Ocular Motor and Sensory Function in Parkinson's Disease
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.
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.
PII: S0161-6420(11)00619-1
doi:10.1016/j.ophtha.2011.06.040
© 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
