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Vision Symptoms in Parkinson's Disease

on June 30, 2022

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With this blog I am trying to recreate the conversations I have with my patients in my neuro-ophthalmology practice. If you are not a patient of mine, you are welcome to read, but in that case, I am just another guy putting advice online. Take it for what it is worth...

Visual Snow

I know there are a lot of internet resources about visual snow syndrome already out there. I guess I just wanted to add my two cents. First of all, the proper name of visual snow syndrome is persistent positive visual phenomena distinct from migraine aura. That is just not a handy name to throw around and PPVPDFMA is not easy on the tongue either. So, although the name is in many ways inadequate most people say "visual snow syndrome" One of the main features of visual snow syndrome is an appearance of snow or TV static in the vision. Patients who have this symptom know exactly what this means. It looks like a texture over everything they see. It usually does not interfere with the true image, but this sensation overlays that image. There is much more, too... Patients with visual snow syndrome often describe floaters, seeing lights when their eyes are closed, experiencing after images and visual trails of moving objects. Some patients even have non-visual symptoms like ...

Papilledema Grades

Papilledema is a swollen nerve due to elevated intracranial pressure. It is one of the features of IIH and papilledema is important particularly because it could lead to vision loss. We use a simple grading scale depending on how blurry the nerve looks. (The nerve can also be called the disc.) It is a 6 point scale Grade 0 means normal- no papilledema Grade 1-2 is considered low grade and does not often cause vision loss. Grade 3-5 is high grade and the risk of vision loss goes up. Grade 5 is particularly high and only very rare. Grade 0 0: This is a normal optic nerve. Notice that the disc margins are nice and distinct, no blurriness here. Grade 1 1: We start to see blurriness on one side of the nerve. (It is always the side closest to the nose.) Grade 2 2: Now the nerve looks blurry all the way around. (Circumferential disc margin obscuration) Grade 3 3: At this stage, the blurring is severe enough that it seems to obscure the blood vessels as they cross over the edg...

NAION

N on-arteritic A nterior I schemic O ptic N europathy Sometimes people joke that neuro-ophthalmology is the specialty of determining what things aren't. So, first of all, we are not discussing Giant Cell Arteritis, which is why the name of this condition begins with "non-arteritic." Some people say it is like a stroke of the eye. That is a handy shortcut to roughly explain what this disease means, but it is not entirely accurate and I feel like it is important to be clear about what is happening to my patients. First of all, we are not talking about the brain, it is the optic nerve of the eye, so it is not a stroke. A stroke is a brain disease. Second of all, the mechanism is different. Most strokes occur from clots. Maybe a clot forms in the heart or in the neck, then it dislodges and goes up to the brain and does damage. NAION is different because it is due to poor circulation. This image shows the circulation of the eye: The optic nerve is the yellow structure that c...