Elsevier

Ophthalmology

Volume 119, Issue 1, January 2012, Pages 178-182
Ophthalmology

Original article
Ocular Motor and Sensory Function in Parkinson's Disease

https://doi.org/10.1016/j.ophtha.2011.06.040Get rights and content

Purpose

To evaluate the effect of dopaminergic medication and deep brain stimulation on ocular function in Parkinson's disease (PD) and to measure vision-related quality of life in subjects with PD.

Design

Prospective, comparative case series.

Participants and Controls

Twenty-seven PD and 16 control subjects were recruited.

Methods

Visual acuity, ocular motor function, convergence, and vision-related quality of life using the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) were measured. Visual sensory and motor measurements were obtained during the on and off states of PD dopaminergic treatment.

Main Outcome Measures

Convergence ability and vision-related quality of life.

Results

The PD subjects had a mean age of 58.8 years; 30% were female. Their mean duration of PD was 10.9±6.8 years. The control subjects had a mean age of 61.6 years; 56% were female. There was no difference in visual acuity, contrast sensitivity, or color vision of the PD subjects in their on state compared with controls. Convergence amplitudes measured with base-out prism were significantly poorer in PD subjects in their on state compared with controls (24.1±8 Δ vs. 14.8 ±10.3 Δ; P = 0.003). The mean composite VFQ-25 score was significantly worse in the PD subjects compared with the controls (87.1±8.69 vs. 96.6±3.05; P = 0.0001). Comparing the PD subjects in their on with their off states, there was no difference in distance exodeviation, near exodeviation, or ocular ductions. Mean convergence amplitudes and near point of convergence were better in the on state compared with the off state: 14.8±10.3 Δ versus 10.7±9.0 Δ (P = 0.0006) and 13.1±9.1 cm versus 18.1±12.2 cm (P = 0.002), respectively.

Conclusions

Convergence ability is significantly poorer in PD subjects in both the on and off states compared with controls, but improves significantly with systemic dopaminergic treatment. Ocular motor function in PD subjects fluctuates in response to treatment, which complicates ophthalmic management. Parkinson's disease subjects have a significant reduction in vision-related quality of life, especially with near activities, that is not associated with visual acuity.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

Subjects with PD were recruited prospectively from the Morris K. Udall Parkinson Disease Research Center of Excellence at the Johns Hopkins Hospital. The study protocol and consent forms were approved by the Johns Hopkins Hospital/Johns Hopkins University Institutional Review Board. Written informed consent was obtained from each subject in accordance with the Health Information Portability and Accountability Act of 1996.

Eligible subjects were 18 years of age or older with at least

Results

Twenty-seven PD subjects and 16 control subjects were recruited. All subjects were white. The PD subjects had a mean age of 58.8±8.6 years (range, 42–73 years), and 29.6% were female. The control subjects had a mean age of 61.6±13.9 years (range, 33–80 years), and 56% were female. Other demographic and clinical characteristics of the participants are listed in Table 1. The controls were similar in age to the PD subjects (P = 0.42), but more often were female (P<0.05). Nineteen PD subjects

Discussion

We studied a group of patients with PD for a mean duration of 11 years. This study confirmed the presence of substantial convergence insufficiency in subjects with PD as compared with control subjects. Furthermore, the severity of this deficit fluctuated throughout the day in association with the dosing schedule of anti-Parkinson's medications. Whereas the current data showed that duration and severity of the PD did not affect the size of the convergence insufficiency, severity of PD adversely

References (17)

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Cited by (0)

Manuscript no. 2011-361.

Dr. Almer currently is with the Ophthalmology Department, Assaf Harofe Medical Center, Zeriffin, Israel. Dr. Marsh currently is with the Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, and Departments of Psychiatry and Neurology, Baylor College of Medicine, Houston, Texas.

Supported by the National Institutes of Health, Bethesda, Maryland (grant no.: P50-NS-58377 [LM, MG]); subject recruitment was provided by the Morris K. Udall Parkinson's Disease Research Center of Excellence at Johns Hopkins University, Baltimore, Maryland.

Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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