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Observational Study
. 2022 Jul;269(7):3821-3832.
doi: 10.1007/s00415-022-11014-0. Epub 2022 Mar 9.

Undetected ophthalmological disorders in Parkinson's disease

Carlijn D J M Borm  1 , Mario Werkmann  2 , Debbie de Graaf  3 , Femke Visser  4 , Arno Hofer  2 , Marina Peball  2 , Katarzyna Smilowska  3 , Diana Putz  5 , Klaus Seppi  2 , Werner Poewe  2 , Carel Hoyng  6 , Bastiaan R Bloem  3 , Thomas Theelen  6 , Nienke M de Vries  3
Affiliations
Observational Study

Undetected ophthalmological disorders in Parkinson's disease

Carlijn D J M Borm et al. J Neurol. 2022 Jul.

Abstract

Background: Ophthalmological disorders are common and frequently disabling for people with Parkinson's disease (PD). However, details on the prevalence, severity and impact of ophthalmological disorders thus far lacking. We aimed to identify PD patients with undetected ophthalmological disorders in a large cross-sectional, observational study.

Methods: We previously delivered a screening questionnaire to detect ophthalmological symptoms (Visual impairment in PD questionnaire; VIPD-Q) to 848 patients. Here, we report on a subgroup of 102 patients who received complete ophthalmological assessment aimed at identifying clinically relevant ophthalmological diseases, which were classified as either vison-threatening or not. Impact on daily life functioning was measured using the visual functioning-25 questionnaire (VFQ-25) and fall frequency.

Results: Almost all patients (92%) had one or more clinically relevant ophthalmological disorders. Of those, 77% had a potentially vision-threatening disease, while 34% had a potentially treatable ophthalmological disease which impacted on quality of life. The most prevalent ophthalmological disorders were dry eyes (86%), ocular misalignment (50%) and convergence insufficiency (41%). We found a weak but significant association between clinically relevant ophthalmological diseases and both fall frequency (R2 = 0.15, p = 0.037) and VFQ-25 score (R2 = 0.15, p = 0.02). The VIPD-Q could not correctly identify patients with relevant ophthalmological disorders.

Conclusions: Surprisingly, in our study sample, many participants manifested previously undetected ophthalmological diseases, most of which threatened vision, impacted on daily life functioning and were amenable to treatment. Screening for these ophthalmological disorders using a questionnaire asking about symptoms seems insufficient. Instead, episodic ophthalmological assessments should be considered for PD patients, aiming to identify vision-threatening yet treatable diseases.

Trial registration: Dutch Trial Registration, NL7421.

Keywords: Non-motor symptoms; Ophthalmological disorders; Ophthalmology; Parkinson’s disease; Visual impairment.

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Conflict of interest statement

Drs. Borm: reports no disclosures. Drs. Werkmann: reports no disclosures. Drs. De Graaf: reports no disclosures. Drs. Visser: reports no disclosures. A. Hofer: reports no disclosures. Drs. Peball: is an employee of the Medical University Innsbruck and reports travel grants from the International Parkinson’s disease and Movement Disorder Society and the Austrian Parkinson’s Disease Society. Dr. Smilowska: reports research fellowship from European Academy of Neurology. Dr. Putz: reports no disclosures. Prof. Seppi: reports personal fees from Teva, UCB, Lundbeck, AOP Orphan Pharmaceuticals AG, Roche, Grünenthal and Abbvie, honoraria from the International Parkinson and Movement Disorders Society, research grants from FWF Austrian Science Fund, Michael J. Fox Foundation, and International Parkinson and Movement Disorder Society, outside the submitted work. Prof. Poewe: reports no disclosures. Prof. Hoyng: reports no disclosures. Prof. Bloem: Dr Bloem reports grants from the Michael J. Fox Foundation, ZonMw, Stichting Parkinson Nederland, Parkinson Vereniging, Hersenstichting Nederland, Parkinson’s Foundation, Verily Life Sciences, Horizon 2020, and Topsector Life Sciences and Health; grants and personal fees from UCB; and personal fees from Abbvie, Bial, and Zambon, outside the submitted work. Dr. Theelen: reports no disclosures. Dr. De Vries: reports grants from ZonMw and The Michael J Fox Foundation. No other disclosures were reported.

Figures

Fig. 1
Fig. 1
Flowchart of the number of patients with PD and ophthalmological diseases. N = number of PD patients
Fig. 2
Fig. 2
Impact of ophthalmological diseases. A Impact of clinically relevant ophthalmological diseases (grade moderate to severe) on the visual functioning-25 questionnaire (VFQ-25). A total score of 100 on the VFQ-25 indicates perfect functioning in daily life, lower scores relate to impaired function due to ophthalmological symptoms. Shown here is a decrease in the VFQ-25 total score with an increase in ophthalmological diseases. B The impact of ophthalmological diseases on the frequency of falls in the last half year. Patients tend to fall more often with an increased number of clinically relevant ophthalmological diseases
See this image and copyright information in PMC

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