Questionnaire studies have concluded that 78% of people with Parkinson’s disease report at least one visual symptom. This can include difficulty reading, experiencing double vision, and misjudging objects and distances. Visual disturbances are another non-motor symptom that is common with Parkinson's but maybe not always addressed and talked about. Let's discuss the common visual disturbances that you or your loved one may experience.
1. Dry eyes
Dry eyes can happen in PD due to decreased blinking and side effects from medications like amantadine. Some people may actually feel the sensation of dryness, but others can have an increased sensitivity to light, may experience blurry vision, or have a glare. Common symptoms of dry eyes include soreness, stinging, itching, redness, feeling like there is sand in the eyes, and some may experience watery eyes from the dryness. It is important to note that dry eyes can be asymptomatic.
If dry eyes are not treated they can scar the outer later of the eye, create ulcers on the cornea, and even lead to vision loss. Preservative-free over-the-counter eye drops or artificial tears are recommended to treat dry eyes, but talk with your Ophthalmologist first. Avoid anything that is meant to reduce redness as this can irritate or even worsen dry eyes. Too much screen time can worsen dry eyes, while exercising and engaging with friends and family can help you blink more.
2. Trouble reading
Reading involves moving the eyes to follow the lines of a page. We have specific eye muscles that control our eye movements. Sometimes, people can get slowness in these movements and have a hard time moving their eyes, just like for those who have a hard time moving their legs when walking. Blinking can sometimes help our eyes figure out how to move in the direction you need them to, and Levodopa can often help.
3. Convergence insufficiency
This means when your eyes have a hard time working together to focus on things nearby, leading to double vision. Sometimes this can worsen or come on after deep brain stimulation (DBS) surgery. Prisms, a special type of eyeglass lens, are often prescribed to help with the double vision. Some people report relief from wearing an eye patch. Occupational Therapy and/or Vision Therapy can help strengthening your eye muscles and help your muscles work together.
4. Involuntary closure of the eyelids (eyelid apraxia)
Eyelid apraxia can happen when the muscles that open your eyelid have difficulty doing their job. This commonly happens during speech. If your eyelid apraxia is mild, just rubbing your eyelids may help you gain more control. Other times, injections of Botox are needed to help. "Lid crutches" may also be helpful. This includes a small bar that rests along the inside of the eyeglass frame. This supports the eyelid and helps the eyelid stay where it should be.
5. Color Vision
Some people with PD report a difficulty with differentiating between colors, especially for shades of blue or green. Sometimes this can improve with PD medication, so make sure you talk with your neurologist. Changes with color can also be a symptom of non-Parkinson's eye changes, like cataracts or glaucoma. Talk with your doctor to make sure you are getting screened for these conditions. If you have glaucoma, anticholinergic drugs and levodopa may not be appropriate for you.
6. Spatial awareness
Spatial awareness disorders means having difficulty judging the space around you. This can make it harder to move in more narrow spaces, navigate around piecing of furniture, or even stepping onto objects like a curb. An occupational therapist can really help with this! Check out our list of OTs in our area.
7. Difficulty seeing movement
Sometimes, people with PD have a hard time seeing movement accurately or they are unable to judge the speed of moving objects, like cars and busses. Talk with your neurologist if you are experience this problem
If you are experiencing any of these problems, ask your doctor if you should be seeing a Neuro-Ophthalmologist. Neuro-Ophthalmologists have further training with neurological conditions and the effects on the eye, so they have a unique appreciation for and understanding of the intersection between the eyes and the brain.
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