Dr. Richard Armstrong has written extensively on visual impairment in PSP and other parkinsonism syndromes. His latest article for optometrists is a good general review of PSP, followed by a review of the visual signs that can be used to identify PSP, and a comparison between these PSP visual symptoms and those of other movement disorders, especially Parkinson’s Disease (PD).
Dr. Armstrong states:
Although primarily a neurological disorder, patients with PSP may develop a variety of visual signs and symptoms that could be useful in differential diagnosis. In addition, a PSP patient may develop visual problems during the course of the disease and the eye-care practitioner can contribute to the management of these problems.
He examines these many “ocular aspects,” including eyelid mobility (such as apraxia of lid opening, blepharospasm), fixation, ophthalmoplegia (such as vertical supranuclear gaze palsy), saccades, smooth pursuit movements, nystagmus (including square wave jerks), and reading.
Here is Dr. Armstrong’s list of practical ways an optometrist can help a PSP patient:
- “PSP patients tend to fall more readily, resulting in a sedentary life style, while vertical gaze palsy also leads to difficulties with reading and eating. New devices are being tested in which refraction positive moveable prism glasses are placed in front of the eyes to help patients with these problems.”
- “PSP patients often complain of dry eyes due to decreased blinking and artificial tears can be used to help this problem.”
- “Patients with difficulties in opening their eyelids may have ‘lid crutches’ fitted to spectacle frames that can hold the lids open.”
- “[Blepharospasm] has been treated successfully with botulinum toxin A…”
- “PSP patients have a particular difficulty with vertical saccades and in suppressing fixation, both of which may contribute to vertical gaze palsy. Deficits in gaze control may … increase the risk of trips or falls while climbing stairs. Balance training in combination with eye movement and visual awareness exercises have been shown to improve gaze control in PSP patients. Patients can be referred to physiotherapists or occupational therapists.”
- “Some patients with PSP may have been treated with L-dopa… Some patients treated with L-dopa exhibit a worsening of apraxia of eye opening as a result, a condition that is often alleviated when the drug is discontinued. By contrast, treatment with apomorphine may reduce apraxia of eye opening.”
- “[Visual] problems that cannot be corrected, such as oculomotor apraxia or visual field defects, should be brought to the attention of carers. As a consequence of such information, carers can make accommodations for these problems, for example, by careful positioning of objects.”
I’ve copied the abstract below along with a link to the full article, which is available at no charge online.
Robin
Clinical and Experimental Optometry. 2010 Jul 12.
Visual signs and symptoms of progressive supranuclear palsy.
Armstrong RA.
Vision Sciences, Aston University, Birmingham, UK
Progressive supranuclear palsy is a rare, degenerative brain disorder and the second most common syndrome in which the patient exhibits ‘parkinsonism’, that is, a variety of symptoms involving problems with movement. General symptoms include difficulties with gait and balance; the patient walking clumsily and often falling backwards. The syndrome can be difficult to diagnose and visual signs and symptoms can help to separate it from closely related movement disorders such as Parkinson’s disease, multiple system atrophy, dementia with Lewy bodies and corticobasal degeneration. A combination of the presence of vertical supranuclear gaze palsy, fixation instability, lid retraction, blepharospasm and apraxia of eyelid opening and closing may be useful visual signs in the identification of progressive supranuclear palsy. As primary eye-care practitioners, optometrists should be able to identify the visual problems of patients with this disorder and be expected to work with patients and their carers to manage their visual welfare.
PubMed ID#: 20629667