Femke Visser1, Annemarie M M Vlaar2, Carlijn D J M Borm3, Valentin Apostolov4, Y X Lee5, Irene C Notting6, Henry C Weinstein2,7, Henk W Berendse7. 1. Department of Neurology, Onze Lieve Vrouwe Gasthuis (OLVG), Location OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. visser.femke@gmail.com. 2. Department of Neurology, Onze Lieve Vrouwe Gasthuis (OLVG), Location OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. 3. Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Parkinson Centre (ParC), Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. 4. Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis (OLVG), Location OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. 5. Department of Neurology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands. 6. Department of Ophthalmology, Leids University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. 7. Department of Neurology, Amsterdam UMC, Location VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Abstract
INTRODUCTION: Approximately 20% of patients with Parkinson's disease (PD) experience diplopia; however, the cause of the diplopia is unclear. We aimed to explore the association of diplopia, and its subtypes, with oculomotor abnormalities, impaired vision, and visual hallucinations, in patients with PD. METHODS: This exploratory study included 41 PD patients, recruited from two general hospitals, of whom 25 had diplopia and 16 did not have diplopia, as well as 23 healthy controls (HCs). We defined subtypes of diplopia as selective diplopia, i.e., diplopia of single objects, and complete diplopia, i.e., diplopia of the entire visual field. All participants underwent a full orthoptic and ophthalmologic examination. RESULTS: PD patients with diplopia had a high prevalence of oculomotor abnormalities (84%), impaired vision (44%), and visual hallucinations (44%), compared to PD patients without diplopia (33%, 6%, and none, respectively, p < 0.01), and compared to HCs (23%, 9%, and none, respectively, p < 0.01). Oculomotor abnormalities were equally prevalent in both subtypes of diplopia (selective and complete), whereas impaired vision was predominantly found in patients with selective diplopia. Moreover, only patients with selective diplopia had visual hallucinations. CONCLUSIONS: In PD patients, diplopia may be indicative of oculomotor or visual impairments. Hence, it is worthwhile to refer PD patients with diplopia to an orthoptist and an ophthalmologist for evaluation and, possibly, treatment of diplopia. Furthermore, in the case of selective diplopia, the neurologist should consider the presence of visual hallucinations, which may require the adjustment of the patient's medication.
INTRODUCTION: Approximately 20% of patients with Parkinson's disease (PD) experience diplopia; however, the cause of the diplopia is unclear. We aimed to explore the association of diplopia, and its subtypes, with oculomotor abnormalities, impaired vision, and visual hallucinations, in patients with PD. METHODS: This exploratory study included 41 PDpatients, recruited from two general hospitals, of whom 25 had diplopia and 16 did not have diplopia, as well as 23 healthy controls (HCs). We defined subtypes of diplopia as selective diplopia, i.e., diplopia of single objects, and complete diplopia, i.e., diplopia of the entire visual field. All participants underwent a full orthoptic and ophthalmologic examination. RESULTS:PDpatients with diplopia had a high prevalence of oculomotor abnormalities (84%), impaired vision (44%), and visual hallucinations (44%), compared to PDpatients without diplopia (33%, 6%, and none, respectively, p < 0.01), and compared to HCs (23%, 9%, and none, respectively, p < 0.01). Oculomotor abnormalities were equally prevalent in both subtypes of diplopia (selective and complete), whereas impaired vision was predominantly found in patients with selective diplopia. Moreover, only patients with selective diplopia had visual hallucinations. CONCLUSIONS: In PDpatients, diplopia may be indicative of oculomotor or visual impairments. Hence, it is worthwhile to refer PDpatients with diplopia to an orthoptist and an ophthalmologist for evaluation and, possibly, treatment of diplopia. Furthermore, in the case of selective diplopia, the neurologist should consider the presence of visual hallucinations, which may require the adjustment of the patient's medication.
Authors: Guido Ripandelli; Fabio Scarinci; Paolo Piaggi; Gianluca Guidi; Marco Pileri; Gaetano Cupo; Maria S Sartini; Vincenzo Parisi; Sara Baldanzellu; Cristiano Giusti; Marco Nardi; Mario Stirpe; Stefano Lazzeri Journal: Retina Date: 2015-03 Impact factor: 4.256
Authors: Carlijn D J M Borm; Femke Visser; Mario Werkmann; Debbie de Graaf; Diana Putz; Klaus Seppi; Werner Poewe; Annemarie M M Vlaar; Carel Hoyng; Bastiaan R Bloem; Thomas Theelen; Nienke M de Vries Journal: Neurology Date: 2020-03-11 Impact factor: 9.910
Authors: Diego Santos García; Lucía Naya Ríos; Teresa de Deus Fonticoba; Carlos Cores Bartolomé; Lucía García Roca; Maria Feal Painceiras; Cristina Martínez Miró; Hector Canfield; Silvia Jesús; Miquel Aguilar; Pau Pastor; Marina Cosgaya; Juan García Caldentey; Nuria Caballol; Inés Legarda; Jorge Hernández Vara; Iria Cabo; Lydia López Manzanares; Isabel González Aramburu; María A Ávila Rivera; Víctor Gómez Mayordomo; Víctor Nogueira; Víctor Puente; Julio Dotor; Carmen Borrué; Berta Solano Vila; María Álvarez Sauco; Lydia Vela; Sonia Escalante; Esther Cubo; Francisco Carrillo Padilla; Juan C Martínez Castrillo; Pilar Sánchez Alonso; Maria G Alonso Losada; Nuria López Ariztegui; Itziar Gastón; Jaime Kulisevsky; Marta Blázquez Estrada; Manuel Seijo; Javier Rúiz Martínez; Caridad Valero; Mónica Kurtis; Oriol de Fábregues; Jessica González Ardura; Ruben Alonso Redondo; Carlos Ordás; Luis M López Díaz; Darrian McAfee; Pablo Martinez-Martin; Pablo Mir Journal: Diagnostics (Basel) Date: 2021-12-17