Undetected ophthalmological disorders in Parkinson's disease.

BACKGROUND: Ophthalmological disorders are common and frequently disabling for people with Parkinson's disease (PD). However, details on the prevalence, severity and impact of ophthalmological disorders thus far lacking. We aimed to identify PD patients with undetected ophthalmological disorders in a large cross-sectional, observational study. METHODS: We previously delivered a screening questionnaire to detect ophthalmological symptoms (Visual impairment in PD questionnaire; VIPD-Q) to 848 patients. Here, we report on a subgroup of 102 patients who received complete ophthalmological assessment aimed at identifying clinically relevant ophthalmological diseases, which were classified as either vison-threatening or not. Impact on daily life functioning was measured using the visual functioning-25 questionnaire (VFQ-25) and fall frequency. RESULTS: Almost all patients (92%) had one or more clinically relevant ophthalmological disorders. Of those, 77% had a potentially vision-threatening disease, while 34% had a potentially treatable ophthalmological disease which impacted on quality of life. The most prevalent ophthalmological disorders were dry eyes (86%), ocular misalignment (50%) and convergence insufficiency (41%). We found a weak but significant association between clinically relevant ophthalmological diseases and both fall frequency (R2 = 0.15, p = 0.037) and VFQ-25 score (R2 = 0.15, p = 0.02). The VIPD-Q could not correctly identify patients with relevant ophthalmological disorders. CONCLUSIONS: Surprisingly, in our study sample, many participants manifested previously undetected ophthalmological diseases, most of which threatened vision, impacted on daily life functioning and were amenable to treatment. Screening for these ophthalmological disorders using a questionnaire asking about symptoms seems insufficient. Instead, episodic ophthalmological assessments should be considered for PD patients, aiming to identify vision-threatening yet treatable diseases. TRIAL REGISTRATION: Dutch Trial Registration, NL7421.

Seeing ophthalmologic problems in Parkinson disease: Results of a visual impairment questionnaire.

OBJECTIVE: To determine the prevalence and clinical effect of ophthalmologic symptoms in patients with Parkinson disease (PD), compared with controls, using a standardized questionnaire. METHODS: In this observational, cross-sectional, multicenter study, 848 patients with PD and 250 healthy controls completed the Visual Impairment in Parkinson's Disease Questionnaire (VIPD-Q). The VIPD-Q addressed 4 domains according to structures: (1) ocular surface; (2) intraocular; (3) oculomotor; and (4) optic nerve. The questionnaire also assessed the effect of ophthalmologic symptoms on daily activities. RESULTS: One or more ophthalmologic symptoms were reported by 82% (95% confidence interval [CI], 80-85) of patients, compared with 48% (95% CI, 42-54) of controls (p < 0.001). Patients with PD experienced more ophthalmologic symptoms across all domains than controls (p < 0.001), as reflected by a higher VIPD-Q total score among patients (median 10 [interquartile range (IQR) 13]) than controls (median 2 [IQR 5]; p < 0.001). Ophthalmologic symptoms interfered with daily activities in 68% (95% CI, 65-71) of patients, compared with 35% (95% CI, 29-41) of controls (p < 0.001). CONCLUSION: Patients with PD have a higher prevalence of ophthalmologic symptoms than controls. Moreover, these frequently interfere with daily activities. A screening questionnaire such as the VIPD-Q may help with identifying ophthalmologic symptoms in PD, thereby enabling more timely treatment.

Towards seeing the visual impairments in Parkinson's disease: protocol for a multicentre observational, cross-sectional study.

BACKGROUND: Visual disorders are common in Parkinson's disease (PD) but their exact frequency and severity are unknown. Good visual functioning is crucial for patients with PD, because of their need to compensate for loss of automated motor control and their postural instability, forcing patients to guide their movements visually. Here, we describe the study design of a cross-sectional, multi-centre study aiming to: (1) validate the Visual Impairment screening questionnaire (VIPD-Q, which aims to identify PD patients who should be referred to an ophthalmologist for further assessment); (2) study the prevalence of visual disorders in PD; (3) study the severity and clinical impact of different types of visual disorders in PD; and (4) explore treatment options for ophthalmologic disorders in PD, as a basis for future guideline development. METHODS: This study consists of two phases. In phase one, 750 PD patients and 250 healthy controls will be recruited to complete the VIPD-Q. In phase two, a subgroup of responders (n = 100) (with the highest and lowest scores on the VIPD-Q) will be invited for an extensive neurological and ophthalmological assessment. The in-depth ophthalmologic examination will serve as the "gold standard" for validating the VIPD-Q. Moreover, these assessments will be used to study associations between visual disorders and clinical presentation, in order to gain more insight in their clinical impact. DISCUSSION: Our study will heighten the awareness of visual problems in PD and offers a robust starting point to systematically approach this subject. In current daily practice, the association between visual problems and PD is far from obvious to both patients and clinicians. Consequently, patients may not adequately report visual problems themselves, while clinicians miss potentially treatable visual disorders. Routinely asking patients to complete a simple screening questionnaire could be an easy solution leading to timely identification of visual problems, tailored treatment, restored mobility, greater independence and improved quality of life. TRIAL REGISTRATION: Dutch Trial Registration, NL7421 , Registered on 4 December 2018 - Retrospectively registered.

Ultrasound of the lateral femoral cutaneous nerve: normal findings in a cadaver and in volunteers.

OBJECTIVE: To assess the feasibility of ultrasound (US) in visualizing the lateral femoral cutaneous nerve (LFCN) in a cadaver and 8 volunteers. METHODS: Ultrasound and US-guided dye injection was performed in 1 cadaver to show the feasibility of detecting the LFCN. We then performed US in 8 volunteers to assess position of the nerve in respect to the anterior iliac spine. We subsequently performed US-guided anesthetic block of the LFCN on both sides with 0.3 mL local anesthetic. Success rate, time to maximum peak blockade, and duration of blockade were noted. RESULTS: Ultrasound allowed visualization of the LFCN in the cadaveric specimen on both sides and in all but 1 volunteer. Ultrasound-guided block of the LFCN was successful in all but 1 volunteer. The mean distance of LFCN from the anterior iliac spine was 2.9 cm on the right side and 2.8 cm on the left side. The mean duration of the block was 4.4 hours. CONCLUSION: Ultrasound enables visualization of the LFCN in a cadaver and in volunteers. Ultrasound-guided injection successfully blocked the LFCN.

Case report: description of a venous annulus of the external iliac vein.

This report describes a case of a venous annulus of the left external iliac vein. Above the inguinal ligament the external iliac vein divides into two branches, which are interlinked by a communicating branch, forming two loops. The first loop is situated around the external iliac artery, the second loop is found between the communicating branch and the common iliac vein. Although variations of the external iliac vein have already been reported, we could not find any description which would match to our observation.