Exploring Vision Changes in Parkinson’s Disease
Insights from Dr. Gilbert Hosts with Dr. Janet Rucker
Vision changes are a common but often under-discussed non-motor symptom of Parkinson’s disease. These changes can include eye movement problems, dry eyes, visual hallucinations, and more. On a recent episode of APDA’s Dr. Gilbert Hosts, we spoke with Dr. Janet Rucker, a neuro-ophthalmologist with expertise in Parkinson’s disease (PD). Dr. Rucker provided a helpful overview of this interesting topic, and we covered a lot of ground during the broadcast, including answering many questions from the audience. It was a very informative conversation, and we encourage you to watch the full episode, but for your convenience we’ve listed the topics and questions from the episode below with timestamps, so you can skip to what interests you most. Additionally, today we are answering some of the important audience questions that we didn’t have time to get to during the program.
Questions addressed during Dr. Gilbert Hosts: Vision Changes & Parkinson’s Disease
01:16 Dr. Rucker introduction (followed by her presentation)
16:26 Can you elaborate on the causes of double vision perceived with only one eye open?
18:00 What happens if your prisms are “maxed out”?
19:41 Is losing night vision related to PD?
21:15 My eyelids won’t open on many mornings. Is that related to PD?
23:19 I have blepharospasm. Is that related to PD and how is it treated?
25:02 How do you differentiate between having double vision and difficulty with depth perception?
28:07 Can DBS surgery cause issues with vision?
29:43 What are some treatments for dry eyes? What about treatments for excessive tearing?
33:57 If you were evaluated by an ophthalmologist and are still not happy with your vision, which type of doctor should you see next?
37:06 How do you find a neuro-ophthalmologist?
38:39 Is nonarteritic anterior ischemic optic neuropathy associated with PD? Does PD worsen NAION?
41:00 Are there eye surgeons who specialize in eye surgery for people who have tremor?
42:52 Will I have to stop driving due to my PD?
44:34 How do the Parkinson plus syndromes affect vision?
Additional questions about vision and Parkinson’s disease
These are the questions we did not have time to answer during the program.
Q: I developed blurry vision after my doctor changed my PD medication. Could it be a side effect of medication?
A: Yes, certain medications for Parkinson’s disease, such as amantadine and Gocovri, can cause blurry vision. Talk with your doctor about this possibility and he/she may consider adjusting your medication.
Q: I have PD. My wife tells me that I stare too much without blinking. Is there anything I can do about that?
A: Hypomimia, or the reduction of spontaneous facial movements and emotional facial expression, is a common and very characteristic symptom of PD. The same stiffness and slowness that can affect walking can affect the muscles of the face and a person may look like they are staring. This can be very problematic as it can interfere with social interactions and communication. Levodopa formulations and other PD medications that improve stiffness and slowness more generally often improve facial expression as well. Small studies suggest that orofacial physical therapy can also be an effective strategy to improve hypomimia. Finally, the Lee Silverman Voice Treatment, a speech therapy program that focuses on improving the volume of speech for people with PD, was studied in a small trial and showed benefit not only on speech but on facial expression as well.
Q: I frequently get dizzy with blurry vision. Is that related to PD?
A: The most common cause of dizziness in PD is orthostatic hypotension, a condition in which the body is not able to maintain blood pressure when moving from lying to sitting to standing. These episodes of low blood pressure can result in dizziness and lightheadedness and can be accompanied by a darkening of vision or generally impaired vision as the brain is not perfused properly with oxygen.
The solution to these episodes is to:
- Take steps to maintain blood pressure – this could involve increasing fluids and dietary salt
- Moving from lying to sitting to standing very slowly
- Wearing compression stockings
If lifestyle modifications are not effective enough, then a prescription medication to maintain blood pressure may be prescribed.
Q: I find that when I look to the side it takes a few seconds to come into focus. Is this from Parkinson’s disease?
A: Saccadic eye movements are rapid eye movements that allow the eyes to jump quickly to a new target (that is, as opposed to pursuit eye movements that allow the eyes to travel slowly as they follow a moving target). Saccadic eye movements can be slower in PD than in the general population. They also can be smaller in magnitude than they need to be – that is, the eye movement is not big enough to reach the target on the first try, requiring a second eye movement to get to the target. Therefore, when your eyes want to jump quickly to see something off to the side, they may not focus on the target as quickly as they used to, leading to the sensation that you describe.
Q: If I have nystagmus, does that mean I do not have Parkinson’s disease, but rather a Parkinson plus syndrome?
A: Nystagmus is a condition in which your eyes make fast, shaking, rhythmic movements, either side to side up and down or in a circular pattern. This is not something that is commonly seen in Parkinson’s disease but can be seen in the atypical parkinsonian syndromes, also known as Parkinson plus syndromes. These are a group of neurodegenerative conditions that cause some symptoms similar to Parkinson’s disease such as slowness and stiffness, plus other symptoms as well. Progressive supranuclear palsy, Corticobasal ganglionic degeneration, and Multiple system atrophy can all manifest with nystagmus. Having nystagmus may suggest that you have a diagnosis other than Parkinson’s disease.
Q: How do you know if an eye problem is related to PD or something else?
A: Because PD causes so many different non-motor symptoms, it is often hard to know whether a symptom is caused by PD or something else. If you are having trouble with your vision, for example, this could be because you need a new prescription for your reading glasses or because you are developing macular degeneration, cataracts, diabetic retinopathy, glaucoma, or a whole host of other common eye conditions that increase in prevalence with age and are not related to PD. However, the visual changes could also be due to your PD. Best practice therefore is to have any new symptom or worsening symptom evaluated as if you did not have PD. Once other issues are ruled out, then your doctor might conclude that the problem is due to PD, but if you assume that something is due to PD when it is not, you might miss the chance of getting diagnosed and treated for another condition.
Tips & Takeaways
- Vision changes are common for people with PD and can have a major impact on quality of life.
- There are potential lifestyle modifications and treatments to help with the vision symptoms of PD.
- If vision changes are an issue for you, be sure to bring this to your doctor’s attention, as you may be able to minimize your symptoms.
- Listen to a very interesting broadcast dedicated to answering questions about vision challenges and PD.
- Don’t miss future episodes of Dr. Gilbert Hosts by subscribing to APDA’s YouTube channel.
- If you have a PD-related question, you can submit it to our Ask A Doctor portal.