Dept. of Ophthalmology; University of California, Irvine
Cedars Sinai Medical Center, Los Angeles
T
E
P
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/PSP D
Swaraj Bose, M.D. sbose@uci.edu
May 18, 2012

Summary:
 Visual disturbances and eye changes including problems with eye movements are commonly seen in patients with Parkinson’s/PSP/Atypical Parkinson’s
 Visual complaints are usually distortion or blurry vision, near vision problems, color vision abnormalities and even visual hallucinations
 Eye movement abnormalities include: difficulty in convergence (bringing the eyes together while reading), lack of vertical movement of eyes (upward /downward gaze abnormality) and slow eye movements (saccade and pursuit) and eye movement asymmetry
 Other problems include a decrease in blinking of eyelids, difficulty in opening the eyelids, dry eyes and lack of facial expression
 These eye conditions, if diagnosed early in the course of the disease, can be treated and managed by an ophthalmologist or a neuro-ophthalmologist
 Simple measures used in visual rehabilitation + medications given by the movement disorders’ neurologist + supportive care: can significantly alter the
quality of life of patients with these conditions.
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Common Eye Complaints:
 Related to disturbances of down-gaze (PSP)- o Difficulty in coordinating eye movements while reading even if their vision is normal, especially through their bifocal glasses o Difficulty in eating because they cannot look down at their food on the plate o Difficulty in going downstairs and stepping off curbs
 Related to lack of convergence/ fast and slow tracking- o Difficulty in focusing, words run into each other o Hard to shift down to the beginning of the next line automatically after reaching the end of the first line o Inability to quickly move eyes up or down o Inability to track moving objects or maintain eye contact o Double vision
 Related to vision disturbances- o Difficulty in focusing/ blurry vision/ visual hallucinations o Change of reading glasses at a quicker intervals o Decrease in contrast sensitivity (difficulty in distinguishing shades of gray) and color perception
 Eyelid abnormality o Difficulty in voluntarily opening their eyes (apraxia) o Forceful eyelid closing (blepharospasm, Rx: Botox ) o Decrease in the rate of blinking (3-4/min vs. 20/m)
 Dry eyes o Burning sensation, redness, watering, itching, excessive tearing, rubbing of eyes, blurry vision, o Double vision with one eye- usually result in ‘ghosting’ of images or shadowing of images
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Treatment: A multi disciplinary approach
 Diagnosis of the movement disorder is important – this will determine the course , manifestations and outcome
 Communication with neurologist, neuro-ophthalmologist, rehabilitation personnel, nurses, therapists, care givers, neuropsychiatrists & primary care physicians is - VITAL
 Record a thorough history
 Set realistic goals
 A thorough eye examination should include- o Best corrected for distance/near vision o Color vision o Visual field examination o Detailed record of eye movements in all directions o Prism measurements and correction o Evaluation of eye surface including dry eyes o Eyelid evaluation o Convergence estimation o Retina and Optic nerve evaluation
 Prescribe glasses for distance and near
 Optimize eye movement problems by exercises, prisms and rehabilitation
 Treat dry eyes and other associated eye conditions
 Alter/Re-design equipment for reading (lighting, position), position of book and food (at eye level), devices/support for walking and stepping down stairs to prevent falls (safety)
 Take medications regularly/ watch for side effects
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Living and Seeing well with PSP:
 Safety begins at home- o Rooms/hallways free of clutter o Remove cords/rugs from floor o All rooms well lit, night lights along hall ways o Install grab bars in shower, stairs to prevent falls o Cane, walker, wheel chair
 Proper reading lights (from left and behind)
 Reading material- books/newspapers at eye level (use piano reading stand)
 Place food at patients’ eye level, raise table, small platform
 Get correct glasses prescription filled
 Use separate glasses for reading and distance
 Use lubricating eye drops like Systane or Refresh during the day and a gel (Genteal gel ointment) at bed time.
 Regular eye exercises (when prescribed), body and breathing exercises
 Take medications regularly
 Visual hallucinations- can be a side effect of medications
 Driving can be tricky, speak with your eye doctor
 Keep yourself engaged with some creative activities/projects
 Regular follow up with neurologist and neuroophthalmologist
 Join a support group
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Notes Page:
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Thanks.
Swaraj Bose, MD
Director, Neuro-Ophthalmology; Orbital Surgery
Associate Professor of Ophthalmology & Neurology
University of California, Irvine sbose@uci.edu
Offices:
1.
1 Medical Plaza Dr. Gottschalk Medical Plaza, UCI, Irvine, Ca 92697
2.
101 The City Dr., Pavilion II, UCI Medical Center, Orange, CA
Appointments: 949 824 2020
3.
Cedars Sinai Medical Towers, 8635 W, 3 rd Street, Ste # 390W, Los Angeles, CA
Appointments: 310 652 1133
Eye & PSP/ S. Bose Page 6