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Vision Changes

Some people with Parkinson’s disease (PD) notice that as the disease progresses their vision loses sharpness or becomes blurred, and they have trouble with dry eyes.  Difficulties related to the eyes and vision often progress alongside other PD symptoms.

If you have PD, consider adding a neuro-opthalmologist to your medical care team. This is a specialist, either an opthalmologist or a neurologist, who has additional training in diagnosing and treating problems with the eyes and with vision that are associated with PD and other neurological diseases.

Symptoms

Visual motor symptoms

Some vision difficulties are related to changes in the movement of the eyeball.  These are motor symptoms, similar to other motor symptoms caused by loss of dopamine neurons.

  • Blurred or double vision, and eye strain, because the eyes may have trouble moving together to focus on things traveling toward or away from a person
  • Trouble reading, because the eye movements needed to follow the lines of a page are slowed and have trouble starting (similar to gait freezing in the legs)
  • A person with PD may need to blink in order to change eye position;  levodopa can help
  • Trouble opening the eyes voluntarily, known as apraxia (treated with “lid crutches” or lid tape)
  • Eyelid spasms, called blepharospasm, and excessive blinking

Discomfort

  • Dry eyes;  people with PD may blink only 1-2 times per minute (normal is 16-18 times), leading to itching and burning
  • Skin irritation on the eyelid; known as seborrheic blepharitis, this can worsen dry-eye symptoms

Changes in perception

  • Decreased sensitivity to contrast (color and brightness), making vision less sharp, caused by the loss of dopamine neurons in the eye’s retina
  • Altered color vision, a sort of blue-yellow color blindness.
  • Difficulty judging distance, and the position of body parts
  • Impaired ability to read other people’s facial expressions
  • Visual hallucinations, such as flickering lights, that could be related to PD medications

Problems associated with aging

  • Glaucoma
  • Cataracts
  • Macular degeneration

What to Do

  • Be aware of how medications affect vision - medications containing levodopa (Sinemet, for example) can improve movement-related symptoms as well as contrast sensitivity while other drugs may exacerbate hallucinations
  • Have a thorough eye examination
  • Get two pairs of glasses – one for distance and one for reading – may be better than bifocals, or your ophthalmologist may prescribe prism glasses
  • Apply warm moist compresses or ointments for eyelid irritation
  • Use artificial tears to moisten dry eyes