Written by SMH Occupational Therapist Cassandra Santiago
Dry eyes. Double vision. Difficulty reading. What do these symptoms have in common?
They are all vision problems that commonly affect someone who has Parkinson’s disease.
Vision deficits often go undiagnosed due to a lack of awareness of the changes that are occurring or are misdiagnosed because of other issues occurring at the same time, such as cataracts and glaucoma. The problems also are often overshadowed by larger issues, such as motor movement changes (short, shuffling steps or arm tremors) or speech changes.
What types of vision deficits are common with Parkinson’s disease?
- Double vision
- Blurred vision
- Eye dryness, irritation or burning
- Difficulty reading because of slowed eye movements
- Objects appear to jump, jiggle or vibrate, when they’re actually still
- Slowed blinking
- Trouble opening the eyes
- Decreased sensitivity to color and brightness
- Only seeing half or part of the visual field
- Unawareness of neglecting part of the visual world (maybe ignore the left half of a room)
- Floor may appear tilted, or the walls and floor may appear to move
- Veering to one side when walking, or a feeling of imbalance
- Difficulty moving gaze from one object to another
- Difficulty following an object as it moves in front of you
- Overcompensating by turning your head to see objects around you, instead of using the eyes
- Difficulty judging distance or sensing body position in space
- Crashing into objects while walking and increase in falls
- Eye fatigue or frequent need to “rest” the eyes
- Forward head thrust
- Difficulty recognizing familiar faces
- Discomfort when driving (often tailgate, particularly at night due to impaired depth perception)
Parkinsons-related vision problems can make walking and driving unsafe, and can even make it difficult to thoroughly complete self-care tasks. They can make it difficult to see changes in flooring, locate clothing in a crowded closet, discern the sidewalk’s end or keep their eyes open to cook a meal. If simple tasks like these become challenging, imagine the impact on hobbies and interests that rely more on functioning vision. In order to safeguard quality of life and personal safety, vision problems should be addressed regularly for those with Parkinson’s disease.
A Neuro-ophthalmologist Can Help
If you or a loved have Parkinson’s disease and any of the above symptoms, consider a visit to a neuro-ophthalmologist, an eye doctor trained in diagnosing and treating disorders of the eye-brain connection. Neuro-ophthalmologists address problems with the muscles of the eye, the optic nerve and its connection to the brain, and the areas of the brain that receive and process the visual information. The neuro-ophthalmologist or your neurologist may order occupational therapy to address the visual concerns.
He/she might also recommend:
- Proper prescription eyeglasses for daily activities and to prevent falls. Contact lenses may be preferred for patients with tremor or dyskinesias.
- Early cataract surgery; this is more successful when involuntary head and body movements are less advanced.
- Purchasing two pairs of glasses, rather than bifocals, so you can have one for distance and the other for close-up activities and reading.
- Using reading glasses with base-in prism or monocular occlusion for reading to address convergence insufficiency.
- Botulinum toxin injections, to help keep the eyes open.
- Managing inflammation with warm, moist compresses, lid scrubs and medicated ointments.
- Using artificial tears to decrease dry eye symptoms.
How Can Occupational Therapy Help?
Occupational therapists who are trained in neurological vision can create a treatment plan that addresses each concern in hopes of improving overall vision through neurorehabilitation or compensatory strategies. By improving vision, you boost independence and safety, and can get back to those hobbies and interests that bring joy to their life.
Neurorehabilitation uses vision techniques like vestibular ocular exercises, Brock string, Marsden ball and diopter prisms to retrain the eye-to-brain connection. A neurorehabilitation therapist may also suggest strategies to compensate for visual deficits in order to get back to those important life skills. These strategies include:
- Ensuring you have good ambient light while reading
- Choosing lens tints to help correct color/visual disturbances
- Taping off part of glasses lens or using an eye patch to help with double vision
- Using a larger font size when typing
- Using lid crutches or lid tape to hold eyelids open
- Increasing visual contrast, such as placing a brightly colored placement underneath a dinner plate to see its edges better
- Increased contrast accessibility option on computer/tablet for reading
- Increasing awareness of deficits (such as turning the head to the left to compensate for decreased left visual field)
- Avoiding visual over-stimulation in the house (clutter)
- Giving your eyes a break to avoid over-stimulation
- Employing anchor strategies, such as using a colored piece of tape or your finger, in the direction of the limited visual field can increase recognition
- Placing brightly colored tape on the edges of stairs or side of a doorway for increased contrast to avoid injury
Vision deficits impact more than just what we see with our eyes, they also have an impact on attention, cognitive function, postural stability and ability to walk.
Studies have shown that people with Parkinson’s disease who have visual deficits experience a significant reduction in vision-related quality of life, especially close-up activities like buttoning a shirt, putting toothpaste on a toothbrush and making a sandwich. These activities comprise the bulk of our day-to-day lives, so the impact of visual challenges can be profound.
It is important to have neurological vision screens and to address deficits early on in Parkinson’s disease to maintain the highest quality of life.
To learn more about vision rehab and other therapies for those with Parkinson’s disease, please call 941-724-2620.
Sarasota Memorial Parkinson’s Rehab
Neuro Challenge Foundation for Parkinson’s
Local Support & Education Programs
American Parkinson Disease Association
Micheal J. Fox Foundation for Parkinson’s Research
Cassandra Santiago, OTR/L, MOT, is a neurological occupational therapist at the outpatient clinic at Sarasota Memorial's Health Care Center at Clark Road. She specializes in therapies for neurological disorders, particularly stroke, Parkinson’s disease/LSVT Big, seating and mobility, neurological vision impairments and concussion rehab. She also manages the Muscular Dystrophy and ALS clinics, a partnership between SMH and the Muscular Dystrophy Association.