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Dr. Okun

Post of the Week: Changes in the Eye in Parkinson's Disease

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Dear forum members,

 

Researchers led by Ivan Bodis-Wollner at the NPF Center in Brookyn (Suny) found differences in foveal thickness in PD patients. Below is the abstract from their recent paper.

 

J Ophthalmol. 2012;2012:728457. Epub 2012 Aug 1.

Interocular Asymmetry of Foveal Thickness in Parkinson Disease.

Shrier EM, Adam CR, Spund B, Glazman S, Bodis-Wollner I.

 

Source

Department of Ophthalmology, SUNY Downstate Medical Center, State University of New York, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.

 

Abstract

Purpose. To quantify interocular asymmetry (IA) of foveal thickness in Parkinson disease (PD) versus that of controls. Design. Prospective case-control series. Methods. In vivo assessment of foveal thickness of 46 eyes of 23 PD patients and 36 eyes of 18 control subjects was studied using spectral domain optical coherence tomography (SD-OCT). Inner versus outer layer retinal segmentation and macular volumes were quantified using the manufacturer's software, while foveal thickness was measured using the raw data from each eye in a grid covering a 6 by 6 mm area centered on the foveola in 0.25 mm steps. Thickness data were entered into MATLAB software. Results. Macular volumes differed significantly at the largest (Zone 3) diameter centered on the foveola (ETDRS protocol). By segmenting inner from outer layers, we found that the IA in PD is mostly due to changes on the slope of the foveal pit at the radial distances of 0.5 and 0.75 mm (1.5 mm and 1 mm diameter). Conclusions. About half of the PD patients had IA of the slope of the foveal pit. IA is a potentially useful marker of PD and is expected to be comparable across different SD-OCT equipment. Data of larger groups may be developed in future multicenter studies.

PMID: 22900149 [PubMed - as supplied by publisher]

 

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Thank you for addressing vision problems with PD. There is little written about it in layman's terms, however. Do you have a source for those of us with ocular abnormalities that distinguishes PD vision problems from other diseases?

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This can be tricky and I always recommend a visit to a trained neuro-opthalmologist. The eyes have trouble working together (convergence insufficiency) particularly when looking at objects close by. Also blinking and seeing contrasts in colors as well as dry eyes. It is always best to be seen and evaluated and treated, rather than to guess if PD related or not. Nancy Newman at Emory has written some review papers on PD and the eyes, but I would hate to confuse the population by looking too hard at these.

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Thank you for the information and a reminder of Mark Twin's warning " Be careful of reading health books. You might die of a misprint".... Or perhaps a misinterpretation ?

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My mom is 74, has had Parkinson's since age 42....has recently been diagnosed with Epi-retinal membrane syndrome in both eyes.....also has developed cataracts and glaucoma, but both are mild...her vision is very limited and distorted....any suggestions?

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Dr,

Will this have any affect on one eye getting "stuck" when looking in in certain direction and not coming back into place when the are both supposed to move, let's say, in the opposite direction?

Or, is this mostly a muscle issue that may or may not be an affect of PD?

 

Thanks,

Mark, you're pharmacist.

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The glaucoma and retinal membrane stuff is really out of the realm of PD and best checked by an ophthalmologist.

 

The sticky eye is tricky. Occasionally it is PD especially when the eyes have to work together (convergence insufficiency), and a neurophthalmologist can fix with prisms. It can also be something else neurological so best to be checked out.

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My father was diagnosed with Parkinson's disease for 1 year (I believe that the diagnosis was made late). One of the symptoms he presents: suddenly his eyes are closed and he can't open them with ease. Are you know what can that be? Is it one symptom of Parkinson's disease? If yes, is treatable? His doctor doesn't know what is that.

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This may be an issue called blepharospasm and in many cases is treatable by botulinum toxin injections by someone expert in that area.

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just a word to alert parkinsons patients that are not aware that they have narrow angle glaucoma. I was shocked recently to learn that I had narrow angle glaucoma and didnt know that sinemet had a serious interaction that could lead to blindness if one has narrow angle glaucoma. There is a laser procedure which rectifies the problem and allows patients with parkinsons and narrow angle glaucoma to continue the use of carbidopa/levadopa. Thankfully I had the procedure and avoided any potential complications from the drug. So in conclusion I would suggest that any one with parkinsons has a regular check up with opthamologidst.

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Thanks for the information. I do not have specific information on this issue, but it sounds important. If you have glaucoma and PD you probably at the very least need frequent checkups with the eye doc.

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specific warnings on narrow angle glaucoma, are listed in the sinemet dosage and warning information. Information that is tucked away and goes unnoticed just like the warnings on higher risk of melanoma.

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This is the first time I have been on here. I have recently been diagnosed with Parkinsons Disease, although now that I have been reading and researching, I think I have had it for several years. I have Systemic Lupus, Type 2 Diabetis ( insulin dependent ), Fibromyalgia, Polycythemia Vera, Spinal Stenosis, Hyperthyroidism ( Graves Disease ), had Thyroid removed, Migraines and 3rd. Stage CKD, Macular Degeneration, Retinal Dystrophy and Cataracts.

My question is, lately my eyes are giving me problems, I feel eye tremors in both eyes if it makes sense. I just had new prescription and I wear Tri-Focals, now I am squinting to see and my eyes are dry and vision is blurry.

Hope I have not taken to much of your time and Thank you for any assistance or advice.

 

                                                                                                                                          Mary

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Dry eyes and decreased blinking can be related to Parkinson's disease.  Sometimes PD affects the ability to see contrasts; but in general visual acuity is not impaired with PD.  Sometimes the eyes do not work together and this may lead to double vision especially when holding objects close to you.  Eye tremors are not common with Parkinson's disease, though rarely dopamine replacement causes dyskinesia of the eyes.

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Dear Dr Okun

 

Is it possible that the "eye tremors" described by the patient may be eye twitching caused by focal dystonia (blepharospasm)? ? 

 

I have YOPD and PD-related blepharospasm, and my eye muscle contractions often seem like fine, quivering contractions resembling PD tremor.

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This is a good point.  Taking a video and bringing to the doctor can often help distinguish blepharospasm and Parkinson.

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Can Clonazepam cause one's vision to see things as a very bright light? I just started taking .25 mg at night for insomnia. While I am finally getting sleep, I have extremely bright vision in the mornings. This began when I started taking this med.

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That is a really interesting potential side effect of clonazepam, but I have never heard seeing bright lights in the morning from any of my patients.  I would suggest you discuss with your doctor.  Good luck.

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I'm having trouble being fitted for new glasses, I have Dystonia mainly on my left side. It seems my left eye draws in and down mot lining up with my other eye is this common ?

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Just a quick shout out for Dr. Okun, and an idea for keeping your prism glasses organized with you regular glasses..... I saw Dr. Okun about two years ago, and mentioned my double vision to him. And after a 20 second "follow the finger test", he diagnosed me with convergence insufficiency. He suggested I see a Neuro-Opthalmologist when I got home to Dallas, which I did. The diagnosis was confirmed. I am now writing this winkle wearing my prism glasses and can read every word. Thank you Dr. O!

 

Note to Readers: for me at least, the convergence insufficiency only occurs when I try to read or work on something up close. If I tried to walk with these glasses I have no doubt I wold take a tumble! My recommendation is to buy yourself a fat eyeglass case (WalMart, $5), then cut a thin sheet of plastic (Walmart, blank Stencil Sheet , 3 sheets for $3) and attach it to the center hinge area with duct tape. Keep your readers on one side and your regular glasses on the other. That way, you will always have both pairs with you!????

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