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Topic Eye Tremor Test - PD Predictor????? Go to previous topic Go to next topic Go to higher level

By makrivah On 2013.08.26 22:42
Today while we were at the Veterans Administration in Richmond, VA for my PWP's regular appointment, the doctor asked if my PWP would mind taking part in a test to see if he had eye tremors. This was a 5 minute non-invasive vision test. The results were dramatic, showing the extent of difficulty he has in tracking an object. Reading must be almost impossible for him... which backs up his complaint that his "drift off" when he reads. We now know that it isn't so much focus as his eyeball is jumping around - both vertically and horizontally!

For more information on the science and research just Google "eye tremors parkinsons". For this particular study include "PADRECC" in the query. This is the VA research group. There are many articles out there on eye tremors and PD. The researchers are claiming that identifying eye tremors is an early predictor/indicator of future development of Parkinson's. Unfortunately, for those already diagnosed, this test has no predictor of speed or degree of progression.

Fascinating stuff. My PWP will continue in the study. We will go back in October for an EARLY morning appointment before he takes his first meds for the day. We will stay until that delayed first dose kicks in, then they will re-do the test and compare the results. As an interesting aside, I might become part of a control group. The doctors/researchers we saw today will be presenting their abstract at the World Parkinson's Conference this year.

I thought many of you would find this bit of research interesting. I was delighted that one of the investigators was able to spend 45 minutes with us before, during and after the test.

By jcoff012 On 2013.08.27 09:55
Wow,,,thank you for posting this...this helps us tremendously...My husband had made an appointment for an eye test because he thinks he needs new glasses, but it sounds more like the symptoms you are experiencing...I will show him your post and again, thank you for it...something he needs to discuss with his new neuro...Please do post the ongoing discussion and results from the study...WE definitely are interested! Great timing! Jane

By susger8 On 2013.08.29 07:26
I've also heard that many or most PWPs have eyes that diverge due to muscle imbalance, so that they need prisms in their prescription to make their eyes work together. My dad needed prisms long before his diagnosis, so I have wondered if this could also be a predictor.

Dad also had a sudden, asymptomatic onset of glaucoma, which the ophthalmologist said was not usual. Another eye-related PD thing?


By parkinit On 2013.08.29 19:45
My husband had to have vertical and horizontal prisms in his glasses. His eyes change so frequently, tho I'm not sure if it really helped.

By LOHENGR1N On 2013.08.30 00:00
parkinit, does your husband say or think the prisms have helped?

By parkinit On 2013.08.30 10:43
Lo - I just gave him the Big Box glasses versus prism glasses test this morning. He put one on and then the other. He said (sounding surprised), "These are better," when viewing through the prismed glasses.

So yes, he thinks the prisms have helped.

He got his glasses through the VA and they showed me how everything my PWP saw was shadowed and basically diagonal to the actual image. They kept correcting with prisms until he only saw one image.

By Freespirit On 2013.08.30 11:35
Hey, guys, can somebody take a moment to explain to me what you mean by these prisms and what exactly it is they are supposed to help?

My husband has recently said he sees two clocks when laying down looking at the alarm clock, but has not complained about actual reading when sitting up.

I'm wondering if his issues are related to what you are talking about and whether I can try to help him.


By makrivah On 2013.08.30 21:04
As an aside on my original post, we had interesting "collateral damage" after the doctor's visit where eye tremors were found.

Driving came up during the eye test with the head PD doctor at Richmond Veterans Admin. When the results showed the eye tremors and the doctors seemed to be interested with the degree of movement, I asked if these tremors interfered with my PWP's driving ability. The doctor said "no, the movement is actually microscopic and interferes with small objects, not large objects." So (I bet you can see this coming...) later in the day my PWP says to me with a lilt in his voice ..."See I told you. There is nothing wrong with my driving. Even Dr. xxxx said so." He heard what he wanted to hear. It is harder and harder to "contain" his driving so that others are not put in harm's way (not to mention my PWP's vulnerability).

When we go back on October 7 for the next eye tremor test, I intend to have talked/emailed with Dr. xxxx and hopefully he will help me get the point across about driving. I have found that resolving the "when to stop driving issue" is one of the hardest thresholds of progression. This is understandable, of course, given that it represents freedom and self sufficiency; but as others have said, how do you draw the line when others are put in jeopardy?

Like I said, this entry is certainly a digression from this great discussion thread about eye tremor research, but obviously I needed to vent ... how could such an interesting discovery about early detection deteriorate into my PWP's position that his driving is as good as it ever was? sigh.

OK, everybody back to the good stuff about what detecting eye tremors might mean.

By LOHENGR1N On 2013.08.31 00:24
Freespirit, If I remember correctly there was a post about blurry vision? (someone refresh my memory if I'm wrong please) I brought up the question of if eye tremor was present, and suggested that they just sit across from their loved one and watch the see if his eyes had a tremor. To their surprise they did. The prisms are supposed to I think focus the light into the eye so one can see better than the tremor disrupted and moving light from the pupil to the receptors on the back of the eye (think of holding a flashlight shining on a wall and moving your hand the spot moves around). So the prisms gather the tremor spread light and refocus it to aid sight.

Your husband probably doesn't notice anything when reading because he is concentrating on the words and page. When glancing at the clock he really isn't concentrating like reading but casually glancing and would notice the vision disruption more easily. I'm not sure the sitting or reclining makes a difference but then it is a different angle so I guess it could. Hope this helps explain a little about what we got to talking about. Take care, best of luck and hang in there

By dans316 On 2013.08.31 10:41

There was a post on 12/31/2012 by JeannieLar titled "vision problems with parkinsons" on page 10 of previous posts.

June had prisms added to her glasses after cataract surgery in one eye in November 2012. I thought the prisms were because of the surgery in just one eye.


By LOHENGR1N On 2013.08.31 13:30
Dan, Thanks that's the post I was refering to!

By susger8 On 2013.09.03 07:24
Freespirit, prisms are added to lenses to correct double vision, which generally is caused by muscle imbalance. The eyes diverge or converge so that they are not focusing on exactly the same point.

Here's an explanation from an optometrist's website.

Prisms bend light and separate white light into its component colors. In vision correction, we like the light bending and don't want the color separation aspects of prism.

How do prisms work? It's complicated, but if you think of a prism as being a triangle pointing upwards, light goes in one side, bends down toward the base, and comes out the other side going in a different direction. Of course, in glasses and contact lenses this is much more sophisticated and doesn't really look like a triangle... but the effect is the same.

Prisms are used in lenses to help keep the eyes working together and aligned. They can make the difference between glasses that are OK and glasses that are wonderful.


By LOHENGR1N On 2013.09.03 08:40
But with Parkinson's Disease it is tremor not muscle imbalance or weakness that causes divergence or converging.

By susger8 On 2013.09.05 08:03
You know, Loh, I tend to think both factors are at work here. Certainly tremors in the eye muscles would make vision blurry and hard to focus. But muscle imbalance is probably involved too. Think about how many PWPs lean to the side, and have various dystonias and muscle contractures. It makes sense that the eye muscles might not contract the same amount on all sides, and that would make the eyes diverge or converge. It does explain why so many PWPs need prisms in their prescriptions -- seems like a considerably higher proportion than in the general population.


By LOHENGR1N On 2013.09.05 08:32
Well you know Sue most of these answers and explanations are taught to optometrists from material that didn't include eye tremor problems from Parkinson's Disease or from when the Medical Field didn't understand that much about Dystonia, Tremor or the effect's of Parkinson's Disease upon our entire bodily functioning. Which is important information as a whole lacking in many fields and side specialities of medicine and really does need catching up to.

By Freespirit On 2013.09.09 08:39
A big THANK YOU for the additional explanation regarding prisms and how PD tremor affects vision!

I am going to look into this further.

Thank you!

By susger8 On 2013.09.09 09:07
That is so true! So few medical people understand that the disease affects every system of the body.


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