February Meeting Notes–The Effects of Parkinson’s on Vision

We welcomed Neuro-Development Optometrist, Dr. John W. Dresely, Jr., as our guest speaker at our February 5th meeting. He used to see mostly children in his practice, but increasingly sees more adults with brain injuries, strokes, and neurological diseases such as Parkinson’s. Anything that affects brain function usually affects vision in some way.

Parkinson’s disease can affect vision in many ways: dry eyes (Parkinson’s inhibits the blink reflex and we blink less); blepharitis (a red, itchy, crusty inflammation of the eyelids); reduced color vision (especially blues and yellows); spasms or weakness of the eyelids; double vision (about 74% of people with Parkinson’s experience this, although double vision may come and go, and not affect them all the time); blurred vision; difficulty shifting focus between close and far away objects; and problems with eye-hand coordination.

Dr. Dresely talked about the myth of 20/20 vision. Most vision problems go undetected because most people think 20/20 means perfect. All it means is that a person standing a testing distance of 20 feet can see the smallest size letters on a chart that most people can see from that distance. Since one eye is visually tested at a time, the test doesn’t show if the eyes do or do not work together.

To differentiate, opticians make prescription eyeglasses. Ophthalmologists are medical doctors trained as eye surgeons who also treat eye diseases. Optometrists also diagnose and treat eye diseases, but they don’t do surgery. Their emphasis is on vision correction. As a Neuro-Developmental Optometrist, Dr. Dresely looks at functional vision–how does vision affect someone’s life and how can he make it better.

Muscles around the eyes adjust the lens. When the muscles loosen, we see far away; when the muscles tighten, we see up close. Optometrists look at the physical health of the eyes and how they focus light. If the eye focuses light in front of the retina, for example, a person is nearsighted and optical devices (eye glasses) are prescribed to adjust the image to fall on the retina.

The rods and cones of the eyes are a part of the brain. A stroke on one side of the brain can affect vision on the other side of the eyes. The brain processes and interprets what we see. How close or far away an object is (depth perception). Whether it is moving or still. Its color, shape, and form. This is all a part of initial visual processing at the back of the brain, or the brain stem, which provides visual support.

Visual information is then processed in different areas of the brain, including the part responsible for balance and motor control. Vision is the guidance system for movement. The visual and motor systems of the body are closely tied together. When the visual system is impacted, it affects standing, walking, and balance. If both eyes don’t work together, it affects 3-D depth perception. If the eyes don’t line up correctly or point to the same place, it can cause double vision (slowing down activities like reading and making them less enjoyable).

Neuro-developmental optometrists can help! They can treat dry eyes and prescribe eyelid hygiene for blepharitis. They can determine what type of eye glasses may be needed, either compensating lenses for visual acuity problems like near-sightedness and astigmatism, or functional lenses to improve functions like balance and gait or to help both eyes work together. Walking in crowds can be visually distracting for some people or provide too much visual information from overloading peripheral or distance vision. Dr. Dresely has had success inserting narrow blinders on the inside of glasses to block peripheral vision.

Vision therapy works to retrain the brain to use the eyes in a more efficient way. Dr. Dresely generally works with an 8 week training session, once-a-week at his office and a home exercise program. Four to six months is the typical training time. About 20% of insurance policies cover visual therapy.

In response to questions:

Dr. Dresely said to consider cataract surgery when you can no longer do the things you enjoy doing. The resultant visual acuity can also improve other symptoms. Driving in the rain at night is difficult for some people due to light reflecting off water, not just lane markers. Cataracts can increase glare off oncoming headlights as well due to light sensitivity.

Glaucoma results from too much pressure from the vitria (water in the eye). Eyes are always producing new fluid and draining off the old fluid. There are two causes–either more water coming in or a plugged up drainage system–and different treatments for each.

Dr. Dresely recommends eye vitamins after age 50 if you have a family history of macular degeneration. He prefers Ocuvite. There are also eye vitamins from a few smaller companies he likes even better.

Dr. Dresely’s office is located in Chantilly at 14121 Robert Paris Court. He can be reached at 703-657-3245 and his website is visioncareforyou.com. Attached is the vision self-assessment he has patients fill out at their first appointment: VisionSymptomSurvey (PDF)



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