Visual and binocular status of Down syndrome children in Malaysia

Vision Impairments in Young Adults with Down Syndrome

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.

Ocular alignment, media, and eyelid disorders in Down syndrome

Background: Determining the age and gender distribution of ocular disorders in Down syndrome patients aged 10 to 30 years.Methods: In this study, 226 of 250 invited patients through special needs schools, the National Down Syndrome Society, and relevant nonprofit organizations were included. In Noor Eye Hospital, the patients underwent a complete eye examination by a general ophthalmologist and suspect cases were reexamined by a sub-specialist. Examinations included ocular alignment, conjunctiva, eyelid, lacrimal system, cornea, iris, and lens assessment.Results: Mean age of participants was 16.05 ± 4.82 years and 53.0% were male. The most common ocular abnormalities were blepharitis (81.9%, 95% CI:78.0 to 85.3), lens opacity (37.8%, 95% CI:33.3 to 42.3), strabismus (23.4%, 95% CI:19.5 to 27.4; 21.2% esotropia, 0.9% exotropia, and 1.8% dissociated vertical deviation), floppy eyelid (19.9%, 95% CI:16.3 to 23.9), posterior embryotoxon (17.7%, 95% CI:14.2 to 21.2) and nystagmus (11.7%, 95% CI:8.9 to 15.0). Based on independent sample t test, the prevalence of nystagmus (P = .041) and congenital lens opacity  (P<0.001) significantly increased with age. There was no significant inter-gender difference in the prevalence of any of the studied disorders by chi-square test.Conclusion: In young patients with Down syndrome, the prevalence of ocular pathologies appears to be high and increase with aging. It can be resulted from the cumulative prevalence of undiagnosed or untreated cases. Findings of the study can be a reliable reference for health policy in terms of screening for eye disease and addressing eye care needs.

Ocular findings in Japanese children with Down syndrome: the course of visual acuity and refraction, and systemic and ocular anomalies

PURPOSE

To investigate the age-related development of refractive errors and changes of visual acuity (VA), and the systemic and ocular anomalies in Japanese children and young adults with Down syndrome (DS).

DESIGN

Retrospective cohort study.

SUBJECTS AND METHODS

This study involved 222 Japanese children and young adults with DS (age range: 3 months to 19 years) seen at the Department of Ophthalmology, Shiga Medical Center for Children, Shiga, Japan. The subjects were divided into the following six age groups: 1) infant (age 0 to <4 years), 2) preschool (age 4 to <7 years), 3) lower primary-school grades (age 7 to <10 years), 4) upper primary-school grades (age 10 to <13 years), 5) junior high school (age 13 to <16 years), and 6) late teen/young adults (age 16 to <20 years). Through examination of the subjects' medical charts, we investigated the development and changes of refractive errors and VA, best-corrected VA (BCVA), and systemic and ocular anomalies.

RESULTS

For vision testing, Teller Acuity Cards™ (Bernell Corporation) were used for the infants, and the Landolt ring was used for the school-age children. VA was found to develop with age. Mean BCVA was 0.19±0.17 logarithm of the minimum angle of resolution (mean age: 11.3±3.2 years). Mean of refractive errors was hyperopia in the infant (2.2±2.4 diopters [D] OD, 2.4±2.5D OS), yet became myopia to the junior high school (-0.3±4.4D OD, -0.2±4.4D OS).

CONCLUSION

Our findings revealed that in children and in late-teen and young-adult subjects with DS, VA slowly develops and that refractive errors requiring correction exist and are difficult to examine.

Visual characteristics of children with Down syndrome

PURPOSE

To analyze long-term visual development in children with Down syndrome who received early ophthalmological intervention.

METHODS

A total of 125 children with Down syndrome who were examined before 6 years of age and followed up for more than 5 years were selected. Visual development, refraction, visual acuity testing, and the prescription of spectacles were examined retrospectively.

RESULTS

Mean visual acuity by age was as follows: 2 years, 1.13 ± 0.23 logarithm of the minimum angle of resolution (logMAR); 5 years, 0.55 ± 0.25 logMAR; 8 years, 0.27 ± 0.19 logMAR; 11 years, 0.17 ± 0.16 logMAR; and 14 years, 0.10 ± 0.15 logMAR. In 32 children (25.6%), visual acuity reached 0.0 logMAR or better. Hyperopia of +2D or more was observed in 132 eyes (52.8%), and astigmatism of 2D or more was observed in 153 eyes (61.2%). Subjective testing was difficult in many children prior to 4.5 years of age, and grating acuity testing was necessary. Spectacles were prescribed at a mean age of 3.5 ± 1.6 years in 120 children (96.0%). The average duration until the spectacles were worn constantly was 9.0 ± 9.3 months.

CONCLUSION

Early ophthalmological intervention and longitudinal care is important for children with Down syndrome.

Visual function of children with visual and other disabilities in Oman: A case series

Background:

We assessed the visual functioning of the children with special needs in Oman between 2009 and 2012. We present the methods of assessing different visual functions, outcomes, and interventions carried out to improve their functioning.

Methods:

Optometrists assessed visual functions of children of “Day care centres” in Oman. Experts further assessed them and provided low vision care. Ocular movements, refractive corrections, near, distance, contrast color, motion, field of vision, and cognitive visual function test results were noted. Feedback to caregivers was given to improve visual functioning of these children.

Results:

We grouped 321 participants, (196 [61.1%] boys, age range of 3–18 years) into 61; Down syndrome (DS), 72 with intellectual disabilities (IDs), 67; hearing impaired and 121 with other conditions. Refractive error and lag of accommodation were 26 (42.6%) and 14 (22.6%) among children with DS. Contrast sensitivity was impaired in 8 (12.7%) among hearing impaired children. Defective distant and near vision was in 162 (70%) and 104 (42%) of our cohort. Children with ID were most difficult to assess. Children in a group of other disabilities had a higher proportion of impaired visual functioning. They were given low vision aids (telescopes [22], filters [7], and magnifiers [3]) in large numbers compared to those in other groups.

Conclusions:

Visual functioning of children with other disabilities show great variation and difficult to group. The care, therefore, should be at individual level. All visual functions cannot be assessed at one time.

Visual function of children with visual and other disabilities in Oman: A case series

Background:

We assessed visual functioning of the children with special needs in Oman between 2009 and 2012. We present the methods of assessing different visual functions, outcomes and interventions carried out to improve their functioning.

Materials and Methods:

In this case series type of study, optometrists assessed visual functions of children of “day care centers” in Oman. Experts further assessed them and provided low vision care. Ocular movements, refractive corrections, near, distance, contrast color, motion, field of vision and cognitive, visual function test results were noted. Feedback to caregivers was given to improving visual functioning of these children.

Results:

We grouped 321 participants, (196 (61.1%) boys, age range of 3-18 years) into 61; Down syndrome (DS), 72 with intellectual disabilities, 67; hearing impaired and 121 with other conditions. Refractive error and lag of accommodation was 26 (42.6%) and 14 (22.6%) among children with DS. Contrast sensitivity was impaired in 8 (12.7%) among hearing impaired children. Defective distant and near vision was in 162 (70%) and 104 (42%) of our cohort. Children with intellectual disability were most difficult to assess. Children in group of other disabilities” had a higher proportion of impaired visual functioning. They were given low vision aids (telescopes (22), filters (7) and magnifiers (3)) in large numbers compared to those in other groups.

Conclusions:

The outcomes of assessment of visual functioning of children with other disabilities show great variation and difficult to group. The care therefore should be individual. All visual functions cannot be assessed at one time.

Ophthalmic manifestations in children and young adults with Down syndrome and congenital heart defects

PURPOSE

To investigate whether different types of ocular manifestations are associated with congenital heart disease (CHD) in a large Caucasian population of children and young adults with Down syndrome (DS).

METHODS

Population-based, case-control study which included 185 subjects with DS (mean age 13.2 ± 7.9 years), who reported presence or absence of CHD; DS with CHD group (51 subjects, mean age 10.6 ± 5.6 years) and DS without CHD (134 subjects, mean age 14.2 ± 8.4 years).

RESULTS

In our sample with DS and CHD, strabismus was found in 15 subjects (29.4%), nystagmus in 1 (2.0%), epiblepharon in 21 (41.2%) and Brushfield spots in 15 (31.3%). In the DS without CHD group, strabismus was found in 38 participants (28.4%), nystagmus in 13 (9.7%), epiblepharon in 31 (23.5%) and Brushfield spots in 21 (16.0%). Only the variables epiblepharon and presence of Brushfield spots differed significantly between the two groups (p = 0.02 and p = 0.03, respectively). Hyperopia was present in 26 participants (53.1%) in the DS with CHD group, and in 65 (57.0%) in the DS without CHD group. Oblique astigmatism was present in 25 (52.1%) in the DS with CHD group and in 61 (53.5%) in the DS without CHD group.

CONCLUSIONS

Frequencies of DS participants presenting with strabismus, nystagmus, hyperopia and oblique astigmatism were not statistically different between those with CHD and those without CHD in this sample. Further studies are needed to confirm if there are associations between the presence of Brushfield spots or epiblepharon and CHD in patients with DS.

The accuracy of photoscreening at detecting treatable ocular conditions in children with Down syndrome

BACKGROUND

Children with Down syndrome (DS) have an increased prevalence of ocular disorders, including amblyopia, strabismus, and refractive error. Health maintenance guidelines from the Down Syndrome Medical Interest Group recommend ophthalmologic examinations every 1 to 2 years for these children. Photoscreening may be a cost-effective option for subsequent screening evaluations after an initial complete examination, but no study has evaluated the accuracy of photoscreening in children with DS. The purpose of this study is to determine the sensitivity, specificity, and positive and negative predictive values of photoscreening in detecting treatable ocular conditions in children with DS.

METHODS

Photoscreening and complete ophthalmologic evaluations were performed in 50 consecutive 3- to 10-year-old children with DS. Sensitivity, specificity, and positive and negative predictive values were calculated with the use of ophthalmologic examination findings as the reference standard.

RESULTS

Most children were able to complete photoscreening (94% with Medical Technology and Innovations [MTI] and 90% with Visiscreen OSS-C [VR]). Many children had an identified diagnosis on ophthalmologic examination (n = 46, 92%). Of these, approximately one-half (n = 27, 54%) had one or more condition(s) requiring treatment. Both the MTI and VR photoscreening devices had a sensitivity of 93% (95% confidence interval 0.76-0.99) for detecting treatable ocular conditions. The specificities for the MTI and VR photoscreening were 0.35 (0.18-0.57) and 0.55 (0.34-0.74), respectively.

CONCLUSIONS

Photoscreening is sensitive but less specific at detecting treatable ocular conditions in children with DS. In specific instances, the use of photoscreening in the DS population has the potential to save time and expense related to routine eye examinations, particularly in children with a normal baseline comprehensive examination.

Bifocals in children with Down syndrome (BiDS) - visual acuity, accommodation and early literacy skills

PURPOSE

Reduced accommodation is seen in children and young adults with Down syndrome (DS), yet providing bifocals has not become a routine clinical management. This study investigates the impact of bifocals on visual function, visual perceptual and early literacy skills in a group of school children with DS.

METHODS

  In this longitudinal study, each child was followed for 5months with single-vision (SV) lenses after which bifocals were prescribed if required, based on their accommodative response. Visual acuity (VA), accommodation, perceptual and literacy skills were measured after adaptation to bifocals and 5months later. Educational progress and compliance with spectacle wear were assessed through school and parental reports.

RESULTS

  Fourteen children and young adults with DS participated in the study. Eighty-five percent required bifocals with additions ranging from +1.00D to +3.50D. The mean near logMAR VA improved with bifocals (p=0.007) compared to SV lenses. Repeated measures anova showed that there was more accurate focus (less accommodative lag) through the bifocals (p=0.002), but no change in the accommodation exerted through the distance portion compared to SV lenses (p=0.423). There was a main effect of time on sight words (p=0.013), Word Identification (p=0.047), Visual Closure (p=0.006) and Visual Form Constancy (p=0.001).

CONCLUSION

Bifocals provide clearer near vision in DS children with reduced accommodation. This is shown by improved VA and decreased lag of accommodation. The results indicate that the improvement in VA results in improved scores in early literacy skills. Better compliance with bifocals over SV lenses was seen.

Ophthalmic abnormalities in children with Down syndrome

A comprehensive review of the available literature was performed to determine the common ophthalmic disorders in children aged 0 to 16 years with Down syndrome. The UK National Library for Health interface was used to search seven electronic databases, including MEDLINE and EMBASE. Terms related to Down syndrome, ophthalmology, and pediatrics were combined in the search strategy, which yielded 230 articles. Application of exclusion criteria left 23 articles to include in the review. Literature synthesis demonstrated that children with Down syndrome are at risk for several ocular disorders. Refractive error was a common finding, particularly hyperopia. Strabismus was also reported regularly, particularly esodeviation. Other frequent findings included poor visual acuity, nystagmus, and blepharitis, whereas cataract and glaucoma were less common but had potentially serious implications for future vision. Only one study compared routine pediatric examination to that of a pediatric ophthalmologist. The findings of this review confirm the need for an ophthalmic screening program for children with Down syndrome. Additional work should investigate how such a program could be best implemented and ascertain how to involve different professionals in such a service.

Refractive errors and strabismus in children with Ddown syndrome: a controlled study

PURPOSE

To evaluate the prevalence of refractive errors, strabismus, nystagmus, and congenital cataract in children with Down syndrome and control subjects of similar age.

METHODS

Seventy-seven children with Down syndrome and 151 control subjects were evaluated for the prevalence of ocular findings.

RESULTS

Ocular findings were discovered in 97.4% of children with Down syndrome and 42.4% of control subjects (P < .0001). The point prevalence of nystagmus, strabismus, hypermetropia, astigmatism, and congenital cataract was significantly higher in children with Down syndrome (P < .0001 for the first four categories, and P < .01 for congenital cataract).

CONCLUSION

Evaluation, treatment, and regular review of ocular and refractive findings in children with Down syndrome is urgently needed.

Refractive errors and ocular findings in children with intellectual disability: a controlled study

PURPOSE

To evaluate the ocular findings and refractive errors in children with intellectual disability and in controls of average intellectual development of similar socioeconomic backgrounds.

METHODS

The study was conducted at Diskapi Children's Hospital in Ankara, Turkey: 724 subjects with intellectual disability and 151 control subjects were evaluated. The subjects with intellectual disability were subdivided into mild (IQ 50-69, n = 490), moderate (IQ 35-49, n = 164), and severe (IQ <34, n = 70) groups, and syndromic (n = 138) versus nonsyndromic (n = 586) disability. All children underwent cycloplegic autorefraction or retinoscopy, slit-lamp biomicroscopy, and dilated fundus examination. Ocular alignment was assessed by Hirschberg, Krimsky, or prism cover test. The main outcome measure was the prevalence of refractive errors and ocular findings.

RESULTS

Seventy-seven percent of subjects with intellectual disability, and 42.4% of controls, had ocular findings. The children with intellectual disability had significantly more nystagmus, strabismus, astigmatism, and hypermetropia than controls. Children with syndromic intellectual disability had significantly more nystagmus, strabismus, astigmatism, and hypermetropia than subjects with nonsyndromic intellectual disability. Increasing severity of intellectual disability was related to higher prevalence of nystagmus, strabismus, astigmatism, hypermetropia, and anisometropia.

CONCLUSIONS

From a public health perspective, evaluation and treatment of ocular and refractive findings in children with moderate, severe, and syndromic intellectual disability categories is urgently needed and likely to be highly effective in alleviating future health and social care costs, as well as improving the productive lives of individuals with intellectual disability.