Jackson Mary Lou, Bex Peter J, Ellison James M, Wicks Paul, Wallis Jennifer
Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, United States.
Interact J Med Res. 2014 Jan 6;3(1):e1. doi: 10.2196/ijmr.2744.
Patients with Parkinson's disease (PD) experience visual hallucinations, which may be related to decreased contrast sensitivity (ie, the ability to discern shades of grey).
The objective of this study was to investigate if an online research platform can be used to survey patients with Parkinson's disease regarding visual hallucinations, and also be used to assess visual contrast perception.
From the online patient community, PatientsLikeMe, 964 members were invited via email to participate in this study. Participants completed a modified version of the University of Miami Parkinson's disease hallucinations questionnaire and an online vision test.
The study was completed by 27.9% (269/964) of those who were invited: 56.9% of this group had PD (153/269) and 43.1% (116/269) were non-Parkinson's controls. Hallucinations were reported by 18.3% (28/153) of the Parkinson's group. Although 10 subjects (9%) in the control group reported experiencing hallucinations, only 2 of them actually described formed hallucinations. Participants with Parkinson's disease with a mean of 1.75 (SD 0.35) and the control group with a mean of 1.85 (SD 0.36) showed relatively good contrast perception as measured with the online letter test (P=.07). People who reported hallucinations showed contrast sensitivity levels that did not differ from levels shown by people without hallucinations (P=.96), although there was a trend towards lower contrast sensitivity in hallucinators.
Although more Parkinson's responders reported visual hallucinations, a significant number of non-Parkinson's control group responders also reported visual hallucinations. The online survey method may have failed to distinguish between formed hallucinations, which are typical in Parkinson's disease, and non-formed hallucinations that have less diagnostic specificity. Multiple questions outlining the nature of the hallucinations are required. In a clinical interview, the specific nature of the hallucination would be further refined to rule out a vague description that does not indicate a true, formed visual hallucination. Contrary to previous literature, both groups showed relatively good contrast sensitivity, perhaps representing a ceiling effect or limitations of online testing conditions that are difficult to standardize. Steps can be taken in future trials to further standardize online visual function testing, to refine control group parameters and to take steps to rule out confounding variables such as comorbid disease that could be associated with hallucinations. Contacting subjects via an online health social network is a novel, cost-effective method of conducting vision research that allows large numbers of individuals to be contacted quickly, and refinement of questionnaires and visual function testing may allow more robust findings in future research.
帕金森病（PD）患者会出现视幻觉，这可能与对比敏感度下降（即辨别灰色阴影的能力）有关。
本研究的目的是调查在线研究平台是否可用于就视幻觉对帕金森病患者进行调查，以及是否可用于评估视觉对比感知。
通过电子邮件邀请在线患者社区“PatientsLikeMe”的964名成员参与本研究。参与者完成了迈阿密大学帕金森病幻觉问卷的修改版和一项在线视力测试。
受邀者中有27.9%（269/964）完成了研究：该组中56.9%患有帕金森病（153/269），43.1%（116/269）为非帕金森病对照者。帕金森病组中有18.3%（28/153）报告有幻觉。虽然对照组中有10名受试者（9%）报告有幻觉经历，但其中只有2人实际描述了成形的幻觉。通过在线字母测试测量，帕金森病患者组平均得分为1.75（标准差0.35），对照组平均得分为1.85（标准差0.36），两组显示出相对较好的对比感知（P = 0.07）。报告有幻觉的人与没有幻觉的人相比，其对比敏感度水平没有差异（P = 0.96），不过有幻觉者的对比敏感度有降低的趋势。
虽然更多的帕金森病应答者报告有视幻觉，但相当数量的非帕金森病对照组应答者也报告有视幻觉。在线调查方法可能未能区分帕金森病中典型的成形幻觉和诊断特异性较低的不成形幻觉。需要多个问题来概述幻觉的性质。在临床访谈中，幻觉的具体性质将进一步细化，以排除不表明真正成形视幻觉的模糊描述。与先前的文献相反，两组均显示出相对较好的对比敏感度，这可能代表了天花板效应或难以标准化的在线测试条件的局限性。未来的试验可以采取措施进一步规范在线视觉功能测试，细化对照组参数，并采取措施排除可能与幻觉相关的混杂变量，如合并症。通过在线健康社交网络联系受试者是一种新颖、经济高效的视力研究方法，它能迅速联系大量个体，完善问卷和视觉功能测试可能会使未来的研究结果更可靠。
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