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.;
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.
How Parkinsons Affects Your Eyes
Eye Movement Problems
There are three fundamental types of eye movements.
- Pursuit eye movementsallow the eyes to travel together to follow a moving target in the horizontal or vertical direction.
- Saccadic eye movements are the rapid eye movements that allow the eyes to quickly jump to a new target. They are important when reading as the eyes need to jump from the end of one line and to the beginning of the next.
- Vergence eye movements are used when the target is coming towards or away from a person. When the target comes towards a person for example, the eyes have to move slightly together, or converge, to keep vision of the target clear.
In PD, the saccades tend to be slow, which means reading can be difficult if the eyes are unable to find the correct place on the next line. If a person has Levodopa-induced dyskinesias, the saccades can become fast and erratic which can also be problematic.
Another common eye movement issue for people with PD is difficulty with vergence eye movements. In PD, the eyes are often not able to come together sufficiently as a target draws near. This is called convergence insufficiency, which can cause double vision, especially when focusing on near tasks. This problem can also affect a persons ability to read.
Eye movement solutions
In terms of complementary and alternative therapies, art therapy has been seen to alleviate some of the vision effects associated with Parkinsons disease.
Abnormalities of blinking
External eye disease
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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
How Parkinsons Disease Affects The Eye
Parkinsons disease is a progressive degenerative condition of the neurological system.; The majority of Parkinsons effects are on movement, often starting off very slowly and subtly. One of the earliest symptoms is a slight tremor in one or both hands. Other early symptoms include a lack of facial expression and decreased blinking of the eyes, so it looks like the person is always staring. ;
The next stage usually results in difficulty with initiating movement, especially walking.; It frequently looks like it takes a tremendous concentrated effort to initiate walking and the steps often start off very small with a shuffling of the feet.; At the same time, the disease stiffens the muscles of the arms so that when the person is walking there is a noticeable decrease in the swinging of the arms. Speech becomes much softer and writing becomes more of an effort, with handwriting getting smaller and smaller as the disease progresses.
Parkinsons can also affect your visual performance, mainly in two parts of your eyes: the tear film and the ocular muscles.
If you dont blink enough, the tear film begins to dry out in spots and having dry spots next to moist spots results in an irregular film and therefore blurred vision. That is how the decreased blinking frequency in people with Parkinsons disease results in a complaint of intermittent blurred vision.
The majority of these problems do improve if the Parkinsons is treated with medication or even brain stimulation.
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Research Is Underway To Further Understand The Cardiac Effects Of Parkinsons
It is possible to image the sympathetic nervous system of the human heart by injecting a radioactive tracer, meta-iodo-benzyl-guanidine, . Development of this technique, known as MIBG cardiac imaging, holds much promise as a test to confirm the diagnosis of PD , to identify those who are at risk of developing PD in the future, and to distinguish PD from related disorders. MIBG cardiac imaging is still considered an experimental procedure for detection of PD and is not yet in use as a clinical tool for this purpose.
A recent research study was conducted in monkeys in which the destruction of the sympathetic nerves of the heart was chemically induced to mimic the changes that are seen in PD. The cardiac system was then imaged using a number of new-generation radioactive tracers, which bind to markers of inflammation and oxidative stress. This model system may help to shed light on the molecular changes that accompany the loss of the sympathetic nerves of the heart and can also be used to track the response of the cardiac system to therapeutic agents.
Ocular Motor And Sensory Function In Parkinson Disease
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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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.
What Can We Do
Armed with the above knowledge, is there anything we can do about it? I have been implementing various strategies to see if these help and I do strongly believe these are cumulatively benefitting me and reducing my symptoms over time.
The main thrust is to look after our eye health. In this regard, many of the strategies I discussed for blood-brain-barrier health follow over directly:;keeping our bodies very well hydrated;;avoiding inflammation and stress as best we can; making sure our nutritional support is maximized. In terms of nutrition specifically for the eyes, Dr Axe recommends two special anti-oxidants,;Lutein and Zeaxanthin, as well as Zinc and Omega 3 supplementation too. I have been taking all of these for several weeks and do feel my eyes are less sore and dry now. The A, C, E vitamins are also recommended by Dr Axe.
Like most of the rest of our body parts, exercising the eyes and visual brain functions will also be most important to maintaining their health, see:
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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.;;
Difficulty Moving The Eyes
You may have difficulties when starting to move your eyes or when trying to move them quickly. This might be more noticeable when looking at fast-moving objects, such as cars.;Sometimes, instead of a smooth movement, your eyes move in a slow and jerky way.;Difficulties in moving the eyes up or down are more common in progressive supranuclear palsy than Parkinson’s.
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Vision Problems More Common In Patients With Parkinson Disease
This article, Vision Problems May Be Common in Parkinson Disease, was originally published on NeurologyLive.
Results of a new study have uncovered a link between the development of Parkinson disease and an increase in ophthalmologic symptoms that impact a patients day-to-day activities.
The study, which included 848 patients with Parkinson and 250 healthy controls, showed that 82% of those with disease had 1 ophthalmologic symptom in comparison with 48% of the control group . Study author Carlijn D.J.M. Borm, MD, of Radboud University Medical Centre in Nijmegen, The Netherlands, and colleagues noted that screening questionnaires like the Visual Impairment in Parkinson’s Disease Questionnaire which the study utilizedmay aid in recognizing these vision problems, thus improving timely treatment.
It is especially important for people with Parkinsons 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, Borm said in a statement. Our study found not only that people with Parkinsons disease had eye problems that go beyond the aging process, we also found those problems may interfere with their daily lives. Yet a majority of eye problems are treatable, so its important that people with Parkinsons be screened and treated if possible.
Does Parkinsons Disease Affect Vision
By Kathy Herrfeldt 9 am on March 15, 2021
When people think about Parkinsons, they typically focus on the loss of motor skills. However, the disease can also impact vision and make it difficult to complete various tasks that dont involve motor function or mental health. Continue reading to learn how Parkinsons disease can affect a seniors vision and what family caregivers can do to help with each issue.
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How Often Should I Get An Eye Test
If you have Parkinsons, its recommended that you have an eye test with an optometrist at least once a year. You should try to do this even if you arent experiencing any problems with your eyes.;
You must tell the DVLA if you have any problem with your eyesight that affects both your eyes, or the remaining eye if you only have one eye.;
For more information visit www.gov.uk/driving-eyesight-rulesor call 0300 790 6806.;
For Northern Ireland visit www.nidirect.gov.uk/articles/driving-eyesight-requirements or call 0300 200 7861.;
You can also speak to your GP, specialist;or Parkinson’s nurse for advice.
Clinical Disorders Of Vision In Parkinson’s Disease
In patient surveys, large proportions of PD and virtually all PDD/DLB patients report some disturbance of vision. Symptoms include complaints about dry eyes, photophobia, diplopia, difficulties with reading, difficulties estimating spatial relations, or freezing when passing narrow spaces. Although, as a group, PDD/DLB patients perform worse on just about every measure of visual function – visual acuity, contrast sensitivity, motion and colour perception are all impaired in PD – there is substantial individual variation .
The causes of such symptoms and signs can rarely be established with confidence. Potential explanations include reduced blink rate, oculomotor abnormalities or reduced retinal contrast sensitivity. Alternatively, they may be an expression of cortical dysfunction manifesting as visuoperceptual, visuospatial and attentional impairment, or general perceptual slowing. As these factors usually co-exist, it can be difficult to disentangle the purely perceptual from lower level disturbances of visual and motor function.
Cortical visual processing depends upon two overlapping, but distinct, networks – the dorsal and ventral streams. There is now considerable evidence that the disease process in PD and DLB impacts on both of these streams, influencing the nature of the visual symptoms reported by patients.
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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.
My Parkinson’s Story: Visual Disturbances
This 6-minute video alternates between an interview with a man and and doctors. The man shares his vision changes due to Parkinson’s disease. The doctors explain that the muscles of the eyes develop a tremor in those with Parkinson’s disease, causing blurry vision. Parkinson’s medication reduces eye tremors by 75-90%, but eye exercises and reading are also beneficial.
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Problems With Low Light And Pbright Light :
You might find that it is difficult to see in low light levels. You may also be unable to make out the shape of things clearly, such as a light-coloured object on a light background. This can also affect your ability to read small print. The use of daylight bulbs may provide better lighting. If bright light is a problem, wraparound sunglasses or tinted lenses can help.;
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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Coping With Vision Problems From Parkinson’s
There is currently no cure for the disease itself, but there are options to treat the symptoms of PD. A combination of medications, physical and/or occupational therapy, support groups, and of course, top-quality vision care can give a PD patient relief for some of their symptoms and tools to help cope with the condition.
Research and clinical trials are continuing as doctors and others in the medical community work towards the goal of finding a cure for PD.
No two patients are alike, and each can experience PD differently from the other, so finding what works for you or your loved one is key. During this Parkinson’s Awareness Month, share your #KeyToPD and give your loved ones hope for a healthy and high quality of life.