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Vision Problems With Parkinson’s

Everyone Needs Regular Eye Exams

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

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.

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.

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.

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The Gut Digestive System And Parkinson’s 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”.

Eye Exercises And Parkinson’s Disease

How vision gets affected by Parkinsons 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:

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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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Vision Problems Are Common In Parkinsons

Research has shown that visual symptoms are extraordinarily common in people living with Parkinsons. Visual symptoms may occur due to changes in the front of the eye due to dry eye, changes in the retina , or changes in how our eyes move together. At the same time, many other things can affect vision, including diseases such as age-related macular degeneration, glaucoma, and cataracts, which increase with age. Distinguishing between visual symptoms caused directly by Parkinsons versus one of these other conditions can be difficult.

Visual symptoms related to Parkinsons can be specific: eyes can feel dry, gritty/sandy, and may burn or have redness. You may experience crusting on the lashes, lids that stick together in the morning, sensitivity to light, or dry eye. On the other hand, symptoms can be non- specific: you may notice your vision just isnt what it used to be, and you have difficulty seeing on a rainy night, in dim lighting, or while reading, etc.

Why Loss Of Sense Of Smell Occurs

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

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.

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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.

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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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.

Difficulty Moving The Eyes

Parkinsons disease: Colour vision, dry eyes and double vision could be ...

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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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

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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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.

Tips For Managing Vision Changes

Seeing Clearly with Parkinson’s Disease: Vision Changes

Taking part in an active lifestyle moving and looking around, exercising and engaging with people is important to eye health. It can boost blinking and minimize dryness. Be mindful of too much television or screen time, which can worsen dry eyes.

  • See your ophthalmologist regularly for an eye examination.
  • Get two pairs of glasses, one for distance, one for reading. This may be better than bifocals. If you have double vision, ask your ophthalmologist if prescribing prism glasses can help.
  • Apply warm, moist compresses for eyelid irritation.
  • Use artificial tears to moisten dry eyes.
  • Consider adding a neuro-ophthalmologist to your medical care team. This is a specialist, either an ophthalmologist or a neurologist, who has additional training in diagnosing and treating eye and vision problems associated with PD and other neurological diseases.

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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.

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

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We Need Greater Awareness Of Vision Issues In Parkinsons

Most people associate Parkinsons disease with shaking, tremors, balance, and gait issues. However, we dont often consider the impact of PD on vision.

According to the American Parkinson Disease Association , vision issues may cause a number of symptoms. Not every person with PD experiences these issues, but it is important to know what they are and which treatment options are available.

Rachel Dolhun, MD, Senior Vice President of Medical Communications at The Michael J. Fox Foundation for Parkinsons Research, wrote an article in 2015 about vision and PD. She noted, Not only can visual disturbances interfere with reading or driving, they can worsen walking or balance problems, and even contribute to hallucinations.

PD can cause eye movement problems, blinking problems, dry eyes, blurred vision, inability to sense individual colors, contrast issues, and visual hallucinations, known as PD psychosis.

My sister, Bev, who has been diagnosed with stage 3 PD, has difficulty reading and her eyes are very dry because she blinks infrequently. Though not daily, she sometimes sees or senses things that arent really there.

Bev told me, I dont really see a form of anything. I just see things brushing by in my peripheral vision. The other day I was at the kitchen window and could have sworn that someone or something passed by. I even went to the front door to check and no one was there.

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

Parkinson

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.

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