Vision Problems Common In Parkinsons Disease
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People with Parkinsons disease have a higher prevalence of ophthalmologic symptoms than those without the disease, according to research published in Neurology, the medical journal of the American Academy of Neurology.
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,Carlijn D.J.M. Borm, MD, of the Radboud University Medical Centre in Nijmegen, The Netherlands, said in a press release. Our study found not only that people with Parkinson’s disease had eye problems that go beyond the aging process, we also found those problems may interfere with their daily lives.
Borm and colleagues conducted an observational, cross-sectional study across multiple centers in the Netherlands and Austria as part of a larger study on visual impairments in patients with Parkinsons disease.
The researchers evaluated the prevalence and clinical effects of ophthalmologic symptoms in adults using participant responses to the Visual Impairment in Parkinsons Disease Screening Questionnaire. The questionnaire included questions on demographic information and visual hallucinations, and assessed the four domains of ophthalmologic disorders ocular surface, intraocular, oculomotor and optic nerve.
Eye Exercises And 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:
How Is Psp Different From Parkinson’s Disease
PSP is often misdiagnosed as Parkinsons disease, especially early in the disorder, as they share many symptoms, including stiffness, movement difficulties, clumsiness, bradykinesia , and rigidity of muscles. The onset of both diseases is in late middle age. However, PSP progresses more rapidly than Parkinsons disease.
- People with PSP usually stand exceptionally straight or occasionally tilt their heads backward . This is termed axial rigidity. Those with Parkinson’s disease usually bend forward.
- Problems with speech and swallowing are much more common and severe in PSP than in Parkinson’s disease and tend to show up earlier in the disease.
- Eye movements are abnormal in PSP but close to normal in Parkinson’s disease.
- Tremor is rare in PSP but very common in individuals with Parkinsons disease.
Although individuals with Parkinson’s disease markedly benefit from the drug levodopa, people with PSP respond minimally and only briefly to this drug.
People with PSP show accumulation of the protein tau in affected brain cells, whereas people with Parkinsons disease show accumulation of a different protein called alpha-synuclein.
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The Retina In Parkinson’s Disease
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 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 “
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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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.
Potential Effects Of Parkinsons Disease On Eyesight
By Patricia Schumacher 9 am on March 27, 2020
Growing older often means a greater risk of experiencing certain vision problems, such as cataracts and age-related retina damage . Typically, these changes have nothing to do with Parkinsons disease and can affect any older adult. However, there are some vision issues specifically related to this condition. Five of the more common ones are discussed below.
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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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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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Ask The Md: Vision And Parkinsons Disease
This webpage explains the visual problems that are due to Parkinsons disease, the medications used to treat it, or to unrelated conditions of the eye or eyelid. If you have visual problems, dont assume it is due to either aging or Parkinsons. Address it with your doctor to maintain your ability to read, drive, and walk steadily to reduce your risk of falling.
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.
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Reduced Blinking & Eye Movement Disturbances
Other eye movement disturbances have been described in parkinsonism. These include an impaired ability to pursue a moving target with the eyes, difficulty initiating gaze shifts or taking the eyes off a face. Also, the ability to maintain eccentric gaze is impaired, and the blink frequency tends to be reduced. Of these abnormalities, only the latter tends to show significant symptoms, as reduced blinking can cause a feeling of dry eyes. This may be further enhanced by reduction in tear secretion, which is not uncommon in parkinsonism. Management of dry eyes usually involves the use of artificial tears. It is rare that additional measures are needed to combat symptoms of dry eyes in patients with parkinsonism.
Patients with parkinsonism are also susceptible to visual hallucinations. These can be related to the underlying neurological illness or medications used for treatment. PD patients who have visual hallucinations respond well to antipsychotic medications such as quetiapine. Hallucinations should always be reported to the physician.
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.
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The Role Of Dopamine In The Eye
Note in the above, I emphasized dopamine and its shortage is important in the eye. For most PwP, this link between dopamine and vision will come as unexpected, because, while we are informed at diagnosis that our PD is due to dead dopamine producing cells in a small part of our brains called the Substantia Nigra, we are typically not being properly informed that the dopamine deficiency issues are much more widespread, including in the gut
Parkinson’s And Vision Issues: Vision Problems In Parkinson’s Disease
Eye problems are not unusual in people with Parkinson’s disease. Dr Jay B Lavine is an ophthalmologist from Tucson, Arizona, USA, who has written a most helpful article in the latest Educational Supplement published by the American Parkinson Disease Association. We reproduce it in full here.Robert Griffith, Content Editor, HealthandAge.com.
Vision Problems and Parkinson’s Diseaseby Jay B Lavine, MD
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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.
What Researchers Have Found
The recent study involved 848 people with Parkinsons and 250 people without the disease.
The participants completed a questionnaire developed to assess visual impairment. The findings are in line with what has been seen in other studies.
A found hallucinations were more common.
Each of those studies included about 90 people with Parkinsons.
These findings are really not that surprising, Beck said. What sets this study apart is the number of individuals surveyed about their own visual issues using this new patient-reported outcome tool.
Dr. Rebecca Gilbert, vice president and chief scientific officer at the American Parkinson Disease Association, said that physicians with experience with people with Parkinsons are very aware of visual difficulties in people with the disease.
But what stood out to her about the new study was the variety of different vision issues that were reported.
The more research that is done, the better, so we can learn more about how prevalent the specific issues are for people and then work to help them in more targeted ways, Gilbert told Healthline.
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How Is Psp Diagnosed
Currently there are no tests or brain imaging techniques to definitively diagnose PSP. An initial diagnosis is based on the persons medical history and a physical and neurological exam. Identifying early gait problems, problems moving the eyes, speech and swallowing abnormalities, as well as ruling out other similar disorders is important. Diagnostic imaging may show shrinkage at the top of the brain stem and look at brain activity in known areas of degeneration.
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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Screening Tests And Recommended Treatments
We recommend starting the examination by excluding severe visual impairment. This can be done by briefly testing the near visual acuity . This is an excellent screening test since it is easy to administer and because only few significant disorders leave visual acuity unaffected. Above the age of 45, appropriate reading glasses are required for normal near vision. Reading acuity as well as reading speed are good predictors of everyday visual function . Moderate vision impairment can be defined as < 6/24 on the visual acuity test and severe vision impairment as < 6/60 . Dopaminergic medication may influence visual acuity, causing refraction changes during the medication cycle. Therefore, some patients may need adapted glasses depending upon the medication phase. Referral to an ophthalmologist is advised in case of significant vision impairment.