Hans F. Lessmann, O.D., F.C.O.V.D.
Vision Development Institute, P.C.
Trisomy 21 Research Conference
September 13-14, 2003. New Orleans, LA
  Reproduced with the permission of the author.
© 2002. All rights reserved.
This material may not be published, broadcast, rewritten or redistributed by any means mechanical or electronic without the explicit written permission of the author.

Jessica Lessmann

Enhancement because:

The Dreaded "Lazy Eye" Syndrome

Lazy Eye

Today's Objective

Take Home Points on Vision and Down syndrome

About the Presenter

Jessica Lessmann


Why Scooby Doo?


Key Question

Scooby Doo
Where are you?

To see what they see we must first:

What is the cause?

Premise for People with Down syndrome


Why be intelligent?

What is the impetus for growth? —Jean Piaget

Jessica's Team

Jessica's Team

Common Issues

Money, Math & Quantities

Time Concept

Time Perception & Behavior

Happiness Defined

Well, What about Vision?

What Problems do we see with Vision and Down Syndrome?

Ocular Stats on Children with Down Syndrome

Hearing Loss in Children with DS

Out of Focus & Instability

Demonstration of Poor Fixation and /or Tracking


Demonstration of Poor Eye Teaming

Double Vision

Binocularity — "it's a miracle"

Key Visual Skills, besides Acuity

Vision Facts

A Quote from Psychology

...."Vision is our most dominant sense, and this is reflected in our own internal hardware, since more of the brain is devoted to processing vision than all the other senses put together." p 151
"The Right Mind" published by Harcourt 1997 by psychologist, Dr. Robert Ornstein

Vision's Uniqueness

How Does Vision Develop?

Synaptic Density as an Indicator of Sensory Development Chronology

Synaptic Density as an Indicator of Sensory Development Chronology

Vision Development Depends On:

Optometric Significance

What two human functions are frequently most affected in challenged children?

  1. Speech
  2. Vision
  3. However, I would reverse the above
  4. Speech is obvious, because we hear it
  5. But Vision is covert in it's function as well as it's dysfunction,
  6. Hence it's dysfunction is hidden

What is covert about vision?

Can you see this?

What is this? Cow



20/20 is not Perfect Vision!!!

What's else is the Problem?

What are the Unique Optometric Considerations for individuals with DS?

The Problem of Blur & The Problem of Double Vision

The Problem of Blur

Close Working Distance

Close Working Distance

Contrast Problem: Pencil vs. Print

Contrast Problem

Cardiff University, University of Wales College of Medicine, & others DS Accommodation Study

How would I then characterize the visual system of one with DS

Unstable & Fragile

Focus Analogy

Like an end stage adult presbyope
One who has worn bifocals for a while

Why are bifocals generally not prescribed?

Jessica's Optometric Findings

Bifocals in Action

Bifocals in Action

Bifocals a Must!!!

A Case Study

Case Study Case Study

How does your eye doctor know what to prescribe?

When they say yes to everything.

Static & Dynamic Retinoscopy

What to avoid?

What to avoid? What to avoid?

Small Room / Big Room

Small Room

What is the problem?

What to ask for?

A dry trial frame refraction based on retinoscopy

Will you get it?

What about Double Vision?

Signs, Symptoms, & Behaviors

Problem for Surgeon & Prescribing

What is Suppression?

What is the Problem with Suppression?

Lost Fixation

Lost Fixation

Patching for Double Vision

Patching for Double Vision

Patching for Double Vision

Thick Glasses - Distortive

Thick Glasses - distortive

Crossed Right Eye with Glasses

Crossed Right Eye with Glasses

Crossed Left Eye (alternating) with Glasses

Crossed Left Eye (alternating) with Glasses

Closed Right Eye with Excessive Blinking to Try and Manage the Diplopia

Closed Right Eye with Excessive Blinking to Try and Manage the Diplopia

Uncorrected Crossed Right Eye and Stressed

Uncorrected Crossed Right Eye and Stressed

Contacts and Straight Eyes

Contacts and Straight Eyes

Contact Removal

Contact Removal

Qualifiers on Visual Performance

Visual Perception

Cautionary Note: Be wary of the high verbal

More Confusion—Who does what? The 3 O's

What is lacking in Vision Care for Down Syndrome

Take Home Points

Why Help These People?

The Assets



So We Can All Be Winners!!!

So We Can All Be Winners!!!

Contact Information

Vision Development Institute, P.C.
Hans F. Lessmann, OD, FCOVD
1789 S. Braddock Ave.
Suite 130
Pittsburgh, PA 15218
Voice 412-731-5007
Fax 412-731-5251
Email: visiondevelopment1992@yahoo.com


Additional Web Sites

Developmental Delay Resources
DDR www.devdelay.org
Parents Active for Vision Education
PAVE www.pave-eye.com
College of Optometrists in Vision Development
COVD www.covd.org
Optometric Extension Program Foundation
OEPF www.oep.org
American Foundation for Vision Awareness
AFVA www.afva.com
American Optometric Association
AOA www.aoa.org


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