Prakinsons disease and its affect on eye.

Enhance your knowledge about Parkinsons' disease and about basic concept that medical personnel should know regarding this topic.It is very important to know about systemic disease and its impact on the eye so, here you can learn quickly about Parkinson's disease and its ocular manifestation.Download the ppt for visualization of animation.Thank you.

1. PARKINSONS DISEASE RIYA BIST BOPTM HIMALAYA EYE INSTITUTE,(PU) 6th SEMESTER

2. CONTENTS INTRODUCTION TYPES PATHOPHYSIOLOGY SIGNS /SYMPTOMS STAGES RISK FACTOR DIAGNOSTGIC TEST TREATMENT OCULAER MENIFISTATION ROLE AS AN OPTOMETRIST

3. 03 Parkinson's disease is a progressive neurodegenerative condition that affects the nervous system and the parts of the body controlled by the nerves. Parkinson disease (PD) causes problems with movement, mental health, sleep, pain and other health issues. INTRODUCTION Parkinson’s disease is an age-related neurological condition which affects the brain’s ability to produce dopamine – the chemical which helps us control movement . The disease usually occurs in older people, but younger people can also be affected. Men are affected more often than women.

4. 04 Parkinson’s disease (PD) is a chronic, progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement ( bradykinesia ), increased muscle tone (rigidity), tremor at rest, and gait changes.

5. 05 Primary PD :. This is the most common type of Parkinson’s disease and usually affects people over the age of 60. It is caused by the gradual loss of brain cells that create dopamine, which aids with movement control Dementia associated with Parkinson’s: This type of Parkinson’s occurs when dementia-like symptoms appear along with other motor symptoms such as tremor and slow movements. TYPES

6. Atypical PD: This form of Parkinson’s affects younger people (under 40) and has different symptoms than primary or dementia-associated forms of the disorder like d ifficulty in speaking or swallowing and drolling . Multiple System Atrophy (MSA): This rare form of atypical PD affects many systems in the body including movement but also disrupts autonomic functions like breathing or heart rate regulation as well as cognitive functions such as memory . 06

7. 07 PATHOPHYSIOLOGY

8. 08

9. 09 MOTOR SYMPTOMS RESTING TREMOR BRADYKINESIA MUSCLE RIGIDITY POSTURAL INSTABILITY GAIT INSTABILITY HYPOMIMIA(lack of facial expression) NON-MOTOR SYMPTOMS GASTRO-INTESTINAL SYMPTOMS(CONSTIPATION,DYSFAGIA(swallowing difficulty)) HYPOSMIA(decreased sense of smell) UNINTENSIONAL WEIGHT LOSS PYSCHIATRIC SYMPTOMS(MOOD DISORDERS,HALLUCINATIONS,PSYCHOSIS) URINARY AND SEXUAL DYSFUNCTIONS CIRCADIAN RHYTHM DISORDER PARKINSON DISEASE SIGNS AND SYMPTOMS

10. STAGES OF PARKINSONS DISEASE Stage 1 During the initial stages, the symptoms are not typically severe. A person can perform everyday tasks with minimal difficulty. Some signs and symptoms of this stage include changes in:tremors , (usually on one side of the body than the other), posture,facial expressions and walking difficulty. Stage 2 Tremors, trembling, and stiffness affect both sides of the body and become more noticeable. As stiffness increases, the person may find that daily tasks are harder to carry out and take longer than before. Walking, speech, and posture problems are often more noticeable in stage 2 of Parkinson’s disease. 10

11. Stage 3 During stage 3, a person will experience most or all of the symptoms of stage 2 plus some others, including:problems with balances,low movements,slow reflexes There is also a higher risk of falling due to coordination problems. Dressing and other self-care tasks may become more difficult. Medication and occupational or physical therapy may help people manage the symptoms and daily living. Stage 4 At stage 4, daily activities become even more challenging. A person will likely need some form of daily care, as independent living is not usually possible. The person may be able to stand on their own but require a walker or another assistive device to walk. 11

12. Stage 5 At stage 5, a person may not be able to stand or move around due to stiffness. Depending on their age and overall health, they may need a wheelchair for mobility. The individual will need constant care to carry out daily activities and protect them from hazards, such as falling. The person may also experience : dementia,confusion,a reduced response to medication 12

13. 13 Several environmental factors may increase the risk of developing Parkinson’s disease. These include : Past traumatic brain injury Toxin exposure: Such as pesticides, solvents, metals, and other pollutants. Gender: Males are 50% more likely to develop the condition than females Age: The condition often appears from the ages of 60 years. Some drugs and medications Family history : Having one or more close reletives with this disease increases the risk. RISK FACTORS Idiopathic

14. 14 Blood tests (these can help rule out other forms of parkinsonism). Computed tomography (CT) scan. Genetic testing. Magnetic resonance imaging (MRI). Positron emission tomography (PET) scan. DIAGNOSTIC TEST

15. 15 Treatments for Parkinson’s disease Although there is no cure for Parkinson’s disease, medicines, surgical treatment, and other therapies can often relieve some symptoms . Medications: A person can take medications to increase their dopamine levels and control non-motor symptoms. The main medication to treat Parkinson’s disease is levodopa . A doctor may also prescribe carbidopa to prevent or reduce some of the side effects of levodopa . Deep brain stimulation (DBS ): A doctor may suggest DBS if medications prove ineffective. During a surgical procedure, a doctor implants electrodes into part of the brain and connects them to a small electrical device implanted in the chest.This painlessly stimulates the areas of the brain that control movement. Therapies: A person with Parkinson’s disease may benefit from: physical therapy occupational therapy speech therapy massage therapy

16. Dopamine agonists to stimulate the production of dopamine in the brain Enzyme inhibitors to increase the amount of dopamine by slowing down the enzymes that break down dopamine in the brain Amantadine to help reduce involuntary movements Anticholinergic drugs to reduce tremors and muscle rigidity A person should aim to eat a nutritious diet and exercise regularly. They may also benefit from practicing yoga and tai chi to increase their flexibility. Other medications are also given : 16

17. Ocular manifestation Eyelids : Blepharospasm : Involuntary, sustained, and forceful closure of the eyelids, which can cause significant discomfort and impair vision. Decreased blink rate: Reduced spontaneous blinking, which can lead to dry eyes and discomfort. Apraxia of eyelid opening:  where patient can close the eyes voluntarily but can Not open them back. This can be overcome by opening the eye mechanically with the fingers Pupils: Pupillary light reflex abnormalities: Delayed or impaired pupillary response to light, which can affect visual acuity and contrast sensitivity. 17

18. Ocular motility : Ophthalmoparesis : Weakness or paralysis of the extraocular muscles, resulting in impaired eye movements and double vision. Impaired smooth pursuit and saccadic eye movements: Difficulties in smoothly following moving objects or quickly shifting gaze. convergence insufficiency Tear production: Decreased tear production: Reduced tear secretion, leading to dry eyes and increased risk of corneal complications. Cornea : Corneal sensitivity reduction: Decreased corneal sensation, which can increase the risk of corneal abrasions and infections. . 18

19. Lens: Cataract formation: Accelerated development of cataracts, which can impair vision and require surgical intervention. Retina : Visual contrast sensitivity reduction: Decreased ability to detect differences in contrast, affecting visual perception and depth perception. Color vision impairment : Difficulties in distinguishing between certain colors, particularly in the blue-yellow range. Visual processing: Visual hallucinations: Parkinson's disease can sometimes be associated with complex visual hallucinations, which can be distressing for patients. Impaired visuospatial function: Difficulties in perceiving spatial relationships, judging distances, and navigating through environments. 19

20. ROLE AS AN OPTOMETRIST Optometrists play an important role in managing certain vision-related symptoms and complications associated with Parkinson's disease (PD). visual impairments: Optometrists can diagnose and monitor these visual problems, and provide appropriate treatments or vision aids to help improve the patient's quality of life. Eye movement disorders: PD can affect the smooth pursuit and saccadic eye movements, leading to difficulties in tracking moving objects or quickly shifting gaze. Optometrists can assess these eye movement abnormalities and recommend exercises or strategies to manage them. Blepharospasm and apraxia : Optometrists can provide treatments such as botulinum toxin injections manage this condition. 20

21. Reading difficulties: Optometrists can recommend low-vision aids, prism glasses, or other assistive devices to help with reading and near-vision tasks. Monitoring disease progression: Regular eye examinations by optometrists can help monitor the progression of PD by assessing changes in visual function, eye movements, and ocular health over time. Dry eye and blepharitis can be treated with topical tears and ointments, topical anti-inflammatory drops, ocular lubricants, oral fish oil, oral medications and lid hygiene . Patients with PD might benefit from separate sets of glasses (as opposed to bifocal or progressive lenses) for different distances (e.g., reading, the computer, and distance). The bradykinesia of PD is manifest in the eye movements as well, leading to difficulty in transitioning between the different lens areas, so bifocals and progressive lenses may be difficult to use in PD. 21

22. In addition, their PD postural changes (e.g., chin down) may position their gaze through the upper segment of the bifocal lens. This may increase the risk of falls because they are unable to focus at distance to see the floor and may not be able to avoid obstacles in their path. Prisms may be added to reading glasses to help with convergence insufficiency. Impairments in color vision and contrast sensitivity can be corrected with levodopa . 22

23. Co-ordination with other health workers: Visual hallucinations may be related to the underlying disease or to medications. Consider working with the patient’s neurologist to adjust dopaminergic medications, if possible. Support groups:While the progression of Parkinson’s ,Activities such as working, taking care of a home, and participating in social activities with friends may become challenging. Experiencing these changes can be difficult, but support groups can help people cope. These groups can provide information, advice, and connections to resources for those living with Parkinson’s disease, their families, and caregivers. 23

24. 24 https://my.clevelandclinic.org/health/diseases/8525-parkinsons-disease-an-overview https://www.nia.nih.gov/health/parkinsons-disease/parkinsons-disease-causes-symptoms-and-treatments https://www.medicalnewstoday.com/articles/323396 https://www.atrainceu.com/content/2-pathophysiology-parkinson%E2%80%99s-disease REFRENCES https://eyewiki.aao.org/Visual_Symptoms_of_Parkinson%E2%80%99s_Disease

25. THANK YOU