Patients With Parkinson Disease at Increased Risk of Vision, Eye Issues, Study Shows

Patients with Parkinson disease (PD) 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 (PwP), 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 (dry eyes).

While PwP face a potential risk of developing vision and eye issues, study authors noted that ophthalmologic symptoms are underreported by patients and often overlooked by their treating physicians. Additionally, the few studies that have examined this risk in PwP included a limited number of ophthalmologic issues in PD.

Researchers aimed to determine the prevalence of a wide range of ophthalmologic symptoms in a large sample of PwP (n = 848) compared with controls (n = 250) and to explore the effect of these ophthalmologic symptoms on daily life functioning. The study cohort (average age of 70 years) completed a questionnaire on vision and eye problems, known as the Visual Impairment in Parkinson’s Disease Questionnaire (VIPD-Q), that focused on 4 domains according to structures: ocular surface, intraocular, oculomotor, and optic nerve.

For each potential problem described in the VIPD-Q’s 16 questions, participants were asked to choose from a range of 4 responses, in which a response a of “never have symptoms” was worth 1 point and a response of “daily symptoms” was worth 4 points. The total possible score a patient could obtain was 51 points.

In the study findings, researchers found that 82% of PwP (95% CI, 80%-85%) reported 1 or more ophthalmologic symptoms, compared with 48% of controls (95% CI, 42—54) (P < .001). Additionally, PwP reported more vision and eye problems across all 4 domains than controls (P < .001), indicated by a higher VIPD-Q total score among PwP (median [interquartile range (IQR)] = 10 [13]) than controls (median [IQR] = 2 [5]; P < .001).

In PwP with ophthalmologic symptoms, 68% (95% CI, 65%-71%) reported that it interfered with daily activities, compared with 35% of controls (95% CI, 29%-41%) (P < .001).

Study author Carlijn Borm, MD, Radboud University Medical Center, highlighted the frequency of vision and eye issues in study participants with PD, which can affect daily activities. “Eye problems make it more difficult for people with Parkinson to physically navigate daily life, for example we found that half of study participants experienced problems with reading, and 33% had eye problems that interfered with driving a car,” said Borm.

As many of these vision and eye issues are potentially treatable, Borm notes the importance of screening within PD communities. “People with Parkinson’s who express that they have eye problems should be referred to a specialist for further evaluation. For those who do not express such problems, using a questionnaire to screen for problems that may otherwise be missed might allow for recognition, timely treatment and improving the quality of life,” said Borm.

Study authors note that potential selection bias may have contributed to an overestimation of ophthalmologic symptoms in the study findings, as patients with visual complaints may have been more likely to respond and participate in the study.

Reference

Borm CDJM, Visser F, Werkmann M, et al. Seeing ophthalmologic problems in Parkinson disease [published online March 11, 2020]. Neurology. doi: 10.1212/WNL.0000000000009214.