily activities, such as driving a car, working on a computer, walking or personal care, compared to 35% of people without the disease.

More information

Parkinsons Impacts On Vision Can Make Everyday Life More Challenging

Many of the visual symptoms experienced by people living with Parkinsons are mild, and overall visual function can remain quite good with routine examinations by an eye care professional. However, multiple, small abnormalities in combination may become problematic and cause more significant symptoms. For example, difficulty with color vision and loss of contrast sensitivity can make reading signs or walking down patterned stairs difficult. Problems with motion perception and clarity of vision can affect driving.

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

Retired neurologist and young onset Parkinsons patient, Dr. Maria De León reminds us that vision is integral to our quality of life and safety, especially with respect to driving. She lists 11 common eye problems with PD, and a few uncommon ones. They may be helped by adjusting medications, with special lenses, or artificial tears. See your doctor to find out.

Ocular Motor And Sensory Function In Parkinson Disease

Webinar: âVision Problems in Parkinsonâs Diseaseâ? April 2019

The purpose of this paper is to evaluate the effect of dopaminergic medication and deep brain stimulation on ocular function in Parkinson Disease and to measure vision-elated quality of life in subjects with PD. The conclusion is that convergence ability is significantly poorer in PD subjects in both on and off states compared with controls, but significantly improves with systemic dopaminergic treatment. Ocular motor function in PD subjects fluctuates in response to treatment, which complicates ophthalmic management. PD subjects have a significant reduction in vision-related quality of life, especially near activities, that it not associated with visual acuity.

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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

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.

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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

Treatment For Vision Problems In Parkinson’s Disease

Parkinson

Preservative-free artificial tear eye drops, sold over the counter, can be used as a way of lubricating the eye and temporarily improving the quality of the tear film. However, because of the involuntary spasmodic closing of the eyelids that is often present, it may not always be easy to instill the drops. And the effect of the drops may be for no more than fifteen minutes. It’s fine to use the drops that frequently, provided they are the preservative-free kind. These drops lack the chemicals that can irritate the eye when drops are used more than two or three times a day. They are packaged in single-use containers, usually about thirty to the box. Different brands use different formulations, and no onebrand can be recommended for everyone. Everyone’s tears are different in terms of their acidity, viscosity, salt content, etc. Try different ones and see which one works best for you. Using an eye-wash to flush out the debris and wet the eye may also be helpful.

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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.

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

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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.

The Retina In Parkinson’s Disease

Eye Problems and Visual Disorders in Parkinsonism Dr. Rana

A number of studies have found strong evidence for significant visual problems in the PwP population. These eye issues tend to worsen when a PwP is an “off” state, but improve again when they are “on” due to l-dopa supplementation. Visual problems that are strongly correlated with PD include:

  • visual acuity

  • motion perception

  • visual disturbances, hallucinations.

Sufficient evidence exists that these can be linked to dopamine deficiencies in the retina, and cannot all be ascribed to just being age related or to the cognitive decline of PD. Indeed, physical and structural changes to the eye and retina are also implicated in PD, as determined by a number of modern eye examination methods.

“The Parkinsonian retina may therefore exist in an inappropriately dark-adapted ( state. This, in turn, to lower spatial and temporal resolving potential and an ultimate impact on visual acuity, and colour perception. Evidence is now emerging that visual dysfunction directly contributes to more traditional motor complications of PD

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There Is A Wide Array Of Vision Problems People With Parkinsons May Experience

Here are several common, and a few not-so-common, visual symptoms you may experience:

Blurry vision and difficulty with color vision. Blurry vision may be related to dopamine depletion in the back of the eye and within the visual connections through the brain. This may be partially corrected with dopaminergic medications, though medication effects are usually subtle regarding vision, so you may not notice them.

Visual processing difficulty. This refers to the orientation of lines and edges, as well as depth perception. This can take different forms, including:

  • Troubles with peripheral vision: distracted by objects and targets in your peripheral vision
  • Difficulties perceiving overlapping objects
  • Difficulty copying and recalling figures
  • Difficulties detecting whether motion is occurring and in which direction
  • Difficulties recognizing faces, facial expressions, and emotions

Dry Eye. Dry eyes are a consequence of decreased blinking and poor production of tears. Dry eye can be worsened by certain medications prescribed for Parkinsons. Dry eye improves with liberal use of artificial tears and good eye/eyelid hygiene. Of note, dry eye doesnt always feel dry! Sometimes it feels like watering, and other times it just feels like blurring or being out of focus.

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