Sunday, 3 April 2016

Eyes and Parkinson’s

I have had a lot of problems with my eyes recently, and this has helped me to understand it much better. Now I need to speak to the Parkinson's Nurse about this


People with Parkinson’s often experience problems with their eyes

and eyesight.1 Some of these problems may be due to Parkinson’s itself, or Parkinson’s medication, but they may also be due to other causes.

This information sheet looks at the common eye problems you may experience, such as blurred vision and glaucoma, and looks at other causes and possible solutions.
Who treats eye problems?

Ophthalmologists – are medically trained doctors. They examine, diagnose and treat diseases and injuries in and around the eye. They also perform operations on the eye.

Optometrists – examine eyes and give advice on visual problems. They also prescribe and fit glasses or contact lenses. They usually work in the high street, but may also work in a hospital eye service. Some have a role in caring for patients with stable, long-term (chronic) eye conditions.

Orthoptists – diagnose and treat vision problems and abnormal eye movement. They are usually part of a hospital care team looking after people with eye problems.

If you are having problems with your vision, you should speak to your GP or specialist. You can also speak to your Parkinson’s nurse, if you have one. A Parkinson’s nurse is a qualified registered general nurse with specialist experience, knowledge and skills in Parkinson’s. They play a vital role in the care of people with Parkinson’s. You can read more about them on page 5.

Your GP, specialist or Parkinson’s nurse may suggest that you visit the relevant eye and vision health professional to help treat your problem.

How often should I get an eye test?

If you have Parkinson’s, it is recommended that you attend regular eye exams with an optometrist, at least once a year, even if you aren’t experiencing any specific problems with your eyes. You may find it helpful to tell them you have the condition, so they can look

Parkinson’s can affect your ability to move parts of the body, including your eyes. So you may have difficulties when starting to move your eyes or when trying to move them quickly.2,3 It may be more noticeable when looking at a fast-moving object, such as when watching moving cars or a tennis match. Sometimes, instead of a smooth movement, your eyes may move in a slow and jerky way.2

This can make certain activities, such as driving, more difficult. If this happens talk to your GP, specialist or Parkinson’s nurse because Parkinson’s medication may help.2

Difficulties in moving the eyes up or down are more common in a condition called progressive supranuclear palsy (PSP), which is a form of parkinsonism (an umbrella term that describes many conditions that share some of the symptoms of Parkinson’s).4 If you are experiencing this problem,
your specialist or Parkinson’s nurse will be able to give you advice.

Find out more: see our booklet Driving and Parkinson’s and information sheet Parkinsonism.

Blurred vision
Blurred vision can be caused by difficulty moving the eyes.2 But it can also be a side effect of Parkinson’s medication,2 particularly anticholinergics (such as Disipal, Arpicolin, and Broflex).5
Blurred vision may happen when you start taking anticholinergic drugs and may improve with time as your body gets used to the medication.5

But it can also happen after you’ve been taking the drugs for a long time or when an adjustment has been made to the dosage. If blurred vision continues or gets worse, consult your GP, specialist or Parkinson’s nurse. Don’t stop taking your medication before seeking advice.

If you wear reading glasses you may find it helpful to visit your optometrist. A slight change to your prescription might improve blurred vision.
Find out more: see our booklet Drug treatment for Parkinson’s.

Double Vision
Doe visionuble vision is seeing two images of a single object some or all of the time. The two images may be one on top of the other, side by side, or a mix of both.6 This is also often caused by problems moving the eyes.2 Some people with Parkinson’s experience ‘tracking’.

This is when the eyes do not move smoothly across a line or from one object to another, for example moving across a page when reading, or up and down.2 Poor co-ordination and fatigue of the muscles that move the eyeballs can mean that the eyes do not quite move together.2 This can cause double vision.2

There are also causes of double vision (a common and usually minor eye condition) that are nothing to do with having Parkinson’s, such as thyroid problems, diabetes, or an astigmatism in one eye.7 If the problem continues, see your optometrist for advice. or ask your GP or specialist if you can be referred to an ophthalmologist for further tests. Slight changes in your glasses prescription may also help with this.

Dry eyes
People with Parkinson’s may blink less often than other people.2 Blinking helps to clean the eyes by removing dust and dirt. If you blink less often these can build up, making the eyes dry or sore. Dry eyes can have other causes, so see your optometrist for advice.8 They may suggest you try artificial tears. These are available from pharmacies and may help reduce discomfort and dryness.9

“My wife has been having problems for some time with her eyes after taking her medication.
At last I can put a name to the problem. It’s called ‘blepharospasm’. This is a side effect of the medication but quite rare.” Graham, a carer for his wife who has Parkinson’s

Involuntary closure of the eyelids (blepharospasm)
Blepharospasm occurs when the muscle that closes the eyelid contracts or goes into spasm. This can cause repeated twitching of the eyelid or difficulty in keeping the eyelid open. Sometimes the eyelid may close completely.10

The cause and treatment of blepharospasm are complex because levodopa, one of the main drugs used to treat Parkinson’s, may cause it,2 but on other occasions these drugs can help to improve it.11 In mild cases, simply rubbing the eyelids may help. Sometimes, injections of botulinum toxin (botox) are used to treat blepharospasm.10

Blepharospasm is more common in parkinsonism than Parkinson’s.12 Your GP, specialist, or Parkinson’s nurse can offer you more advice.

“I often think I see someone or a dark shadow out of the corner of my eye and experience flashes and pulsing of light in low light conditions. This has been confirmed by my ophthalmologist as an optic nerve problem due to Parkinson’s.” JC, diagnosed in 2006

Hallucinations
Some people with Parkinson’s may have visual hallucinations.3 This is where they see things that aren’t there, such as flickering lights, objects, people or animals.2 It is more common in those who have had Parkinson’s for a long time.2 It may be partly due to Parkinson’s itself and partly to the medication that is used to treat it.2 Older people and those with memory (cognitive) problems are more likely to have hallucinations.13

If you are experiencing visual disturbances, your specialist may suggest reducing or changing your Parkinson’s medication.3 If the hallucinations keep happening there are other treatments that can help.

If you’re experiencing hallucinations, it is important to rule out causes other than Parkinson’s, such as poor eyesight or bad lighting. The sudden onset of hallucinations may also be due to an infection or other illness.3 Speak to your healthcare professional if you are having hallucinations.
Find out more: see our information sheet Hallucinations and delusions in Parkinson’s.


Other visual issues
Problems with low light levels (contrast sensitivity)
You may find that it difficult to see in low light levels.2 You may also be unable to make out the shape of things clearly, such as a light-coloured object on a light background. This may also affect your ability to read fine print.

Colour vision
Some people with Parkinson’s may have difficulty telling the difference between some colours.2 This problem may be worse for shades of blue or blue/green. Your colour vision may improve with Parkinson’s medication.

Spatial awareness
Some people with Parkinson’s may have difficulty judging the space around them.2 They may not be able to judge the distance between objects, and may have problems when walking past objects2 or getting through a narrow space.14 Sometimes reaching out to touch the sides of doorways or other objects may help. An occupational therapist may be able to help with advice about organising your home or work space to help you manage this problem. Speak to your GP, specialist and Parkinson’s nurse about a referral.

Problems with spatial awareness can affect driving as well as walking so you may have to give up driving. You must tell DVLA if you’ve got any problem with your eyesight that affects both of your eyes, or the remaining eye if you only have one eye. For more information visit gov.uk/driving-eyesight-rules or call 0300 790 6806. You can also speak to your health professional for advice.
Find out more: see our booklet Driving and Parkinson’s and information sheet Occupational therapy and Parkinson’s.

Seeing movement
Some people with Parkinson’s don’t see movement accurately,2 and seem unable to judge
the speed of moving objects such as traffic. If you experience this problem, try to take extra care when crossing roads or when driving. Speak to your health professional for advice.
Problems with glasses

If you have Parkinson’s, your posture may become stooped.15 This can cause problems if you wear glasses. If you often lean forward, then you might find that you end up looking over your frames instead, or your glasses may slip down.
Your optician should be able to help you adjust your frames and lenses to suit your posture.

Glaucoma and Parkinson’s medication

Glaucoma is a type of eye disease that damages the optic nerve, which, if untreated, can lead to loss of sight.16 If you have glaucoma you may have problems with some Parkinson’s medications, such as anticholinergic drugs and levodopa.17,18

‘Open-angle’ glaucoma is the most common type of glaucoma. It is called ‘open-angle’ because the angle between the iris and the cornea is open.16 If you have open-angle glaucoma there may be risks when using anticholinergic drugs.19 Where there is no other option you should discuss the advantages and disadvantages of using them with an ophthalmologist or a Parkinson’s specialist, so that you can make a decision together about whether they’re the right treatment for you.

Anticholinergic drugs are not recommended for people who have the less common, closed-angle glaucoma,20 and levodopa (Sinemet and Madopar) should only be used with caution.21, 22
Some dopamine agonists can have side effects that affect the eyes. For instance, rotigotine23 is not recommended for people who have closed-angle glaucoma. Yearly eye check-ups are recommended if you are using these drugs.

It is helpful if your Parkinson’s specialist and the ophthalmologist can work together when prescribing medication for you if you have glaucoma. So, if you have this condition, always tell your GP, specialist or Parkinson’s nurse.
Find out more: see our booklet Drug treatments for Parkinson’s.

More information and support

Look after your eyes
This website has been set up for the general public by the College of Optometrists. They have developed a set of patient information leaflets to give straightforward advice about some common eye problems. You can also search for optometrists in your local area.
www.lookafteryoureyes.org
Royal College of Ophthalmologists
An independent professional body that sets the standards and examinations for medical doctors aiming to become ophthalmologists, and provides surgical skills training.
020 7935 0702
www.rcophth.ac.uk
College of Optometrists
The professional, scientific and examining body for optometry in the United Kingdom.
020 7839 6000
www.college-optometrists.org

Parkinson’s nurses
Parkinson’s nurses provide expert advice and support to people with Parkinson’s and those who care for them. They can also make contact with other health and social care professionals to make sure your needs are met.
The role of the Parkinson’s nurse varies. Each will offer different services, aiming to meet local needs. Some nurses are based in the community, whereas others are based in hospital settings.
Many Parkinson’s nurses are independent prescribers. This means they can prescribe and make adjustments to medication, so someone with Parkinson’s doesn’t always need to see their specialist for changes to or queries about their Parkinson’s drugs.
Parkinson’s nurses may not be available in every area, but your GP or specialist can give you more details on local services.
You can find out more at parkinsons.org.uk/nurses

Information and support from Parkinson’s UK


You can call our free confidential helpline for general support and information. Call 0808 800 0303 (calls are free from UK landlines and most mobile networks) or email hello@parkinsons.org.uk. We run a peer support service if you’d like to talk on the phone with someone affected by Parkinson’s who has faced similar issues to you. The service is free and confidential – ring the helpline to talk to someone about being matched with a volunteer.

Our helpline can also put you in touch with one of our local information and support workers, who give one-to-one information and support to anyone affected by Parkinson’s. They can also provide links to local groups and services.

We also have self-management programme for people with Parkinson’s, partners and carers. It is an opportunity to reflect on life with the condition, learn about self-management and think about the future. To find out if there is a group near you visit parkinsons.org.uk/selfmanagement

Our website parkinsons.org.uk has a lot of information about Parkinson’s and everyday life with the condition. You can also find details of your local support team and your nearest local group meeting at parkinsons.org.uk/localtoyou

You can also visit parkinsons.org.uk/forum to speak with other people in a similar situation on our online discussion forum.







Elderly and driving

After the news in the media during the last few days, I think it's time that elderly people had their eyes etc tested on a regular basis...