Department of Neurology, Onze Lieve Vrouwe Gasthuis (OLVG), Location OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Parkinson Centre (ParC), Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
J Neurol. 2019 Oct;266(10):2457-2464. doi: 10.1007/s00415-019-09430-w. Epub 2019 Jun 18.
Approximately 20% of patients with Parkinson's disease (PD) experience diplopia; however, the cause of the diplopia is unclear. We aimed to explore the association of diplopia, and its subtypes, with oculomotor abnormalities, impaired vision, and visual hallucinations, in patients with PD.
This exploratory study included 41 PD patients, recruited from two general hospitals, of whom 25 had diplopia and 16 did not have diplopia, as well as 23 healthy controls (HCs). We defined subtypes of diplopia as selective diplopia, i.e., diplopia of single objects, and complete diplopia, i.e., diplopia of the entire visual field. All participants underwent a full orthoptic and ophthalmologic examination.
PD patients with diplopia had a high prevalence of oculomotor abnormalities (84%), impaired vision (44%), and visual hallucinations (44%), compared to PD patients without diplopia (33%, 6%, and none, respectively, p < 0.01), and compared to HCs (23%, 9%, and none, respectively, p < 0.01). Oculomotor abnormalities were equally prevalent in both subtypes of diplopia (selective and complete), whereas impaired vision was predominantly found in patients with selective diplopia. Moreover, only patients with selective diplopia had visual hallucinations.
In PD patients, diplopia may be indicative of oculomotor or visual impairments. Hence, it is worthwhile to refer PD patients with diplopia to an orthoptist and an ophthalmologist for evaluation and, possibly, treatment of diplopia. Furthermore, in the case of selective diplopia, the neurologist should consider the presence of visual hallucinations, which may require the adjustment of the patient's medication.
大约 20%的帕金森病（PD）患者会出现复视；然而，复视的原因尚不清楚。我们旨在探讨 PD 患者复视及其亚型与眼球运动异常、视力障碍和视觉幻觉之间的关系。
这项探索性研究纳入了来自两家综合医院的 41 名 PD 患者，其中 25 名患者有复视，16 名患者没有复视，还有 23 名健康对照者（HCs）。我们将复视的亚型定义为选择性复视，即单物体复视，以及完全性复视，即整个视野的复视。所有参与者都接受了全面的眼科和眼肌检查。
与无复视的 PD 患者（分别为 33%、6%和无，p<0.01）和 HCs（分别为 23%、9%和无，p<0.01）相比，有复视的 PD 患者眼球运动异常（84%）、视力障碍（44%）和视觉幻觉（44%）的发生率更高。选择性和完全性复视的眼球运动异常发生率相同，但视力障碍主要见于选择性复视患者。此外，只有选择性复视患者有视觉幻觉。
在 PD 患者中，复视可能表明存在眼球运动或视觉障碍。因此，值得将有复视的 PD 患者转诊给眼科医生和眼肌科医生进行评估，可能还需要治疗复视。此外，在选择性复视的情况下，神经科医生应考虑是否存在视觉幻觉，这可能需要调整患者的药物治疗。
