In response to recent requests for information about visual consequences of
PD, I have a document I prepared for an address to my colleagues in
Neuro-Ophthalmology about a year ago on diagnosis and treatment of visual
problems in PWP. I would be glad to email it to anyone who requests it. It
was rejected by the LISTSERV because it is too long.
Every few months, the discussion comes around to visual problems -- blurring,
double vision or general discomfort are typical in PWP. There is not much
new to say. Here is a message I posted a few years ago on the subject.
Some visual problems especially common in PD:
1. Drying of the cornea owing to infrequent blink, exacerbated by autonomic
dysfunction and medicines, causes eye pain and blurred vision. Treat by
clearing up blepharitis with lid scrubs and applying non-preserved tears
frequently. When vision blurs after reading for a few minutes, just try
blinking four or five times [like running your windshield wiper on a dusty
windshield -- need lots of liquid and lots of blinks].
2. Convergence insufficiency causes diplopia [double vision] at near [for
reading].
3. Less often divergence insufficiency causes diplopia at distance [driving].
Prism and/or translucent occlusion of one spectacle lens improves function
and comfort. Your local neuro-ophthalmologist can attach a Fresnel prism to
your glasses and in the meantime, just put a piece of scotch tape on the
inside of your left spectacle lens to block the double image. You'll be
surprised at how comfortable that can be.
4. Vertical gaze may be slowed or difficult to control. Upgaze may become
slowed or absent in the elderly with PD.
In "PSP" [progressive supranuclear palsy = Steele-Richardson-Olshewsky
syndrome] downgaze is especially impaired and unstable fixation [i.e.
"square-wave-jerks"] makes reading difficult. For these reasons - among
others - bifocals are a bad idea and reading will be easier with separate
glasses.
Balance problems make bifocals -especially Varilux lenses without the line --
difficult to use and unsafe to walk in.
5. It is hard to read when your head is shaking or you can't hold a book
still. Try a music stand to hold the newspaper still.
5. Of course, having PD does not exempt us from the usual problems of aging
eyes--glaucoma, presbyopia, cataract, macular degeneration, ischemic attacks
causing visual loss or nerve palsies.
It sounds simple, but often takes some practical solution that is not
offered by your local eye doc.
Just yell and I'll try to help.
Jacquie
[Jacqueline M.S. Winterkorn, PhD, MD
[log in to unmask]
Neuro-Ophthalmology
900 Northern Blvd.
Great Neck, NY 11021]
