Objective: Examine multiple aspects of visual functions in PD patients divided into subgroups by stage of disease to establish: the evidence of visual disorders, their impact on QOL, the benefit of a diagnostic protocol specifically developed

Background: There are many known alterations with almost all visual functions in PD [1-3]. Despite many visual alterations negatively affect motor function and QOL, these are overlooked [4]. Furthermore, to date, there is no specific diagnostic protocol for visual disorders in PD

Method: 60 PD patients and 60 health subjects. PD patients are evaluated by the UPDRS part I-II-III-IV.
PDQ-39 and Visual Function Questionnaire 25 (VFQ-25) [5] are used to assess QOL. Subjects undergo an extended visual assessment

Results: Among PD patients VFQ-25 negatively correlate with UPDRS-I (r=-0.62, p< 0.001), UPDRS-II (r=-0.66, p<0.001), UPDRS-III (r=-0.59, p<0.001) and PDQ-39 summary index (r=-0.70, p<0.001). Patients with impaired chromatic sense showed a higher disease duration (p=0.008), a worse score of UPDRS-III (p=0.0009) and PDQ-39 SI (p=0.02). Patients with altered smooth pursuit have worse UPDRS-III (p=0.004); those with altered saccades show higher disease duration (p=0.04) and worse UPDRS-III (p=0.03). Dividing patients by H&Y stages, we found significant difference in VFQ-25, fusional amplitudes, ganglion cell layer thickness (GCL): VFQ-25 H&Y 1 (82.04 ± 9.29), H&Y 2 (81.81 ± 13.46), H&Y 3 (63.47 ± 17.76) (p=0.03); fusional amplitude H&Y 1 (7.00 ± 4.41), H&Y 2 (6.67 ± 3.05), H&Y 3 (4.33 ± 1.97) (p=0.03); GCL H&Y 1( 50.17 ± 6.05) H&Y 2 (46.80 ± 4.83), H&Y 3 (43.80 ± 3.83) (p=0.04). PD patients significantly differed from controls in VFQ-25 (p<0.001), contrast sensitivity (p=0.0003), near point of convergence (p<0.001), fusional amplitudes range (p<0.001), Schirmer Tear Test (p=0.01) and Outer Retinal Layer ORL (p < 0.05) and Ganglion Cell Layer GCL (p < 0.05)

Conclusion: Some alterations begin already in the initial stages of disease, starting with the reduction of fusional amplitudes [6], a completely novel feature to date. The VFQ-25 seems to be sensitive for visual impairments in PD demonstrating how vision can worsen the QOL. The application of a specific protocol for PD allows the identification of visual dysfunctions, becoming a potential support both for identifying specific clinical phenotypes and to carry out appropriate treatments for the improvement of QOL

References: 1. Archibald NK, Clarke MP, Mosimann UP, Burn DJ. Visual symptoms in Parkinson’s disease and Parkinson’s disease dementia. Mov Disord. 2011 Nov;26(13):2387-95
2. Weil RS, Schrag AE, Warren JD, Crutch SJ, Lees AJ, Morris HR. Visual dysfunction in Parkinson’s disease. Brain. 2016 Nov 1;139(11):2827-2843
3. Huang L, Zhang D, Ji J, Wang Y, Zhang R. Central retina changes in Parkinson’s disease: a systematic review and meta-analysis. J Neurol. 2021 Dec;268(12):4646-4654
4. Ekker MS, Janssen S, Seppi K, Poewe W, de Vries NM, Theelen T, Nonnekes J, Bloem BR. Ocular and visual disorders in Parkinson’s disease: Common but frequently overlooked. Parkinsonism Relat Disord. 2017 Jul;40:1-10
5. Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD; National Eye Institute Visual Function Questionnaire Field Test Investigators. Development of the 25-item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol. 2001 Jul;119(7):1050-8
6. Lança CC, Rowe FJ. Measurement of fusional vergence: a systematic review. Strabismus. 2019 Jun;27(2):88-113

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