Wednesday, July 17, 2024

Parkinson’s Disease Eye Problems

Why Loss Of Sense Of Smell Occurs

Eye Test May Reveal Parkinsons Disease Earlier

96% of newly diagnosed people with Parkinsons will have lost some ability to smell. Little is confirmed about what causes hyposmia, the loss of smell. One popular theory in Parkinsons research has to do with the protein ‘alpha-synuclein’, which is found in clumps in all people with Parkinsons in the part of the brain affected by Parkinsons. This region of the brain is also very close to the Olfactory Bulb, which is responsible for our sense of smell.

Involuntary Closure Of The Eyelids

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.

Like Parkinsons Vision Is Linked To The Brain

Vision plays such a critical function that a substantial portion of our brain is made up of pathways that connect our eyes to the visual areas of our brain and the areas that help process this visual information . The primary purpose of the front part of our eyes is to produce the clearest possible image, which is then transmitted to the back part of the eye, called the retina. The retina is made up of nerve cells that communicate via visual pathways using the neurotransmitter dopamine. In addition, we have two eyes with overlapping visual fields, which enables our brain to see the world in three dimensions and process complex visual information.

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

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


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


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
  • The Gut Digestive System And Parkinson’s Disease

    How vision gets affected by Parkinsons disease

    but also in the retina too.

    Indeed, according to the scientific review article mentioned above, the role of neurotransmitters in the eye has been known since at least the 1960s, when dopamine producing cells – dopaminergic neurons – were found in the retinas of animals, and later in humans. Since then, several types of dopaminergic neurons have been discovered in the retina and it is now known their functions are strongly affected by light levels. They have a pivotal role in the processing of visual information through the retina. Different types of photo-receptors in the eye can either be switched on or off due to the concentration of dopamine in the retina.

    It has also been found that there is a significant diurnal variation in levels of dopamine in the eye, with higher levels in the day and lower levels at night, and hence time of day and even the weather/seasons impact on the complex feedback between the functions of the photo-receptors and dopamine concentration in the visual system – and ultimately on PD symptoms.

    “This circadian rhythm is in counterphase with the retinal concentrations of melatonin, and indeed, dopamine and melatonin have mutually inhibitory effects on each other’s productionacting as a biological clock for the retina. Because of this light-sensitive variation in dopamine concentration, it has been postulated that dopamine plays a role in the transition from a dark- to light-adapted state”.

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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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    Blurred Vision And Difficulty Focussing

    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.

    What Are The Most Common Vision Problems Associated With Parkinsons Disease

    Vlog #123 Eye Problems In Parkinson’s Disease

    Difficulty moving the eyesParkinsons disease affects all movements, particularly those that are usually automatic. Eye movements are no exception. Your muscles move more slowly, causing delayed eye movement when watching an object in motion, for example. Your eye movement may also become jerkier.

    The delay can affect your ability to clearly see objects that move very quickly, such as cars. If you are experiencing this problem, you should talk to your doctor about it and be vigilant in situations where vision delays could prove dangerous.Blurred visionBlurred vision may be related to difficulty moving the eyes, or it could be a side-effect of antiparkinsonian medications like anticholinergics. Talk to your neurologist about adjusting your dose.

    If you wear glasses, your optometrist can also help improve your vision by adjusting the strength of your lenses.Double visionDouble vision is when you see two images of the same object. These images may be superimposed or next to each other. This can occur when you are watching something in motion and your eyes arent moving at the same speed. Lack of eye coordination and eye muscle fatigue are often the cause of double vision.

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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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    How Often Should I Get My Eyes Checked

    Its a good idea to get your eyes checked by an optometrist at least once a year, even if you dont have any particular vision problems.Tell the optometrist that you have Parkinsons disease so that they know to watch out for signs of vision problems that are common among those living with the disorder.

    Potential Effects Of Parkinsons Disease On Eyesight

    Parkinsons Disease Could Be Diagnosed Through Eye Check
    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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    Uf Researchers Are Looking Into The Eyes Of Patients To Diagnose Parkinsons Disease

    This article was originally published on Forbes.

    With artificial intelligence , researchers have moved toward diagnosing Parkinsons disease with, essentially, an eye exam. This relatively cheap and non-invasive method could eventually lead to earlier and more accessible diagnoses.

    Specific changes within the brain signify Parkinsons and other neurodegenerative brain diseases . But healthcare providers have few affordable or noninvasive ways to diagnose these conditions. Because of this, neurodegenerative diseases in the brain are primarily diagnosed only once symptoms appear.

    Even then, diagnosis might involve expensive brain imaging tests patients cant afford. Although these diseases arent currently curable, earlier, cheaper diagnosis could help patients and their families prepare for more advanced disease symptoms like dementia which can improve quality of life.

    In recent years, scientists have been developing new diagnostic methods by looking through an easily accessible peephole to the brain: the retina of the human eye.

    Blood vessels are selected from the original fundus image by a machine learning network. The vessels are then fed into the SVM classifier to diagnose whether a person has Parkinsons disease.

    Comparison of Segmentation from input image to increase contrast of blood vessels.

    But Fang said that their next step is further testing this method and figuring out what specific characteristics of the blood vessels signify Parkinsons disease.

    Vision Problems May Be Common In People With Parkinsons Disease

    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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    Ophthalmologic Features Of Parkinsons Disease

    This paper is a systematic evaluation of the ocular complaints and ocular finding of 30 PD patients with early untreated PD, and 31 control subjects without neurologic or known ocular diseases. The ocular abnormalities found more commonly encountered by PD patients frequently respond to treatment. Abstract and access to the full article.

    Apda In Your Community

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

    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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    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.

    Visual Changes In Parkinsons Disease

    Parkinsons disease is a chronic disease that affects the nervous system. It causes a variety of symptoms that often progress over time. It can also lead to some changes in the eyes. April is Parkinsons Awareness Month. It is an opportunity to learn more about this disorder and how eye problems can be managed.

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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.

    Excessive Watering Of The Eyes

    How Vision Is Affected by Parkinson

    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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    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.

    Progressive Supranuclear Palsy And Cortico

    PSP and CBD are both four-repeat tau diseases exhibiting considerable similarities and overlap . Distinguishing PD from PSP can be especially difficult early in the disease. Atypical features of PSP include slowing of upward saccades, moderate slowing of downward saccades, the presence of a full range of voluntary vertical eye movements, a curved trajectory of oblique saccades, and absence of square-wave jerks . Hence, particularly useful in separating PSP from PD is the presence in the former of vertical supranuclear gaze palsy, fixation instability, lid retraction, blepharospasm, and apraxia of eyelid opening and closing . Downgaze palsy is probably the most useful diagnostic clinical symptom of PSP . Deficits in colour vision appear to be more important in PD and directly related to the dopamine system. However, in untreated early PD, no consistent deficits in colour vision were demonstrated making this alone an unreliable indicator of PD .

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