Session: Free papers Session VIII - Graves & Neurologic disease

Binocular vision problems in Parkinson’s disease Patients: How can we help?

Objective: To describe the binocular complains, the examinations and the possible therapy to improve binocular vision in patients with Parkinson’s disease.



Material and Methods: Forty elderly patients, age 64 to 82, with Parkinson’s disease who underwent a complete motility and orthoptic examination were included in this prospective study. Ocular alignment, fusion amplitudes, stereopsis, convergence, horizontal and vertical eye movements were evaluated.



Results: Near exodeviation varied from 2 prism dioptres (PD) exophoria (X’) to 30 PD exotropia (XT’) with a median angle of 13 PD X’. At distance fixation, the deviation ranged from 4 PD esophoria (E) to 18 PD exotropia (XT) with a median angle of 5 PD exophoria (X). Convergence fusional amplitude at near ranged from 0 to 20 PD (mean 9.2 PD) and from 0 to 16 PD (mean 5.6 PD) at distance. Divergence fusional amplitude at near ranged from 4 PD to 18 PD (mean 11 PD) and from 2 to 16 PD (mean 8.5 PD) at distance. Stereopsis was reduced or absent is 72% of the patients. Convergence was limited from 10 cm to 50 cm (mean 22.5 cm). Saccadic smooth pursuit movements were seen in about 40% of the patients especially in horizontal gaze, followed by slow saccades and reduced elevation. All patients were treated with blinking exercises and convergence/fusion exercises, horizontal prisms were given in the reading glasses (2 to 16 PD Base In, mean 4.7 PD Base In), in distance glasses (4PD Base Out to 16 PD Base In, mean 2.2 PD Base In) and 5 patients needed vertical prisms in both reading and distance glasses (2 to 8 PD, mean 5 PD).

 

Conclusion: Patients with Parkinson’s disease complain especially about near problems often associated with double vison due to convergence insufficiency and reduced fusion amplitudes. Patients with Parkinson’s disease can be helped with blinking exercises, convergence and fusion exercises and two pairs of prism glasses instead of multifocal glasses.