Objective: To evaluate the presence of changes in color vision in patients with REM sleep behavior disorder (RBD), Parkinson’s disease (PD), and controls.

Background: Visual dysfunction has been identified in neurological diseases and can be detected through ophthalmological exams1. It has been reported that color vision deficiency may serve as a preclinical marker for neurodegenerative diseases2,3. Therefore, the possibility of identifying these markers offers an opportunity for early diagnosis. Furthermore, changes in color vision have been associated with a higher risk of dementia in patients with PD and have also been identified as markers of neurodegeneration in RBD, which is considered a prodromal manifestation of the disease4,5,6. Despite its importance, the impact of color vision dysfunction in RBD patients has not been well studied.

Method: This is an observational case-control study, with a convenience sample of 21 individuals with clinical manifestations of RBD, 14 with PD, and 18 controls, from the city of Veranópolis-RS. The participants were evaluated using the Farnsworth D-15 color vision test, along with a standard ophthalmological evaluation and a sociodemographic questionnaire, from December 2023 to August 2024.

Results: Monocular evaluation of the Farnsworth D-15 test between the groups showed an altered test in the right eye in 69.2% of PD, 55.0% of the RBD group, and 17.6% of the controls (p = 0.011); in the left eye, the altered test occurred in 81.8% of PD, 42.9% of RBD, and 16.7% of the controls (p = 0.003). In binocular evaluation, color deficiency differed between the three groups (p = 0.005). Our results showed that color deficiency was more common in the group with clinical manifestations of RBD compared to controls but less frequent than in the group of PD patients, suggesting a gradual increase in the condition between the groups analyzed.

Conclusion: Determining the frequency of color vision deficiency in PD and in the group with clinical manifestations of RBD, considered a prodromal phase of PD, may contribute to understanding this clinical sign as an early marker of neurodegeneration. Color vision assessment in elderly individuals has shown to be a promising tool for the early identification of individuals at risk of developing PD.

References: 1.Grzybowski, Andrzej, and Piero Barboni. 2016. OCT in Central Nervous System Diseases: The Eye as a Window to the Brain. Springer.
2.Birch, J., R. U. Kolle, M. Kunkel, W. Paulus, and P. Upadhyay. 1998. “Acquired Colour Deficiency in Patients with Parkinson’s Disease.” Vision Research 38 (21): 3421–26.
3.Li Y, Zhang H, Mao W, Liu X, Hao S, Zhou Y, Ma J, Gu Z, Chan P. 2019. “Visual Dysfunction in Patients with Idiopathic Rapid Eye Movement Sleep Behavior Disorder.” Neuroscience Letters 709 (September):134360.
4.Fereshtehnejad, Seyed-Mohammad, Chun Yao, Amelie Pelletier, Jacques Y. Montplaisir, Jean-François Gagnon, and Ronald B. Postuma. 2019. “Evolution of Prodromal Parkinson’s Disease and Dementia with Lewy Bodies: A Prospective Study.” Brain: A Journal of Neurology 142 (7): 2051–67.
5.Postuma, Ronald B., Jean-François Gagnon, Mélanie Vendette, Catherine Desjardins, and Jacques Y. Montplaisir. 2011. “Olfaction and Color Vision Identify Impending Neurodegeneration in Rapid Eye Movement Sleep Behavior Disorder.” Annals of Neurology 69 (5): 811–18.
6.Postuma, Ronald B., Alex Iranzo, Michele Hu, Birgit Högl, Bradley F. Boeve, Raffaele Manni, Wolfgang H. Oertel, et al. 2019a. “Risk and Predictors of Dementia and Parkinsonism in Idiopathic REM Sleep Behaviour Disorder: A Multicentre Study.” Brain: A Journal of Neurology 142 (3): 744–59.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/color-vision-in-patients-with-clinical-manifestations-of-rem-sleep-behavior-disorder/