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Li H, Ma W, Li C, He Q, Zhou Y, Xie A. Combined diagnosis for Parkinson's disease via gait and eye movement disorders. Parkinsonism Relat Disord 2024; 123:106979. [PMID: 38669851 DOI: 10.1016/j.parkreldis.2024.106979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/14/2024] [Accepted: 04/21/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND AND OBJECTIVES With the discovery of the potential role of gait and eye movement disorders in Parkinson's disease (PD) recognition, we intend to investigate the combined diagnostic value of gait and eye movement disorders for PD. METHODS We enrolled some Chinese PD patients and healthy controls and separated them into the training and validation sets based on enrollment time. Performance in five oculomotor paradigms and in one gait paradigm was examined using an infrared eye tracking device and a wearable gait analysis device. We developed and validated a combined model for PD diagnosis via multivariate stepwise logistic regression analysis. Furthermore, subgroup comparisons and multi-model comparison were performed to assess its applicability and advantages. RESULTS A total of 145 PD patients and 80 healthy controls in China were recruited. The pro-saccade velocity, the trunk-sway max, and the turn mean angular velocity were finally screened out for the model development. Incorporating age factor, the ternary model demonstrated more satisfactory performance on ROC (AUC of 0.953 in the training set and AUC of 0.972 in the validation set), calibration curve, and decision curve. A nomogram was drawn to visualize the model. The combined model outperforms individual models with a broad application and the unique diagnostic value for early detection of PD patients, especially TD-PD patients. CONCLUSION We demonstrated the presence of gait and eye movement disorders, as well as the feasibility, applicability, and superiority of employing them together to diagnose PD.
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Affiliation(s)
- Han Li
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Wenqi Ma
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Chengqian Li
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Qiqing He
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Yuting Zhou
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Anmu Xie
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China; Institute of Cerebrovascular Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Piñero DP, Bataille L, Martínez-Plaza E, Molina-Martín A. Professional perspective and practice patterns of vision therapy in Spain. Clin Exp Optom 2024; 107:341-348. [PMID: 37218547 DOI: 10.1080/08164622.2023.2215383] [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: 01/31/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
CLINICAL RELEVANCE An analysis of the professional perspective of vision therapy (VT) by eye care professionals allows understanding the current controversies about this therapeutic option of which aspects can be improved for its correct application in clinical practice. BACKGROUND The aim of the current study was to analyse the perception of VT and the clinical protocols in this context followed among optometrists and ophthalmologists in Spain. METHODS A cross-sectional survey among Spanish optometrists and ophthalmologists. Google Forms tool was used to collect data via an online questionnaire divided into 4 sections (40 questions): consent to participate, demographic characteristics, opinion of the professional perspective of VT, and protocols. Only one submission from each email address was permitted by the survey tool. RESULTS A total of 889 Spanish professionals answered (age, 25-62 years): 848 optometrists (95.4%) and 41 ophthalmologists (4.6%). VT was considered as a scientifically-based procedure by 95.1% of participants, but its recognition and prestige was considered as low. The main cause reported for this was bad reputation or perception of placebo therapy (27.3%). The main indication of VT according to the surveyed professionals was convergence and/or accommodation problems (72.4%). Significant differences were found in the perception of VT among optometrists and ophthalmologists (p ≤ 0.027). A total of 45.3% of professionals reported performing VT in their current clinical practice. A combination of training sessions in office and home was regularly prescribed by 94.5% of them, but with significant variability in the duration of such sessions. CONCLUSIONS VT is perceived by Spanish optometrists and ophthalmologists as a therapeutic option with scientific basis, but with limited recognition and prestige, although with more negative perception among ophthalmologists. A great variability was found in the clinical protocols followed between specialists. Future efforts should be focused on creating internationally recognised evidence-based protocols for this therapeutic option.
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Affiliation(s)
- David P Piñero
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Visutrain project, Science Park of the University of Alicante, Alicante, Spain
- Advanced Clinical Optometry Unit, Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain
| | - Laurent Bataille
- Visutrain project, Science Park of the University of Alicante, Alicante, Spain
| | - Elena Martínez-Plaza
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Visutrain project, Science Park of the University of Alicante, Alicante, Spain
- University of Valladolid, Valladolid, Spain
| | - Ainhoa Molina-Martín
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Visutrain project, Science Park of the University of Alicante, Alicante, Spain
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Li H, Zhang X, Yang Y, Xie A. Abnormal eye movements in Parkinson's disease: From experimental study to clinical application. Parkinsonism Relat Disord 2023; 115:105791. [PMID: 37537120 DOI: 10.1016/j.parkreldis.2023.105791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease that integrates a series of motor symptoms and non-motor symptoms, making early recognition challenging. The exploration of biomarkers is urgently required. Abnormal eye movements in PD have been reported to appear in a variety of ways since eye tracking technology was developed, such as decreased saccade amplitude, extended saccade latency, and unique saccade patterns. Non-invasive, objective and simple eye tracking has the potential to provide effective biomarkers for the PD diagnosis, progression and cognitive impairment, as well as ideas for research into the occurrence and treatment strategy of motor symptoms. In this review, we introduced the fundamental eye movement patterns and typical eye movement paradigms (such as fixation, pro-saccade, anti-saccade, smooth tracking, and visual search), summarized the symptoms of various ocular motor abnormalities in PD, and discussed the research implications of oculomotor investigation to the pathogenesis of PD and related motor symptoms, as well as the clinical implications as biomarkers and its inspiration on treatment.
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Affiliation(s)
- Han Li
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.
| | - Xue Zhang
- Department of Neurology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, China
| | - Yong Yang
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Anmu Xie
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China; The Cerebral Vascular Disease Institute, Qingdao University, Qingdao, China.
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van der Lijn I, de Haan GA, van der Feen FE, Vrijling AC, Stellingwerf C, Fuermaier AB, Langenberg P, van Laar T, Heutink J. Reading Difficulties in Parkinson's Disease: A Stepped Care Model for Neurovisual Rehabilitation. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1225-1237. [PMID: 37781818 PMCID: PMC10657659 DOI: 10.3233/jpd-230124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND People with Parkinson's disease (PD) frequently experience reading difficulties. Little is known about what functional impairments distinguish people with PD with and without reading difficulties and how these should guide rehabilitation. OBJECTIVE To provide concrete advice for an efficient stepped care model for reading difficulties in PD, based on extensive functional assessments. METHODS This study included 74 people with PD in a neurovisual rehabilitation setting who underwent assessment of visual, visuoperceptual, and cognitive functions. Outcomes were compared between those with frequent (RD+; N = 55) and infrequent reading difficulties (RD-; N = 19). Aids and advice provided during rehabilitation were registered. RESULTS Only a few functions appeared to distinguish RD+ and RD-. Visual functions (i.e., contrast sensitivity, g = 0.76; reading acuity, g = 0.66; visual acuity, g = 0.54) and visuoperceptual functions (i.e., visual attention, g = 0.58, visual motor speed, g = 0.56) showed significant worse scores in RD+ compared to RD-. Aids and advice applied consisted mainly of optimizing refraction, improving lighting, and optimizing text size and spacing. CONCLUSION The test battery showed significant differences between RD+ and RD-on only a few tests on visual and visuoperceptual functions. The applied aids and advice matched well with these impairments. Therefore, we recommend a stepped care model, starting with a short test battery on these functions. If this battery indicates functional impairments, this can be followed by standard aids and advice to improve reading. Only in case of insufficient effect additional testing should take place.
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Affiliation(s)
- Iris van der Lijn
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands
| | - Gera A. de Haan
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands
| | - Fleur E. van der Feen
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands
| | - Anne C.L. Vrijling
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands
| | - Catharina Stellingwerf
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands
| | - Anselm B.M. Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Pia Langenberg
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Joost Heutink
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands
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Eye Movement Alterations in Post-COVID-19 Condition: A Proof-of-Concept Study. SENSORS 2022; 22:s22041481. [PMID: 35214383 PMCID: PMC8875414 DOI: 10.3390/s22041481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023]
Abstract
There is much evidence pointing out eye movement alterations in several neurological diseases. To the best of our knowledge, this is the first video-oculography study describing potential alterations of eye movements in the post-COVID-19 condition. Visually guided saccades, memory-guided saccades, and antisaccades in horizontal axis were measured. In all visual tests, the stimulus was deployed with a gap condition. The duration of the test was between 5 and 7 min per participant. A group of n=9 patients with the post-COVID-19 condition was included in this study. Values were compared with a group (n=9) of healthy volunteers whom the SARS-CoV-2 virus had not infected. Features such as centripetal and centrifugal latencies, success rates in memory saccades, antisaccades, and blinks were computed. We found that patients with the post-COVID-19 condition had eye movement alterations mainly in centripetal latency in visually guided saccades, the success rate in memory-guided saccade test, latency in antisaccades, and its standard deviation, which suggests the involvement of frontoparietal networks. Further work is required to understand these eye movements' alterations and their functional consequences.
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Pengo M, Murueta-Goyena A, Teijeira-Portas S, Acera M, Del Pino R, Sáez-Atxukarro O, Diez-Cirarda M, Tijero B, Fernández-Valle T, Gómez Esteban JC, Gabilondo I. Impact of Visual Impairment on Vision-Related Quality of Life in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1633-1643. [PMID: 35466953 DOI: 10.3233/jpd-213143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Visual impairment is frequent and highly disabling in Parkinson's disease (PD); however, few studies have comprehensively evaluated its impact on vision-related quality of life. OBJECTIVE To evaluate the relationship between visual function tests and the visual impairment perceived by PD patients in daily living activities. METHODS We cross-sectionally evaluated 62 PD patients and 33 healthy controls (HC). Visual disability was measured with a comprehensive battery of primary visual function and visual cognition tests (visual outcomes), and vision-related quality of life was evaluated with the National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25). The relationship between visual outcomes and NEI VFQ-25 sub-scores was analyzed with Pearson's correlations and stepwise linear regression. RESULTS In PD patients, and not in HC, most NEI VFQ-25 sub-scores were significantly correlated with Cube Analysis and Dot Counting from Visual Object and Space Perception (VOSP) battery (visual perception), Clock Drawing Test (visuoconstructive capacity) and Trail Making Test part-A (visual attention and processing speed) and to a lesser extent with high- and low-contrast visual acuity. Dot Counting (VOSP) was the test primarily associated with most NEI VFQ-25 sub-scores (5 out of 12). Roth-28 color test was the one that best explained the variance of Peripheral Vision (R2: 0.21) and Role Difficulties (R2: 0.36) sub-scores of NEI VFQ-25, while photopic contrast sensitivity explained 41% of Driving sub-score variance. CONCLUSION Vision-related quality of life in PD is mainly influenced by alterations in visual perception, visuoconstructive capacity and visual attention and processing speed. Future studies are warranted to confirm and further extend our findings.
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Affiliation(s)
- Marta Pengo
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Ane Murueta-Goyena
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Sara Teijeira-Portas
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Marian Acera
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Rocio Del Pino
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Oihane Sáez-Atxukarro
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Maria Diez-Cirarda
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Beatriz Tijero
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Neurology, Cruces University Hospital, Barakaldo, Spain
| | - Tamara Fernández-Valle
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Neurology, Cruces University Hospital, Barakaldo, Spain
| | - Juan Carlos Gómez Esteban
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
- Department of Neurology, Cruces University Hospital, Barakaldo, Spain
| | - Iñigo Gabilondo
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Neurology, Cruces University Hospital, Barakaldo, Spain
- Ikerbasque: The Basque Foundation for Science, Bilbao, Spain
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Savitt J, Aouchiche R. Management of Visual Dysfunction in Patients with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 10:S49-S56. [PMID: 32741840 PMCID: PMC7592686 DOI: 10.3233/jpd-202103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Parkinson’s disease (PD) is a movement disorder with many symptoms responsive to treatment with dopamine agonists, anti-cholinergics and the dopamine precursor, levodopa. The cardinal features of PD include tremor, rigidity, bradykinesia, and postural instability. There also are non-motor features that include sleep disorders, cognitive and affective dysfunction, hyposmia, pain and dysautonomia (constipation, bloating, orthostasis, urinary symptoms, sexual dysfunction, dysphagia). Among these non-motor features are signs and symptoms of visual system impairment that range from subtle examination findings to those causing severe disability. In this review we describe common PD-related abnormalities in the visual system, how they present, and potential treatments.
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Affiliation(s)
- Joseph Savitt
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rachid Aouchiche
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Neuro-Ophthalmology, Baltimore, MD, USA
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Hamedani AG, Bardakjian T, Balcer LJ, Gonzalez-Alegre P. Contrast Acuity and the King-Devick Test in Huntington's Disease. Neuroophthalmology 2019; 44:219-225. [PMID: 33012907 DOI: 10.1080/01658107.2019.1669668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Saccadic eye movement abnormalities are among the earliest manifestations of Huntington's disease (HD) but are difficult to quantify at the bedside. Similarly, afferent visual pathway involvement in HD is poorly characterised. The objective was to evaluate afferent and efferent visual function in HD. Participants with manifest HD (n = 19) and healthy controls (n = 20) performed the King-Devick test, a timed test of rapid number naming. Binocular high and low-contrast (2.5% and 1.25%) acuities were measured using low-contrast Sloan letter charts, and pupillometric recordings were made using a handheld NeurOptics PLR-3000 pupillometer. The NEI-VFQ-25 questionnaire with 10-item neuro-ophthalmic supplement were also completed. Unified Huntington's Disease Rating Scale (UHDRS) motor score and other clinical and demographic variables were collected. Comparisons between manifest HD and controls were performed using linear regression adjusted for confounders. Mean King-Devick time scores were 102.9 seconds in patients with manifest HD and 48.2 seconds in controls (p < .01, t-test). In unadjusted analyses, binocular high contrast acuity was seven letters (one Snellen line equivalent) lower in manifest HD than controls (p = .043). This effect was similar for low-contrast acuity, but only low-contrast acuity remained statistically significant after adjusting for covariates. Low-contrast acuity also correlated with UHDRS motor score. There were no differences in pupillary reactivity or self-reported vision-related quality of life. In conclusion, HD is associated with reduced low-contrast acuity and abnormal performance on the King-Devick test of rapid number naming. These tests are easy to administer, providing an objective quantitative measure of visual function which could be incorporated into optimised rating scales.
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Affiliation(s)
- Ali G Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tanya Bardakjian
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura J Balcer
- Departments of Neurology, Ophthalmology and Population Health, New York University School of Medicine, New York, New York, USA
| | - Pedro Gonzalez-Alegre
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Raymond G. Perelman Center for Cellular & Molecular Therapeutics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Bernstein JPK, Roye S, Weitzner D, Calamia M. Evaluating the construct validity of the King-Devick test in a psychological outpatient clinical sample. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:627-632. [PMID: 31612728 DOI: 10.1080/23279095.2019.1678159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The King-Devick test (K-D) has demonstrated sensitivity as a screener measure of ocular motor and cognitive problems. Despite its empirical support in the assessment of patients with certain injuries and disorders (e.g., concussion, reading disorders), less is known about the construct validity of the K-D. This study examined this topic in an outpatient, diagnostically heterogeneous clinical sample. A total of 70 individuals seen for an outpatient psychoeducational evaluation completed the K-D in addition to measures of intellectual abilities, speeded reading ability, simple and sustained attention, and executive functioning. Pearson correlation coefficients revealed that poorer K-D performance was associated with poorer processing speed, speeded reading ability and response time to target stimuli (r = .26-.31, p < .05). K-D performance was unrelated to other intellectual abilities, other aspects of attention, or executive functioning (all p > .05). Results suggest that the K-D demonstrates good convergent and discriminant validity in a heterogeneous outpatient clinical sample including individuals with attention-deficit hyperactivity disorder, specific learning disorders, and a number of different depressive and anxiety disorders. Findings support its wider use as a measure of reading ability and processing speed in clinical contexts.
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Affiliation(s)
- John P K Bernstein
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Scott Roye
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Daniel Weitzner
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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Oh AJ, Chen T, Shariati MA, Jehangir N, Hwang TN, Liao YJ. A simple saccadic reading test to assess ocular motor function in cerebellar ataxia. PLoS One 2018; 13:e0203924. [PMID: 30403759 PMCID: PMC6221255 DOI: 10.1371/journal.pone.0203924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 08/30/2018] [Indexed: 01/09/2023] Open
Abstract
Cerebellar ataxia is a neurological disorder due to dysfunction of the cerebellum that affects coordination of fine movement, gait, and balance. Although ataxic patients commonly exhibit abnormal eye movement and have difficulties with saccadic reading, quantification of ocular motor abilities during reading in the clinical setting is rarely done. In this study, we assess visual performance with simple reading tests that can be used in the clinical setting and performed video infrared oculography in 11 patients with hereditary or acquired cerebellar ataxia and 11 age-matched controls. We found that compared with controls, ataxic patients read significantly slower on regularly and irregularly spaced 120 single-digit number reading tasks (read aloud) (p = 0.02 for both) but not on a word reading task (read silently), although there was large variability on the word reading task. Among the 3 reading tasks, the regularly spaced number reading task had the greatest difference (44%) between ataxic patients and controls. Analysis of oculography revealed that ataxic patients had slower reading speeds on the regularly spaced number reading task because of significantly higher saccade and fixation counts, impairment of small amplitude progressive saccades as well as large amplitude, line-changing saccades, greater fixation dispersion, and irregularity of scan paths and staircase gaze patterns. Our findings show that infrared oculography remains the gold standard in assessment of ocular motor difficulties during reading in ataxic patients. In the absence of this capability in the clinical setting, a simple 120 regularly spaced single-digit saccadic number reading test, which most patients can perform in less than 2 minutes, can be a possible biomarker for ocular motor abilities necessary for reading.
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Affiliation(s)
- Angela Jinsook Oh
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Tiffany Chen
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Mohammad Ali Shariati
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Naz Jehangir
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Thomas N. Hwang
- Department of Ophthalmology, Kaiser Permanente Redwood City Medical Center, Redwood City, California, United States of America
| | - Yaping Joyce Liao
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Neurology, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
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