Diplopia in Parkinson’s disease: visual illusion or oculomotor impairment?

Visser, Femke; Vlaar, Annemarie; Borm, Carlijn D.J.M.; Apostolov, Valentin; Lee, Y. X.; Notting, Irene C.; Weinstein, Henry C.; Berendse, Henk W.

doi:10.1007/s00415-019-09430-w

Cited by 17 publications

(52 citation statements)

References 33 publications

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“…38 As with many other ophthalmologic symptoms, patients with PD generally do not report diplopia spontaneously, hence treating physicians should actively ask for double vision and other ophthalmologic symptoms. 39,40 In our study, 22% of patients reported visual hallucinations, compared with 30%-60% in previous studies. 41 This discrepancy may be caused by underreporting of visual illusions-having the feeling that someone is in the room or interpreting a shadow as a person-which were part of earlier studies, but not explicitly surveyed by the VIPD-Q.…”

Section: Discussioncontrasting

confidence: 66%

“…Patients with PD experienced more ophthalmologic symptoms across all domains than controls (p < 0.001), as reflected by a higher VIPD-Q total score among patients (median 10 [interquartile range (IQR) 13]) than controls (median 2 [IQR 5]; p < 0.001). Ophthalmologic symptoms interfered with daily activities in 68% (95% CI, 65-71) of patients, compared with 35% (95% CI, [29][30][31][32][33][34][35][36][37][38][39][40][41] of controls (p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

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Seeing ophthalmologic problems in Parkinson disease

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Section: Discussioncontrasting

confidence: 66%

Section: Resultsmentioning

confidence: 99%

Seeing ophthalmologic problems in Parkinson disease

et al. 2020

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“…Study design and patients. This study involved data obtained in 40 PD patients and in 22 age-and sexmatched healthy controls, most of whom were included in a previously published study 28 , which was performed in the OLVG West (Amsterdam, the Netherlands) between July 1, 2017 and November 21, 2017. In summary, all included patients were diagnosed with PD by a neurologist specialized in movement disorders, fulfilled the UK Parkinson's Disease Society Brain Bank Criteria, had a modified Hoehn and Yahr (mHY) stage between 2 and 5, had a disease duration of at least three years and were older than 50 years.…”

Section: Methodsmentioning

confidence: 99%

Visual hallucinations in Parkinson’s disease are associated with thinning of the inner retina

Visser

Apostolov

Vlaar

et al. 2020

Sci Rep

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Visual hallucinations (VH) are common in patients with Parkinson’s disease (PD), yet the underlying pathophysiological mechanisms are still unclear. We aimed to explore the association of the presence of VH with inner retinal thinning and, secondarily, with visual acuity. To this end, we included 40 PD patients in this exploratory study, of whom 14 had VH, and 22 age- and sex-matched healthy controls. All participants were interviewed for the presence of VH by a neurologist specialized in movement disorders and underwent a thorough ophthalmologic examination, including measurement of the best-corrected visual acuity (BCVA) and optical coherence tomography to obtain macular scans of the combined ganglion cell layer and inner plexiform layer (GCL-IPL). Patients with VH had a thinner GCL-IPL than patients without VH, which persisted after correction for age, disease stage, levodopa equivalent daily dose (LED) and cognitive function. Furthermore, BCVA was lower in the PD group with VH than in the PD group without VH, although only a trend remained after correction for age, disease stage, LED and cognitive function. Taken together, in patients with PD, visual hallucinations appear to be associated with a thinning of the inner retinal layers and, possibly, with reduced visual acuity. Further research using a longitudinal design is necessary to confirm these findings and to establish the causality of these relationships.

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“…Clinicians should take serious note of cognitive impairment in patients with CI objective findings, whether symptomatic or not. Diplopia has been reported in patients with PD [20,42]. It is associated primarily with CI [10,20].…”

Section: Convergence Insufficiency (Ci)mentioning

confidence: 99%

Ocular manifestations of Parkinson disease

Al-Namaeh¹

2020

Med Hypothesis Discov Innov Optom

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Background: Parkinson's disease (PD) is the second most common neurodegenerative disorder. We aimed to review both the disease and the drug-related ocular manifestations of PD. Methods: In this manuscript, we have reviewed and summarized existing literature on the ocular manifestations and drug-related complications of PD. We have also discussed the use of current noninvasive imaging techniques, such as optical coherence tomography (OCT), for the early diagnosis and monitoring of PD. Results: Impaired color vision, reduced stereopsis, reduced contrast sensitivity, pupillary abnormalities, eye movement disorders, convergence insufficiency, dry eye syndrome, glaucoma, visual dysfunctions, retinal abnormalities, and drug-related side effects were among the listed ocular manifestations of PD. There is a large knowledge gap regarding the type of glaucoma affecting PD patients—whether it is open-angle or other types. Further case studies and long-term follow-ups during PD progression are necessary to fill this gap. Patient compliance with follow-up visits for more visual field tests and OCT during PD progression may become problematic when dementia and cognitive impairment occur. Conclusions: There is a general need for clinicians to perform further tests and more visual examinations to rule out ocular manifestations. Furthermore, additional clinical trials are needed to further evaluate the use of different types of OCT findings as biomarkers of PD progression. This would aid in early diagnosis and in delaying disease progression, if treated promptly.

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Diplopia in Parkinson’s disease: visual illusion or oculomotor impairment?

Cited by 17 publications

References 33 publications

Seeing ophthalmologic problems in Parkinson disease

Seeing ophthalmologic problems in Parkinson disease

Visual hallucinations in Parkinson’s disease are associated with thinning of the inner retina

Ocular manifestations of Parkinson disease

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