Visual contrast sensitivity was measured using 2 cycle/deg sinewave gratings of different orientations in 10 patients with Parkinson's disease and in 15 age-matched controls. Loss of visual contrast sensitivity was found in 6 patients, all of whom had normal visual acuity. Visual loss depended on grating orientation; in all cases the maximum sensitivity loss was for the horizontal. Sensitivity loss was most marked at a temporal frequency of 4 to 8 Hz. Visual fields gave no hint of the orientation selectivity. We conclude that orientation selectivity implicates visual cortical cells in Parkinson's disease. We tentatively suggest that a preferential loss of contrast sensitivity to horizontal gratings might be due to a functional abnormality in the striate cortex that relatively spares the extrastriate cortex. The dependence of visual loss on temporal frequency combined with the sparing of visual acuity might possibly be understood if Parkinson's disease preferentially affects the visual pathway leading from the retina to cortex via the magnocellular layer of the lateral geniculate nucleus. There is an intriguing similarity between the pattern of visual loss in Parkinson's disease and in multiple sclerosis.

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