Ophthalmology & Down Syndrome Abstracts

Invest Ophthalmol Vis Sci 42 (1): 55-63 (2001 Jan)

Accommodation and refractive error in children with Down syndrome: cross-sectional and longitudinal studies

Cregg M, Woodhouse JM, Pakeman VH, Saunders KJ, Gunter HL, Parker M, Fraser WI, Sastry P.
Department of Optometry and Vision Sciences, Cardiff University, Wales, United Kingdom

PURPOSE: To examine the relationship between defective accommodation and refractive errors in children with Down syndrome. METHODS: Children with Down syndrome aged 4 to 85 months were seen at their homes as part of an ongoing study of visual development. Seventy-five children contributed cross-sectional data and 69 children longitudinal data. Accommodation was measured using a modification of Nott dynamic retinoscopy technique, and refractive error measurements were obtained using Mohindra retinoscopy. RESULTS: Accommodation was poor, regardless of the refractive error present. The total accommodation produced by the children was related to the refractive error at the time of the test, with the degree of accommodation deficit increasing with the amount of positive refractive error. The longitudinal results showed that although children with Down syndrome did not accommodate accurately, the amount of accommodation elicited did not reflect their maximum amplitude of accommodation. Each child showed a consistent degree of underaccommodation for a given stimulus. Spectacles to correct hypermetropia did not improve the accommodative response. CONCLUSIONS: In children with Down syndrome, underaccommodation is substantial, even when there is no, or a fully corrected, refractive error. The accommodation system of children with Down syndrome may have the physical capacity to respond to a given stimulus, but the neural control of the system has an anomalous set point. Spectacles do not remedy the situation. This has important implications, especially for children in a learning environment, because near vision is consistently out of focus.
Pediatr Neurol 16 (4): 311-4 (1997)

Ocular Abnormalities in Down Syndrome: An Analysis of 140 Chinese Children

Wong, V; Ho, D

One hundred forty Chinese children with Down syndrome (DS) treated in the Child Assessment Centre of the Duchess of Kent Children's Hospital in Hong Kong between 1985 and 1996 underwent a detailed ophthalmologic evaluation, including test of visual acuity by behavioral testing or retinoscopy, determination of ocular motility, visual field examination, binocular examination for strabismus, determination of near point convergence and pupillary reflex, and/or slit lamp bimicroscopy and ophthalmoscopy to assess ocular health. Only 43 children (31%) had no ocular abnormalities. The overall incidence of ocular abnormalities was 69%, and included refractive error (58%), strabismus (20%), nystagmus (11%), blepharitis/conjunctivitis (7%), lens opacities (4%), and glaucoma (0.7%). No child had Brushfield spots or keratoconus. The incidence of refractive errors increased with increasing age and nearly doubled at school age. As compared with white children with DS, the Chinese children with DS exhibited a higher incidence of refractive error and a similar incidence of lens opacities but a lower incidence of strabismus, nystagmus, blepharitis, Brushfield spots, and keratoconus. Regular visual surveillance, especially of visual acuity, in children with DS as they mature is important in preventing amblyopia.
Pa Med 99 (Suppl): 67-70 (1996 Mar)

Ocular Manifestations in Down Syndrome

Davis JS

Down syndrome patients have characteristic ocular findings and associated problems and should have periodic ophthalmologic examinations. The ocular abnormalities of Down syndrome are, for the most part, amenable to treatment and significant visual loss should rarely occur in these patients. Early recognition and treatment will minimize added problems of visual deprivation and permit the patient with Down syndrome to function at his or her highest level of potential.
J Intellect Disabil Res 40 (1): 49-55 (1996 Feb)

Visual Acuity and Accommodation in Infants and Young Children with Down's Syndrome

Woodhouse JM; Pakeman VH; Saunders KJ; Parker M; and others
Department of Optometry and Vision Sciences, UWCC

Accommodation and visual acuity were measured in 53 children with Down's syndrome aged between 12 weeks and 57 months. Results were compared with data for 136 control (typically developing) children aged between 4 weeks and 48 months. Whereas the control children accommodated accurately on near targets, accommodation was defective in 92% of the children with Down's syndrome, and there was no change in accommodative ability with age. On the other hand, visual acuity lay within normal limits for the younger children. Children over the age of 2 years showed a below-normal visual acuity, which is not explained either by refractive error or by the effect of poor accommodation. The data suggest a sudden change in the rate of development of visual acuity which may be associated with physiological changes in the visual cortex. Previously reported defects of accommodation and visual acuity in older children and adults with Down's syndrome are confirmed by our findings in infants and young children.
Am J Ophthalmol 122 (2): 236-44 (1996)

Ocular Findings in Down's Syndrome

da Cunha, RP; and Moreira, JB

PURPOSE: To identify the most common ocular findings in a pediatric group of patients with Down's syndrome. METHODS: A total of 152 children with Down's syndrome between two months and 18 years of age prospectively underwent ocular examination, including visual acuity assessment, slit-lamp biomicroscopy, ocular motility, cycloplegic retinoscopy, and ophthalmoscopy. RESULTS: Ocular findings in decreasing prevalence were the following: upward slanting of the palpebral fissure with the outer canthus 2 mm or higher than the inner canthus (82%), epicanthal folds (61%), astigmatism (60%), iris abnormalities (52%), strabismus (38%), lacrimal system obstruction (30%), blepharitis (30%), retinal abnormalities (28%), hyperopia (26%), amblyopia (26%), nystagmus (18%), cataract (13%), and myopia (13%). Visual acuity was assessed, and the Teller acuity cards were the most useful method of examination. The patients younger than five years old had a higher prevalence of hyperopia than did those in other age groups; patients between five and 12 years old had a higher prevalence of astigmatism; and patients older than 12 years of age had more iris abnormalities, strabismus, and cataract. Myopia and myopic astigmatism were more common in the patients with cardiac malformations. CONCLUSION: The early diagnosis of the ocular abnormalities in patients with Down's syndrome, by using Teller acuity cards in assessing visual acuity facilitates the treatment of refractive errors, strabismus, and amblyopia and may minimize handicaps.
Pediatr 45 (2): 137-9 (1996)

Ophthalmological Exploration of Children with Down's Syndrome

Gonzalez, VI et al

BACKGROUND: Down's Syndrome is the most frequent chromosomal aberration. There is a wide variety of symptoms. From an ophthalmological point of view, numerous alterations associated with Down's Syndrome have been described. MATERIAL AND METHODS: We have carried out a complete ophthalmic exploration on 60 children with Down's Syndrome and 60 control children. RESULTS: The first group showed a high percentage of refraction errors (90%), nystagmus (28%), strabismus (48%) and cataracts (13%). If we compare these results with those of the control group we find that the Down's group has a frequency significantly higher both in refraction errors as a whole (p 0.001) and myopia (p 0.01), hypermetropia (p 0.02) and stigmatism (p 0.001). They have also shown a frequency significantly higher of strabismus (p 0.001). CONCLUSION: All of the observed alterations can have a negative influence on the appropriate educational development of these children. An early ophthalmological exploration would be advisable in children with Down's Syndrome.
Dev Med Child Neurol 36 (7): 594-600 (1994 Jul)

Ophthalmic Disorders in Children with Down Syndrome

Roizen NJ; Mets MB; Blondis TA
Department of Pediatrics, Wyler Children's Hospital, Chicago IL

The goal of this study was to determine the frequency of ophthalmic disorders in a group of young children with Down syndrome who were unselected for ophthalmic abnormalities' and to determine whether examination by a pediatric ophthalmologist should become standard practice. Of 77 children referred to a Down syndrome clinic at a teaching hospital and evaluated by a pediatric ophthalmologist' 61 per cent had ophthalmic disorders needing treatment and monitoring. Furthermore' the percentage of children with ophthalmic disorders increased with age' from 38 per cent in the two- to 12-month-old group to 80 per cent in the five- to 12-year-old group. The authors conclude that children with Down syndrome should be evaluated by a pediatric ophthalmologist in the first six months of life and annually thereafter.
Ophthalmic Physiol 14 (1): 25-31 (1994 Jan)

Facial characteristics in children with Down's syndrome and spectacle fitting

Woodhouse JM, Hodge SJ, Earlam RA

Significant refractive error is very common among children with Down's syndrome so the requirement for spectacles for this group is high. The aim of this study was to measure the facial characteristics of children with Down's syndrome and to compare them with two previous studies which have aided the design of children's spectacle frames. The study was carried out in two schools in South Wales, measuring 20 children between the ages of 3.6 and 14.4 years. The results show that between the ages of 7 and 14 years, facial characteristics of children with Down's syndrome do not change with age and rarely coincide with those of other children, either of a similar age or younger. Thus children with Down's syndrome cannot be fitted satisfactorily with conventional children's frames, and it would be desirable for a specially designed range of frames to be made available.
Ophthalmology 97 (11): 1439-44 (1990)

Nystagmus in Down's Syndrome

Wagner, RS; Caputo, AR; Reynolds, RD

The incidence and characteristics of nystagmus in Down's syndrome are unclear. In 188 consecutive patients, 56 had nystagmus. Most had no clinically recognizable ocular pathology to account for the nystagmus.Twenty-nine had fine rapid horizontal nystagmus, 14 had a dissociated nystagmus which appeared pendular, whereas 9 had a form of latent or manifest latent nystagmus. Of the total patients with nystagmus, 41 had esotropia. Our findings suggest that fine rapid horizontal nystagmus, sometimes dissociated, occurs frequently in patients with Down's syndrome.
Clin Pediatr (Phila) 28 (8): 355-358 (1989 Aug)

Down Syndrome. Clinical Review of Ocular Features

Caputo AR, Wagner RS, Reynolds DR, Guo SQ, Goel AK

A total of 187 medical records of Down syndrome individuals over a 10-year period were reviewed retrospectively for strabismus, myopia, hyperopia, astigmatism, nystagmus, cataract, glaucoma, and other significant eye findings. This study showed that a higher proportion of these individuals than reported in previous studies had strabismus (57%). Refractive errors of myopia (22.5%), hyperopia (20.9%) and astigmatism (22%) were common. The primary care physician needs to be aware of the specific eye problems of Down syndrome individuals so that he or she may initiate or refer the patient for appropriate ophthalmologic care, because most of the eye findings in Down syndrome are treatable. Significant visual loss, a usually avoidable event in Down syndrome, should occur rarely.