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PARKINSON’S AND THE EYES Seeing How Parkinson’s Affects The Eyes Kay Dombkowski, O.D. DEFINITION Parkinson’s Disease is a progressive degenerative disorder of the central nervous system Parkinson’s Disease is caused by the death of dopamine-containing cells in the substantia nigra region of the midbrain Cause of cell death is unknown Result of cell death causes a loss of ability to execute smooth, controlled movements PARKINSON’S AND THE EYES OPHTHALMOLOGICAL SYMPTOMS, CAUSES AND TREATMENTS DIFFICULTY MOVING THE EYES Difficulty in beginning a movement of the eyes or an inability to move the eyes quickly Smooth movement of the eyes is impaired and movement is slow and jerky Difficulties in moving the eyes are usually improved by Parkinson’s medication PARKINSON’S AND THE EYES DOUBLE VISION Impaired coordination of the muscles inhibits proper alignment, causing double vision May be worse at near with a convergence insufficiency Bifocals may prevent eyes from converging, or aiming in, toward a near, or reading, target. Prism glasses may help with symptoms or two separate pairs of glasses may be preferable Other causes of double vision may be unrelated to Parkinson’s. If the problem continues, consult an optometrist so further testing can be carried out PARKINSON’S AND THE EYES BLURRED VISION May be caused by: Due to difficulty moving and aligning the eyes A side effect of anti-Parkinson’s drugs Blurred vision may occur at any time in the course of medical treatment May improve with time If blurred vision persists or worsens, consult your doctor. If you already wear reading glasses, a slight modification to these might improve blurred vision. Your optometrist will be able to advise you about this. PARKINSON’S AND THE EYES DRY EYES Most common ocular complaint in Parkinson’s patients People with Parkinson’s often find that they blink less frequently which may, on rare occasions, lead to conjunctivitis. The treatment is usually antibiotics from the optometrist. Fewer blinks while reading impacts the tear film and causes decreased vision Parkinson’s medications can cause and worsen dry eye Artificial tears can help patient’s comfort PARKINSON’S AND THE EYES INVOLUNTARY CLOSURE OF EYE LIDS Blepharospasm occurs when the muscle that closes the eyelid contracts or goes into spasm and is rare in Parkinson’s patients. Result may be repeated twitching of the eyelid, difficulty in keeping the eyelid open and sometimes complete closure, interfering with vision. The cause and treatment of blepharospasm is confusing because the levodopa drugs that are used to treat Parkinson’s sometimes cause it, but on other occasions these drugs can help improve it. In mild cases, simply treating ocular surface disease can help. Occasionally, injections of the drug Botox are used for treatment. PARKINSON’S AND THE EYES HALLUCINATIONS Hallucinations can manifest early in the course of Parkinson’s and may directly result from the disease Should be monitored closely, as they may occur in patients with early disease who are not yet medicated. In those that are medicated, a reduction in medication may be considered. Often seen in patients taking dopamine agonists and levodopa. Seek advice from your physician if you are experiencing hallucinations. PARKINSON’S AND THE EYES CONTRAST SENSITIVITY A reduction in contrast sensitivity is a difficulty seeing in low light levels and an inability to make out clearly the definition of items such as a light-colored object on a light background. This may also affect the ease with which fine print can be read. The problem may improve with the treatment of Parkinson’s with levodopa PARKINSON’S AND THE EYES COLOR VISION Parkinson's disease patients demonstrate significantly higher error rates on color vision tests than age-matched controls Dopamine reduction in cells of the retina leads to decreased color vision and contrast sensitivity PARKINSON’S AND THE EYES VISUAL SPATIAL ORIENTATION Difficulty in judging the space around them May not be able to assess accurately the distance between objects Occupational therapists can help with advice about organizing space and carrying out everyday activities PARKINSON’S AND THE EYES GLAUCOMA AND PARKINSON’S Glaucoma A group of eye conditions that damage the optic nerve Adverse effects of Parkinson’s medications May cause narrow angle glaucoma and should be avoided or used with caution Care It is helpful if the Parkinson’s specialist and the optometrist and/or ophthalmologist work together when prescribing medication for people who have Parkinson’s and glaucoma. PARKINSON’S AND THE EYES LOOKING FORWARD PERSONAL VISION CARE If you have any difficulties with your eyesight you should consult your physician to consider adjusting medications to ease symptoms Your optometrist will manage your visual concerns once medication doses are stable Have optometrist collaborate with occupational therapist PARKINSON’S AND THE EYES OTHER FACTORS Many problems with vision will not be related to Parkinson’s at all and instead will have a different cause: Other co-existing conditions, such as a cataract Age related visual problems, such as presbyopia PARKINSON’S AND THE EYES WHAT CAN I DO? GET INVOLVED The mission of The Parkinson’s Institute (The PI) is to provide comprehensive patient care, while discovering new treatment options to improve the quality of life for all Parkinson’s disease (PD) patients. As America’s only independent nonprofit organization combining research and patient care for PD under one roof, we are committed to changing the landscape of movement disorder treatment and research. cause care cure PARKINSON’S AND THE EYES PARTICIPATE IN ADVANCED RESEARCH Participating in Clinical Trials at The Parkinson’s Institute and Clinical Center means joining a group of individuals with a common goal of finding new therapies for symptom control and hopefully one day a cure. The Parkinson's Progression Markers Initiative (PPMI) is a landmark five-year clinical study aiming to identify biomarkers of Parkinson's disease progression. People recently diagnosed with PD who are not currently taking medications are needed — and so are individuals who have neither PD, nor a close relative with PD, to serve as controls. PPMI site at the Parkinson’s Institute and Clinical Center PARKINSON’S AND THE EYES PARTICIPATE IN ADVANCED RESEARCH Take an active role in groundbreaking research by providing your DNA sample and answering surveys online. Join 4,500 other patients in this research study to understand the causes of Parkinson's disease and find potential treatments. Goal is 10,000 patients https://www.23andme.com/pd/ PARKINSON’S AND THE EYES SUPPORT STAY INFORMED AND CONNECTED Your generous financial support is an investment in the Institute’s mission to find the cause of Parkinson’s disease, provide world class care for patients, and work towards a cure Take classes to stay informed of latest updates Stay connected to support groups for emotional well-being PARKINSON’S AND THE EYES REFERENCES V. Biousse, B.C. Skibell, R.L. Watts, et al, Ophthalmologic Features of Parkinson’s Disease, 62 NEUROLOGY 177-180 (2004). Parkinson’s and Eyes, PARKINSON’S DISEASE SOCIETY, http://www.parkinsons.org.uk/PDF/FS27_Parkinsonsandeyes.pdf (last visited Aug. 28, 2011). R. A. Armstrong, Visual Symptoms in Parkinson's Disease, PARKINSON’S DISEASE (MAY 25, 2011), http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109513/?tool=pubmed. Neil K. Archibald, Michael P. Clarke, Urs P. Mosimann & David J. Burn, The Retina in Parkinson’s Disease, 132 BRAIN 1128 (2009), available at http://brain.oxfordjournals.org/content/132/5/1128.full.pdf. The Michael J. Fox Foundation for Parkinson’s Research, Parkinson’s Progression Markers Initiative, THE MICHAEL J. FOX FOUNDATION FOR PARKINSON’S RESEARCH, http://www.michaeljfox.org/living_PPMI.cfm (last visited Sept. 1, 2011). 23andMe, 23andMe Parkinson’s Community: Strength in numbers, 23ANDME, https://www.23andme.com/pd/ (last visited Sept. 1, 2011). About the Institute, THE PARKINSON’S INSTITUTE AND CLINICAL CENTER, http://www.thepi.org/index.php?src= (last visited Nov. 14, 2011). PARKINSON’S AND THE EYES Contact me: [email protected] THANK YOU