Barb, I agree. I had my second visit to the neuroligist this am.and ask him
if PD affected the eyes,and he looked at me like I was stupid for asking and
said NO. The thyroid and anemia tests came back normal but when I ask him
what the problem was he said it was inherited. (you do not have PD),then
procedes to prescribe MYSOLINE. My pharm.(pill pusher) and I talk about
every med.I take and how one reacts with another etc.and he told me that
this is one of the first meds neuroligists will prescribe. He said they do a
trial and error period because they don't know. Thank God I'm going to Iowa
City the first part of April. They have a movement disorder clinic. Shirley
-----Original Message-----
From: Barb_MSN <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Friday, January 28, 2000 11:45 AM
Subject: Re: NEWS-Parkinson's hinders patients' ability to distinguish
contrast
Judith...
Thanks for posting this message. It's the most comprehensive
commentary about PD-related visions problems I've yet to read.
I've tried to explain to my daughters that I have aggravating,
annoying, and often scary PD-related vision problems. It feels
like I run into a "optical stone wall" intermittently throughout
the day, with additional problems as day fades into night.
It's not that they don't recognize my visual difficulties. but
rather they lump it under the "Mom's getting older"category. And
while I DO admit to having a birthday once a year and those years
ARE mounting up <GULP>, at 57 I don't consider myself THAT old!
This article really puts things into perspective, and it's message
validates what most of us long-term Parkies have claimed about
our changing, if not actually declining vision.
Barb Mallut
[log in to unmask]
-----Original Message-----
From: judith richards <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Friday, January 28, 2000 11:11 AM
Subject: NEWS-Parkinson's hinders patients' ability to distinguish
contrast
The Medical Post
VOLUME 36, NO. 02, January 11, 2000
Parkinson's hinders patients' ability to distinguish contrast
By Derek Cassels
Condition often goes undiagnosed, doctors don't pass on helpful
tips
LUBBOCK, TEX. - An Americanneurologist with a long-term interest
in
Parkinsonism says it is not widely known visual acuity,
particularly the
ability to perceive contrast, appears to diminish as the disease
progresses.
As a result, patients unaware of the gradual deterioration of
sight do
little to protect themselves again such injuries as falls and
unexpected
collisions.
He says many physicians are unaware of the faltering sight
associated
with Parkinsonism and do not pass on simple tips that could avert
injuries from the annoying to the catastrophic.
Dr. Thomas Hutton, director of the neurology, research and
education
centre at Covenant Health System, Lubbock, Tex., said these visual
symptoms are frequently overlooked and go undiagnosed.
He gives the example of a patient whose wife put a new off-white
bath
mat on the white bathroom floor. This was totally invisible to the
patient. When a green mat was substituted the problem was solved.
Similarly a white safety handle in the shower went unused because
it
could not be seen.
In an interview, Dr. Hutton said as Parkinson's progresses so does
the
ability to differentiate shades of grey.
Some medicines, like L-dopa generally give "significant
improvement" and
this may persist for months or even years.
So Dr. Hutton said this observation supports the theory reduced
contrast
sensitivity is related to dopamine deficiency. However, others
drugs,
like some dopamine agonists, may make things worse.
This is potentially clinically significant in light of the
association
between dopamine agonists and visual hallucinations and confusion.
Whether some visual problems are also associated or exacerbated by
the
use of dopamine agonists is now being studied.
"Contrast sensitivity seems to be somewhat phasic and depends on
the
state of the Parkinsonism. We are trying to relate this to visual
misperceptions which are quite common and think this also may be
related
to the hallucinations you can find in Parkinson's.
"Visual contrast problems are not seen in phase one (of the
disease) but
are there at grades two through five. In the more advanced grades
...
four and five, these are extremely severe.
"I think in terms of becoming clinically very significant this is
a
concern only in the advanced stages ... four and five. I don't
think we
could push it to say that phase two patients have visual problems
but
there are changes nevertheless."
Clinically, he said, this means doctors should listen when
Parkinson's
patients bring complaints such as not being able to see well at
night.
"Typically these patients are found to have normal acuity and no
eye
disease that would explain their visual complaints. Many undergo
repeated visual exams and needless changes in eyeglasses in the
effort
to see better. This can be very frustrating for these patients.
"So we think an analogy to what we are doing in the lab is what a
Parkinson's patient sees at night when the light is fading at dusk
...
or not seeing at night when the ambient lighting is low."
He said the take-away message is that patients with this problem
should
not be driving. He said they also need to increase the lighting in
their
hallways, stairwells and bathrooms.
"Often they can't see the steps and they tend to fall down them.
Make
sure steps are clearly contrasted in the home and places like
garages.
This can be done simply by the use of tape to edge stairs, for
example."
Dr. Hutton said colour perception is also affected by progression
with
the whole colour range diminishing in time.
"It is quite surprising what these people cannot see on our
research
testing screen. We have worked with coloured lenses a bit but
there are
no major conclusions other than we did not see any dramatic
improvements."
© Copyright 1999 The Medical Post. All rights reserved.
~~~~
Judith Richards, London, Ontario, Canada
[log in to unmask]
^^^^
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