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Antoniades CA, Spering M. Eye movements in Parkinson's disease: from neurophysiological mechanisms to diagnostic tools. Trends Neurosci 2024; 47:71-83. [PMID: 38042680 DOI: 10.1016/j.tins.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/13/2023] [Accepted: 11/01/2023] [Indexed: 12/04/2023]
Abstract
Movement disorders such as Parkinson's disease (PD) impact oculomotor function - the ability to move the eyes accurately and purposefully to serve a multitude of sensory, cognitive, and secondary motor tasks. Decades of neurophysiological research in monkeys and behavioral studies in humans have characterized the neural basis of healthy oculomotor control. This review links eye movement abnormalities in persons living with PD to the underlying neurophysiological mechanisms and pathways. Building on this foundation, we highlight recent progress in using eye movements to gauge symptom severity, assess treatment effects, and serve as potential precision biomarkers. We conclude that whereas eye movements provide insights into PD mechanisms, based on current evidence they appear to lack sufficient sensitivity and specificity to serve as a standalone diagnostic tool. Their full potential may be realized when combined with other disease indicators in big datasets.
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Affiliation(s)
- Chrystalina A Antoniades
- Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, UK.
| | - Miriam Spering
- Department of Ophthalmology & Visual Sciences and Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada.
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Gupta P, Murray JM, Beylergil SB, Jacobs J, Kilbane CW, Shaikh AG, Ghasia FF. Objective assessment of eye alignment and disparity-driven vergence in Parkinson's disease. Front Aging Neurosci 2023; 15:1217765. [PMID: 38020777 PMCID: PMC10643751 DOI: 10.3389/fnagi.2023.1217765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background Self-reported diplopia is described in up to one-third of Parkinson's disease (PD) patients. Objective The purpose of our study was to expand our understanding of the mechanistic underpinnings of diplopia in PD. We hypothesize that the time-based control of eye alignment and increased eye deviation under binocular viewing will be related to the fusion-initiating and fusion-maintaining component deficits of disparity-driven vergence in PD. Methods We used high-resolution video-oculography to measure eye alignment under binocular and monocular viewing and disparity-driven vergence in 33 PD and 10 age-matched healthy participants. We computed eye deviation and time-based control of eye alignment, occurrence of conjugate saccadic eye movements, latency and gain of vergence (fusion initiation), and variance of eye position at the end of dynamic vergence (fusion maintenance). Results We categorized PD subjects into three groups, considering their time-based control of eye alignment as compared to healthy controls in binocular viewing. Group 1 = 45% had good control and spent >80% of the time when the eyes were well-aligned, Group 2 = 26% had intermediate control and spent <80% but greater >5% of the time when the eyes were well-aligned, and Group 3 = 29% had very poor control with increased eye deviation majority of the times (<5% of the time when the eyes were well-aligned). All three groups exhibited greater eye deviation under monocular viewing than controls. PD subjects exhibited fusion-initiating and fusion-maintaining vergence deficits (prolonged latencies, reduced vergence gain, increased variance of fusion-maintaining component) with a greater probability of saccadic movements than controls. Group 2 and Group 3 subjects were more likely to exhibit failure to initiate vergence (>20%) than Group 1 (13%) and controls (0%) trials. No significant difference was found in the Unified Parkinson's Disease Rating Scale (UPDRS-a tool to measure the severity of PD) values between the three PD groups (Group 1 = 33.69 ± 14.22, Group 2 = 38.43 ± 22.61, and Group 3 = 23.44 ± 1, p > 0.05). Conclusion The majority of PD subjects within our cohort had binocular dysfunction with increased eye deviation under monocular viewing and disparity-driven vergence deficits. PD subjects with intermediate or poor control of eye deviation under binocular viewing had greater fusion-initiating and fusion-maintaining vergence deficits. The study highlights the importance of assessing binocular dysfunction in PD subjects independent of the severity of motor symptoms.
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Affiliation(s)
- Palak Gupta
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Visual Neurosciences and Ocular Motility Laboratory, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States
- Daroff-Dell’Osso Ocular Motility Laboratory, Cleveland VA Medical Center, Cleveland, OH, United States
| | - Jordan M. Murray
- Visual Neurosciences and Ocular Motility Laboratory, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Sinem Balta Beylergil
- Daroff-Dell’Osso Ocular Motility Laboratory, Cleveland VA Medical Center, Cleveland, OH, United States
| | - Jonathan Jacobs
- Daroff-Dell’Osso Ocular Motility Laboratory, Cleveland VA Medical Center, Cleveland, OH, United States
| | - Camilla W. Kilbane
- Department of Neurology, University Hospitals, Cleveland, OH, United States
| | - Aasef G. Shaikh
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Daroff-Dell’Osso Ocular Motility Laboratory, Cleveland VA Medical Center, Cleveland, OH, United States
- Department of Neurology, University Hospitals, Cleveland, OH, United States
- Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Fatema F. Ghasia
- Visual Neurosciences and Ocular Motility Laboratory, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States
- Daroff-Dell’Osso Ocular Motility Laboratory, Cleveland VA Medical Center, Cleveland, OH, United States
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Vinuela-Navarro V, Goset J, Aldaba M, Mestre C, Rovira-Gay C, Cano N, Ariza M, Delàs B, Garolera M, Vilaseca M. Eye movements in patients with post-COVID condition. BIOMEDICAL OPTICS EXPRESS 2023; 14:3936-3949. [PMID: 37799689 PMCID: PMC10549724 DOI: 10.1364/boe.489037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 10/07/2023]
Abstract
Eye movement control is impaired in some neurological conditions, but the impact of COVID-19 on eye movements remains unknown. This study aims to investigate differences in oculomotor function and pupil response in individuals who suffer post-COVID-19 condition (PCC) with cognitive deficits. Saccades, smooth pursuit, fixation, vergence and pupillary response were recorded using an eye tracker. Eye movements and pupil response parameters were computed. Data from 16 controls, 38 COVID mild (home recovery) and 19 COVID severe (hospital admission) participants were analyzed. Saccadic latencies were shorter in controls (183 ± 54 ms) than in COVID mild (236 ± 83 ms) and COVID severe (227 ± 42 ms) participants (p = 0.017). Fixation stability was poorer in COVID mild participants (Bivariate Contour Ellipse Area of 0.80 ± 1.61°2 vs 0.36 ± 0.65 °2 for controls, p = 0.019), while percentage of pupil area reduction/enlargement was reduced in COVID severe participants (39.7 ± 12.7%/31.6 ± 12.7% compared to 51.7 ± 22.0%/49.1 ± 20.7% in controls, p < 0.015). The characteristics of oculomotor alterations found in PCC may be useful to understand different pathophysiologic mechanisms.
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Affiliation(s)
- Valldeflors Vinuela-Navarro
- Center for Sensors, Instruments and Systems Development,
Universitat Politècnica de Catalunya, Rambla Sant Nebridi 10, Terrassa 08222 (Barcelona), Spain
| | - Joan Goset
- Center for Sensors, Instruments and Systems Development,
Universitat Politècnica de Catalunya, Rambla Sant Nebridi 10, Terrassa 08222 (Barcelona), Spain
| | - Mikel Aldaba
- Center for Sensors, Instruments and Systems Development,
Universitat Politècnica de Catalunya, Rambla Sant Nebridi 10, Terrassa 08222 (Barcelona), Spain
| | - Clara Mestre
- Center for Sensors, Instruments and Systems Development,
Universitat Politècnica de Catalunya, Rambla Sant Nebridi 10, Terrassa 08222 (Barcelona), Spain
| | - Cristina Rovira-Gay
- Center for Sensors, Instruments and Systems Development,
Universitat Politècnica de Catalunya, Rambla Sant Nebridi 10, Terrassa 08222 (Barcelona), Spain
| | - Neus Cano
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
- Department de Ciències Bàsiques. Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Mar Ariza
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
| | - Bàrbara Delàs
- Servei d’Oftalmologia. Consorci Sanitari de Terrassa (CST), Terrassa, Spain
| | - Maite Garolera
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
- Neuropsychology Unit, Hospital de Terrassa, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
| | - Meritxell Vilaseca
- Center for Sensors, Instruments and Systems Development,
Universitat Politècnica de Catalunya, Rambla Sant Nebridi 10, Terrassa 08222 (Barcelona), Spain
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Sun YR, Beylergil SB, Gupta P, Ghasia FF, Shaikh AG. Monitoring Eye Movement in Patients with Parkinson's Disease: What Can It Tell Us? Eye Brain 2023; 15:101-112. [PMID: 37519412 PMCID: PMC10377572 DOI: 10.2147/eb.s384763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/01/2023] [Indexed: 08/01/2023] Open
Abstract
Parkinson's disease (PD) affects approximately 10 million individuals worldwide. Visual impairments are a common feature of PD. Patients report difficulties with visual scanning, impaired depth perception and spatial navigation, and blurry and double vision. Examination of PD patients reveals abnormal fixational saccades, strabismus, impaired convergence, and abnormal visually-guided saccades. This review aims to describe objective features of abnormal eye movements in PD and to discuss the structures and pathways through which these abnormalities may manifest.
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Affiliation(s)
- Yue Ran Sun
- Department of Neurology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Sinem B Beylergil
- Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Palak Gupta
- Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | | | - Aasef G Shaikh
- Department of Neurology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
- Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
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Eye movements in Parkinson's disease during visual search. J Neurol Sci 2022; 440:120299. [DOI: 10.1016/j.jns.2022.120299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/30/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
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