Pupillary supersensitivity and visual disturbance in Parkinson’s disease |
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Authors: | Norio Hori Motoko Takamori Masaaki Hirayama Hirohisa Watanabe Tomohiko Nakamura Fumitada Yamashita Hiroki Ito Naoki Mabuchi Gen Sobue |
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Institution: | (1) Dept. of Neurology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan;(2) Dept. of Neurology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan;(3) Dept. of Neurology, Ichinomiya Municipal Hospital, Aichi, Japan;(4) Dept. of Neurology, Okazaki Municipal Hospital, Aichi, Japan |
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Abstract: | This study evaluated pupillary postganglionic autonomic dysfunction and its relationship to visual disturbance in idiopathic
Parkinson’s disease (PD). Pupillary sensitivity was examined in relation to a parasympathomimetic agent 0.05% pilocarpine
hydrochloride (PL)] and to a sympathomimetic agent 0.02% dipivefrine hydrochloride (DPE)] using infrared pupillography in
40 PD patients and 17 age-matched controls. Visual disturbances were evaluated as well, including blurring, photophobia, night
blindness and involuntary eyelid closure in response to light. Pupillary supersensitivity to PL and DPE and their relation
to visual disturbances were found to be significantly greater in PD patients than in controls (22.3 ± 15.1 vs. 10.4 ± 11.4%,
P < 0.005, and14.5 ± 14.5 vs. 4.9 ± 8.7%, P < 0.01, respectively). In addition, pupillary sympathetic supersensitivity did not correlate with a reduction of 123I-metaiodobenzylguanidine (MIBG) cardiac accumulation. Patients with PD reported more blurred vision (P < 0.001) and involuntary eyelid closure in response to light (P < 0.05) than controls. Patients with supersensitivity to both PL and DPE complained more often of blurred vision than patients
without supersensitivity (P < 0.05). Pupillary sensitivity to PL correlated significantly with a summed score for visual disturbance (P < 0.05, r = 0.417), but DPE sensitivity did not. PD patients have both parasympathetic and sympathetic postganglionic impairments affecting
the pupil. Our findings demonstrate that parasympathetic dysfunction contributes significantly to visual disturbance in PD. |
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Keywords: | Parkinson’ s disease (PD) eye-drop test postganglionic autonomic dysfunction pupillary response visual disturbance |
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