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How can the Visual System in Persons with Parkinson’s (PD) be affected?

Updated: Feb 17




Written by: Megan Kelley, PT, DPT (LSVT Big and Parkinson’s Wellness Recovery Certified Physical Therapist)

How can the Visual System in Persons with Parkinson’s (PD) be affected?

● Impaired eye movement

○ Physicians are able to order prism glasses to help compensate for the eye

not moving, and/or taking in the entire visual field.

● Loss of retinal cells that use dopamine to perceive and process color.

● Reduced blink rate or excessive blinking.

● Dyskinesia of the eyes (Abnormal or involuntary movement of the eyes).

● Hallucinations.

● Visuospatial orientation issues

○ Difficulty processing visual input can lead to visual spatial issues, which

can be seen in gait, motor coordination and activities of daily living²

○ This deficit is associated with freezing and falling, often seen in PD³

● Can also have age-related visual changes that are not related to Parkinson’s, such as acuity issues, macular degeneration and cataracts.


Red Flags that could lead a patient to reach out to their doctor:

● Double vision (greatly increases fall risk!)

● Running into things, missing objects coming at you, bumping your walker into

things, etc.

● Difficulty reading.

● Blurred vision.


It is also important to note that medication could potentially be impacting vision. Below is a short list of the possible medication impacts on vision (this is not an all-inclusive list, but one from the Armstrong Article⁴).




What can your rehab team do to help:

● When a person presents with a balance and movement disorder (PD),there is often a problem with the integration of the three balance systems (visual,

vestibular and somatosensory systems). Vision is VERY important to your

balance and needs to be assessed.⁵

○ Occupational therapy and/or physical therapy can provide vision therapy

to address deficits in depth perception, contrast sensitivity and peripheral

vision. Furthermore, vision therapy, in combination with balance therapy,

can greatly reduce your fall risk and create a more secure living

environment.


A few recommendations to improve vision from a physical therapist:

● When reading:

○ Use a guide on the page to help reduce the chance of losing your place

while reading.

● Use larger print to reduce eye strain.

● Increase lighting around your home to improve visibility.

● Reduce clutter in the visual environment to reduce visual stimuli and decrease

fall risk.

● Put tape on the bottom step to help reduce the fall risk associated with poor

depth perception on stairs.


Thank you,



Megan Kelley, PT, DPT (LSVT Big and Parkinson’s Wellness Recovery Certified

Physical Therapist)

Telephone: 615- 961- 4433

Provides physical therapy services in the home and at the Franklin Bridges

for PD Gym

Accepts Medicare Part B or can pay privately


References:


1. Berliner, J.M., Kluger, B.M., Corcos, D.M., Pelak, V.S., Gisbert, R., McRae, C., Atkinson, C.C., & Schenkman, M. (2018)

Patient perceptions of visual, vestibular, and oculomotor deficits in people with Parkinson’s disease. Physiother Theory

Pract. DOI:10.1080/09593985.2018.1492055.

2. Michael J. Fox Foundation. (2023). A web-based assessment of visual and spatial symptoms in Parkinson’s disease.

3. Armstrong, R.A. (2008), Visual signs and symptoms of Parkinson's disease. Clinical and Experimental Optometry, 91:

4. Understanding and Managing Vision Deficits: A Guide for Occupational Therapists (3rd Edition). SLACK Incorporated;2011.

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