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Pupillary supersensitivity and visual disturbance in Parkinson’s disease

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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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Authors and Affiliations

  1. Dept. of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan

    Norio Hori, Masaaki Hirayama, Hirohisa Watanabe, Tomohiko Nakamura, Fumitada Yamashita & Gen Sobue

  2. Dept. of Neurology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan

    Motoko Takamori

  3. Dept. of Neurology, Ichinomiya Municipal Hospital, Aichi, Japan

    Hiroki Ito

  4. Dept. of Neurology, Okazaki Municipal Hospital, Aichi, Japan

    Naoki Mabuchi

Authors
  1. Norio Hori
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  2. Motoko Takamori
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  3. Masaaki Hirayama
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  4. Hirohisa Watanabe
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  5. Tomohiko Nakamura
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  6. Fumitada Yamashita
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  7. Hiroki Ito
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  8. Naoki Mabuchi
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  9. Gen Sobue
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Corresponding author

Correspondence to Gen Sobue.

Appendix

Appendix

Visual subjective disturbance scale in this study

Please read the following questions and try to answer on the basis of how you feel in daily life.

  1. A.

    Blurred vision: during the day, how often do you feel blurred vision?

    1. 0

      Never

    2. 1

      Sometimes, but it does not bother me

    3. 2

      Often, so I have trouble seeing

    4. 3

      Always

  2. B.

    Photophobia: how much do you feel photophobia?

    1. 0

      Never

    2. 1

      Sometimes, but it does not bother me

    3. 2

      Often, so I have trouble seeing

    4. 3

      Always

  3. C.

    Night blindness: in darkness, do you have no trouble seeing?

    1. 0

      No, I have any trouble seeing

    2. 1

      Yes, I sometimes have trouble seeing in darkness, but it does not bother me

    3. 2

      Yes, I often have trouble seeing in darkness

    4. 3

      Yes, I cannot seeing in darkness

  4. D.

    Involuntary eyelid closure in response to light: how often do you have involuntary eyelid closure in response to light?

    1. 0

      Never

    2. 1

      Sometimes, but it does not bother me

    3. 2

      Often, so I have difficulty in some of daily performance

    4. 3

      Always, so I have difficulty in almost all of daily performance

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Hori, N., Takamori, M., Hirayama, M. et al. Pupillary supersensitivity and visual disturbance in Parkinson’s disease. Clin Auton Res 18, 20–27 (2008). https://doi.org/10.1007/s10286-008-0453-4

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  • DOI: https://doi.org/10.1007/s10286-008-0453-4

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