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Tishad A, Vadakal S, Talati J, Louis M, Jacob R. Comprehensive Care for Adults with Down Syndrome in Primary Care Settings. South Med J 2024; 117:296-301. [PMID: 38830582 DOI: 10.14423/smj.0000000000001693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
This review article aims to bridge the knowledge gap in providing comprehensive care to adults with Down syndrome (DS) in primary care settings. Despite the increasing prevalence of adults with DS, there is a significant lack of familiarity and comprehensive guidelines for their health care among primary care physicians. This often results in subpar health promotion, preventive screenings, and individualized care. This article attempts to provide guidance for healthcare providers on previsit preparation, clinic visit characteristics, testing and screening considerations, and decision making/guardianship for adults with DS. By emphasizing a patient-centered approach, this review aims to enhance the quality of care, reduce associated morbidity and mortality, and ultimately improve the health outcomes of adults with DS.
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Affiliation(s)
| | | | - Jay Talati
- From the University of Florida, Jacksonville
| | - Mariam Louis
- University of Florida College of Medicine - Jacksonville, Jacksonville
| | - Rafik Jacob
- Division of General Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville
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Cheng J, Yang L, Ye Y, He L, Chen S, Wang J. Mendelian Randomisation Analysis of Causal Association between Lifestyle, Health Factors, and Keratoconus. Bioengineering (Basel) 2024; 11:221. [PMID: 38534495 DOI: 10.3390/bioengineering11030221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
Keratoconus (KC), a leading cause of vision impairment, has an unclear aetiology. This study used Mendelian randomization (MR) to explore the causal links between various factors (smoking, asthma, Down syndrome, inflammatory bowel disease, atopic dermatitis, and serum 25-hydroxyvitamin D levels) and KC. A two-sample MR design, grounded in genome-wide association study (GWAS) summary statistics, was adopted using data from FinnGen, UK Biobank, and other GWAS-related articles. The inverse-variance weighted (IVW) method was employed, complemented by the Wald ratio method for factors with only one single-nucleotide polymorphism (SNP). Sensitivity and stability were assessed through Cochrane's Q test, the MR-Egger intercept test, MR-PRESSO outlier test, and the leave-one-out analysis. The IVW results for the ORA (Ocular Response Analyzer) biomechanical parameters indicated significant associations between tobacco smoking (CH: p < 0.001; CRF: p = 0.009) and inflammatory bowel disease (CH: p = 0.032; CRF: p = 0.001) and corneal biomechanics. The Wald ratio method showed tobacco smoking was associated with a lower risk of KC (p = 0.024). Conversely, asthma (p = 0.009), atopic dermatitis (p = 0.012), inflammatory bowel disease (p = 0.017), and serum 25-hydroxyvitamin D levels (p = 0.039) were associated with a higher risk of KC by IVW, and the same applied to Down syndrome (p = 0.004) using the Wald ratio. These results underscore the role of corneal biomechanics as potential mediators in KC risk, warranting further investigation using Corvis ST and Brillouin microscopy. The findings emphasise the importance of timely screening for specific populations in KC prevention and management.
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Affiliation(s)
- Jiaxuan Cheng
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Medical Devices and Drug for Ophthalmic Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Lanting Yang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Medical Devices and Drug for Ophthalmic Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Yishan Ye
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Medical Devices and Drug for Ophthalmic Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Lvfu He
- Department of Ophthalmology, Sichuan Mental Health Center, Mianyang 621054, China
| | - Shihao Chen
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Medical Devices and Drug for Ophthalmic Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Junjie Wang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Medical Devices and Drug for Ophthalmic Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- Department of Ophthalmology, Sichuan Mental Health Center, Mianyang 621054, China
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Mathan JJ, Gokul A, Simkin SK, Meyer JJ, McGhee CNJ. Keratoconus in Down syndrome: Prevalence, risk factors, severity and corneal tomographic characteristics. Clin Exp Ophthalmol 2024; 52:22-30. [PMID: 37963802 DOI: 10.1111/ceo.14316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/17/2023] [Accepted: 10/22/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND This study investigated the prevalence, risk factors and severity of corneal tomographic features of keratoconus in Down syndrome (DS). Additionally, previous studies indicate anomalous corneal features in DS, without keratoconus, this study characterised corneal features in DS without keratoconus. METHODS This prospective observational study included participants with DS ≥10 years old. Keratoconus diagnosis, risk factors and corneal tomographic characteristics were recorded. Participants underwent slit-lamp biomicroscopy, Scheimpflug corneal tomography, corneal topography and autorefraction. A diagnosis of keratoconus (DS-KC), suspect keratoconus (DS-SK) and non-keratoconus (DS-NK) was made based on expert review of scans by three fellowship trained anterior segment ophthalmologists. Corneal tomography parameters from one eye of each participant were analysed. RESULTS Keratoconus affected 50 (26.3%) of 190 participants, diagnosed by corneal tomography, topography or slit-lamp signs. Corneal hydrops affected 14.0% of DS-KC participants. Eye rubbing was a significant risk factor for keratoconus (p = 0.036). 175 (92%) participants could undertake corneal tomography of which tomography assessment alone identified 47 (26.9%) DS-KC participants, 64 (36.6%) DS-SK participants and 64 (36.6%) DS-NK participants. Significant differences (p < 0.001) were identified when the DS-KC, DS-SK and DS-NK groups were compared in maximum keratometry and posterior elevation at the thinnest point respectively: median (interquartile range) 50.20 (10.30D), 47.60 (1.95D), 46.50 (2.40D); 24.0 (38.00 μm), 10.00 (13.75 μm), 8.00 (6.00 μm). The DS-SK and DS-NK cohorts had similar minimum pachymetry, however, had several significantly different parameters among which included greater maximum keratometry, posterior elevation at the thinnest point in the DS-SK group. CONCLUSIONS Keratoconus is common in DS. Keratoconus screening with corneal tomography is recommended for early detection.
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Affiliation(s)
- Joyce J Mathan
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Samantha K Simkin
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jay J Meyer
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Martin-Perez Y, Gonzalez-Montero G, Gutierrez-Hernandez AL, Blázquez-Sánchez V, Sánchez-Ramos C. Vision Impairments in Young Adults with Down Syndrome. Vision (Basel) 2023; 7:60. [PMID: 37756134 PMCID: PMC10536554 DOI: 10.3390/vision7030060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/24/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
People with Down syndrome have more visual problems than the general population. They experience premature ageing, and they are expected to also have an acceleration in worsening visual function. A prospective observational study which includes visual acuity, refractive error, accommodation, binocular and colour vision was performed on young adults with (n = 69) and without (n = 65) Down syndrome and on a senior group (n = 55) without Down syndrome. Results showed significant differences in visual acuity between groups (p < 0.001), and it can be improved with a new prescription in 40% of the participants with Down syndrome. Regarding the accommodative state, no significant differences were found between groups of young people. Concerning binocular vision, 64.7% of strabismus was observed in the group with Down syndrome (p < 0.001). Visual abnormalities are significant in young adults with Down syndrome and are different from those of older people without Down syndrome, some of which can be improved by providing the optimal prescription as well as regular eye examinations.
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Affiliation(s)
- Yolanda Martin-Perez
- Faculty of Optic and Optometry, Department of Optometry and Vision Science, Complutense University of Madrid, 28040 Madrid, Spain; (G.G.-M.); (A.L.G.-H.); (V.B.-S.); (C.S.-R.)
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Rojas-Carabali W, Cortés-Albornoz MC, Flórez-Esparza G, Cifuentes-González C, de-la-Torre A, Talero-Gutiérrez C. Ophthalmic manifestations in children with Down Syndrome in Bogotá, Colombia. BMC Ophthalmol 2023; 23:216. [PMID: 37189079 DOI: 10.1186/s12886-023-02863-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/15/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND To describe the ocular features of a cohort of children with Down Syndrome (DS) in Bogotá, Colombia. METHODS We performed a cross-sectional study, evaluating 67 children with DS. A pediatric ophthalmologist performed a complete optometric and ophthalmological evaluation of each child, including visual acuity, ocular alignment, external eye examination, biomicroscopy, auto-refractometry, retinoscope in cycloplegia, and fundus examination. Results were reported as frequency distribution tables with percentages for categorical variables and means and standard deviation or median and interquartile ranges for continuous variables, according to their distribution. We used the Chi-square test or Fisher's exact test for categorical variables and ANOVA or Kruskal-Wallis for continuous variables when indicated. RESULTS A total of 134 eyes from 67 children were evaluated. Males represented 50.7%. The children's age ranged from 8-16 years, with a mean of 12.3 (SD 2.30). The most frequent refractive diagnosis per eye was hyperopia (47%), followed by myopia (32.1%) and mixed astigmatism (18.7%). The most frequent ocular manifestations were oblique fissure (89.6%), followed by amblyopia (54.5%) and lens opacity (39.4%). Female sex was associated with strabismus (P = 0.009) and amblyopia (P = 0.048). CONCLUSION Our cohort had a high prevalence of disregarded ophthalmological manifestations. Some of these manifestations, such as amblyopia, can be irreversible and severely affect the neurodevelopment of DS children. Therefore, ophthalmologists and optometrists should be aware of the visual and ocular affection of children with DS to assess and provide appropriate management. This awareness could improve rehabilitation outcomes for these children.
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Affiliation(s)
- William Rojas-Carabali
- Neuroscience (NEUROS) Research Group, School of Medicine and Health Sciences, NeuroVitae Center for Neuroscience, Institute of Translational Medicine (IMT), Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia
| | - María Camila Cortés-Albornoz
- Neuroscience (NEUROS) Research Group, School of Medicine and Health Sciences, NeuroVitae Center for Neuroscience, Institute of Translational Medicine (IMT), Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia
| | - Gabriela Flórez-Esparza
- Neuroscience (NEUROS) Research Group, School of Medicine and Health Sciences, NeuroVitae Center for Neuroscience, Institute of Translational Medicine (IMT), Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience (NEUROS) Research Group, School of Medicine and Health Sciences, NeuroVitae Center for Neuroscience, Institute of Translational Medicine (IMT), Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, School of Medicine and Health Sciences, NeuroVitae Center for Neuroscience, Institute of Translational Medicine (IMT), Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia.
| | - Claudia Talero-Gutiérrez
- Neuroscience (NEUROS) Research Group, School of Medicine and Health Sciences, NeuroVitae Center for Neuroscience, Institute of Translational Medicine (IMT), Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia.
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The Ophthalmic Manifestations of Down Syndrome. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020341. [PMID: 36832470 PMCID: PMC9955748 DOI: 10.3390/children10020341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/18/2023] [Accepted: 01/29/2023] [Indexed: 02/12/2023]
Abstract
Down Syndrome is one of the most common chromosomal conditions in the world, affecting an estimated 1:400-1:500 births. It is a multisystem genetic disorder but has a wide range of ophthalmic findings. These include strabismus, amblyopia, accommodation defects, refractive error, eyelid abnormalities, nasolacrimal duct obstruction, nystagmus, keratoconus, cataracts, retinal abnormalities, optic nerve abnormalities, and glaucoma. These ophthalmic conditions are more prevalent in children with Down Syndrome than the general pediatric population, and without exception, early identification with thoughtful screening in this patient population can drastically improve prognosis and/or quality of life.
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Angulo-Chavira AQ, Castellón-Flores AM, Barrón-Martínez JB, Arias-Trejo N. Word prediction using closely and moderately related verbs in Down syndrome. Front Psychol 2022; 13:934826. [PMID: 36262448 PMCID: PMC9574260 DOI: 10.3389/fpsyg.2022.934826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/13/2022] [Indexed: 12/02/2022] Open
Abstract
People with Down syndrome (DS) have several difficulties in language learning, and one of the areas most affected is language production. Theoretical frameworks argue that prediction depends on the production system. Yet, people with DS can predict upcoming nouns using semantically related verbs. Possibly, prediction skills in people with DS are driven by their associative mechanism rather than by the prediction mechanism based on the production system. This study explores prediction mechanisms in people with DS and their relationship with production skills. Three groups were evaluated in a preferential-looking task: young adults, children with DS, and a typically developing control group paired by sex and mental age. Participants saw two images, a target and a distractor. They also heard a sentence in one of the three conditions: with a verb that was closely related to the object (e.g., "The woman read the book"), with a verb that was moderately related to the object (e.g., "My uncle waited for the bus"), or with a verb that was unrelated to the object (e.g., "My sister threw a broom"). Their productive vocabulary was then measured. In the young adult and typically developing groups, the results showed prediction in sentences with highly and moderately related verbs. Participants with DS, however, showed prediction skills only in the highly related context. There was no influence of chronological age, mental age, or production on prediction skills. These results indicate that people with DS base prediction mainly on associative mechanisms and they have difficulty in generating top-down predictions.
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Affiliation(s)
- Armando Q. Angulo-Chavira
- Laboratorio de Psicolingüística, Facultad de Psicología, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alejandra M. Castellón-Flores
- Laboratorio de Psicolingüística, Facultad de Psicología, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Julia B. Barrón-Martínez
- Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Natalia Arias-Trejo
- Laboratorio de Psicolingüística, Facultad de Psicología, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Akoto T, Li JJ, Estes AJ, Karamichos D, Liu Y. The Underlying Relationship between Keratoconus and Down Syndrome. Int J Mol Sci 2022; 23:ijms231810796. [PMID: 36142709 PMCID: PMC9503764 DOI: 10.3390/ijms231810796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Keratoconus (KC) is one of the most significant corneal disorders worldwide, characterized by the progressive thinning and cone-shaped protrusion of the cornea, which can lead to severe visual impairment. The prevalence of KC varies greatly by ethnic groups and geographic regions and has been observed to be higher in recent years. Although studies reveal a possible link between KC and genetics, hormonal disturbances, environmental factors, and specific comorbidities such as Down Syndrome (DS), the exact cause of KC remains unknown. The incidence of KC ranges from 0% to 71% in DS patients, implying that as the worldwide population of DS patients grows, the number of KC patients may continue to rise significantly. As a result, this review aims to shed more light on the underlying relationship between KC and DS by examining the genetics relating to the cornea, central corneal thickness (CCT), and mechanical forces on the cornea, such as vigorous eye rubbing. Furthermore, this review discusses KC diagnostic and treatment strategies that may help detect KC in DS patients, as well as the available DS mouse models that could be used in modeling KC in DS patients. In summary, this review will provide improved clinical knowledge of KC in DS patients and promote additional KC-related research in these patients to enhance their eyesight and provide suitable treatment targets.
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Affiliation(s)
- Theresa Akoto
- Department of Cellular Biology & Anatomy, Augusta University, Augusta, GA 30912, USA
| | - Jiemin J. Li
- Department of Cellular Biology & Anatomy, Augusta University, Augusta, GA 30912, USA
| | - Amy J. Estes
- Department of Ophthalmology, Augusta University, Augusta, GA 30912, USA
- James & Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Yutao Liu
- Department of Cellular Biology & Anatomy, Augusta University, Augusta, GA 30912, USA
- James & Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Correspondence: ; Tel.: +1-706-721-2015
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