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Anderson HA. Sources of reduced visual acuity and spectacle treatment options for individuals with Down syndrome: Review of current literature. Ophthalmic Physiol Opt 2024. [PMID: 39092592 DOI: 10.1111/opo.13372] [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: 06/26/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 08/04/2024]
Abstract
Individuals with Down syndrome are known to have a greater prevalence of ocular conditions such as strabismus, nystagmus, elevated refractive error, poor accommodative function, elevated higher-order optical aberrations and corneal abnormalities. Related to these conditions, individuals with Down syndrome commonly have reduced best-corrected visual acuity at both far and near viewing distances across their lifespan. This review summarises the various optical sources of visual acuity reduction in this population and describes clinical trials that have evaluated alternative spectacle prescribing strategies to minimise these optical deficits. Although refractive corrections may still have limitations in their ability to normalise visual acuity for individuals with Down syndrome, the current literature provides evidence for eye care practitioners to consider in their prescribing practices for this population to maximise visual acuity. These considerations include accounting for the presence of elevated higher-order aberrations when determining refractive corrections and considering bifocal lens prescriptions, even for young children with Down syndrome.
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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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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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Mathan JJ, Simkin SK, Gokul A, McGhee CNJ. Down syndrome and the eye: ocular characteristics and ocular assessment. Surv Ophthalmol 2022; 67:1631-1646. [DOI: 10.1016/j.survophthal.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 01/20/2023]
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Haseeb A, Huynh E, ElSheikh RH, ElHawary AS, Scelfo C, Ledoux DM, Maidana DE, Elhusseiny AM. Down syndrome: a review of ocular manifestations. Ther Adv Ophthalmol 2022; 14:25158414221101718. [PMID: 35795721 PMCID: PMC9252013 DOI: 10.1177/25158414221101718] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/27/2022] [Indexed: 02/01/2023] Open
Abstract
Down syndrome is the most common genetically mediated intellectual disability. Although many physiologic and pathologic features of Down syndrome are discussed at length in the literature, the ocular manifestations of Down syndrome have seldom been discussed in a comprehensive fashion. Given that Down syndrome has ocular manifestations from the front to the back of the eye, it is important for physicians to become familiar with these manifestations, especially given the prevalence of Down syndrome. This review aims to discuss the varied ophthalmologic manifestations of Down syndrome – including strabismus, amblyopia, nystagmus, accommodation deficits, nasolacrimal duct obstruction, keratoconus, optic nerve pathology, neoplastic disease, and retinal pathology – to facilitate better care and visual outcomes in this important patient population.
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Affiliation(s)
- Abid Haseeb
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Elisah Huynh
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Reem H ElSheikh
- Department of Ophthalmology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | | | - Christina Scelfo
- Department of Ophthalmology, Boston Children's Hospital, Hawthorne, NY, USA
| | - Danielle M Ledoux
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel E Maidana
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Pease A, Goodenough T, Borwick C, Watanabe R, Morris C, Williams C. Development of a core outcome set for evaluative research into paediatric cerebral visual impairment (CVI), in the UK and Eire. BMJ Open 2021; 11:e051014. [PMID: 34588256 PMCID: PMC8483040 DOI: 10.1136/bmjopen-2021-051014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Cerebral visual impairment (CVI) comprises a heterogeneous group of brain-related vision problems. A core outcome set (COS) represents the most important condition-specific outcomes according to patients, carers, professionals and researchers. We aimed to produce a COS for studies evaluating interventions for children with CVI, to increase the relevance of research for families and professionals and thereby to improve outcomes for affected children. DESIGN We used methods recommended by the Core Outcome Measures in Effectiveness Trials Initiative. These included a proportionate literature review of outcomes used in previous studies; qualitative interviews with children and families; a two-round Delphi survey involving parents, children and professionals and a consensus meeting to ratify the most important outcomes. SETTING Telephone interviews and online Delphi surveys of participants who all lived in UK or Eire. PARTICIPANTS Eighteen parents and six young people were interviewed. Delphi participants (n=80 did both rounds) included professionals working with children who have CVI (teachers, orthoptists, ophthalmologists, optometrists, qualified teachers for visually impaired, family members (parents and siblings) and affected children. RESULTS The literature review included 13 studies yielding 37 outcomes. Qualitative interviews provided 22 outcomes. After combining and refining similar items, the first round contained 23 outcomes and the second 46. At the consensus meeting, 5 attendees recommended 27 outcomes for inclusion in the CVI COS, of which 15 were ratified as most important, including 4 related to vision; 1 to family well-being; 1 to adults around the child being informed about CVI and the rest to the child's abilities to engage with people and surroundings. CONCLUSIONS Good engagement from participants led to the development of a COS. Future research will be useful to identify the best ways to measure COS items and potentially to update this COS as more interventions for CVI are developed. TRIAL REGISTRATION NUMBER ISRCTN13762177.
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Affiliation(s)
- Anna Pease
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Cath Borwick
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Rose Watanabe
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Cathy Williams
- Bristol Medical School, University of Bristol, Bristol, UK
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One-year effects of bifocal and unifocal glasses on executive functions in children with Down syndrome in a randomized controlled trial. Sci Rep 2021; 11:16893. [PMID: 34413362 PMCID: PMC8377071 DOI: 10.1038/s41598-021-96308-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/04/2021] [Indexed: 11/08/2022] Open
Abstract
Appropriate glasses can improve visual functioning of children with Down syndrome (DS), but it is unknown if such interventions influence their cognitive impairments. In a randomized controlled trial with 1-year follow-up. Children with DS (2-16 years) were provided either bifocal glasses (add +2.5 Dioptres; n = 50) or unifocal glasses (n = 52). Executive functions were assessed pre- and post-intervention with the task-based Minnesota Executive Function Scale (MEFS) and with questionnaires, BRIEF-P and BRIEF, parents' and teachers' version. Intervention effects and associations between executive functions, (near) vision and ocular alignment were analysed. Intervention improved MEFS-Total-scores in the bifocal group (p = 0.002; Cohen's d = 0.60) but not in the unifocal group (p = 0.191; Cohen's d = 0.24). Post-intervention, there was no intergroup difference (p = 0.120; Cohen's d = 0.34). Post-intervention, higher MEFS-scores were associated with better visual acuities (crowded near p = 0.025; uncrowded near p = 0.019; distant p = 0.045). Pre-post changes in MEFS-scores correlated significantly with improved ocular alignment (p = 0.040). Exploratory analysis of the questionnaires showed improved teacher-rated BRIEF-scores in both groups (bifocals: p = 0.014, Cohen's d = 1.91; unifocals: p = 0.022, Cohen's d = 1.46), with no intergroup difference (p = 0.594; Cohen's d = 0.23). These results demonstrate positive effects of wearing better-correcting glasses on executive functioning in children with DS, suggesting a link between their visual and executive functioning. However, the relative contributions of distant and near vision need further study.
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Watt T, Robertson K, Jacobs RJ. Refractive error, binocular vision and accommodation of children with Down syndrome. Clin Exp Optom 2021; 98:3-11. [DOI: 10.1111/cxo.12232] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 09/09/2014] [Accepted: 09/21/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Tanisha Watt
- New Zealand National Eye Centre, Department of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand,
| | - Kenneth Robertson
- New Zealand National Eye Centre, Department of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand,
| | - Robert John Jacobs
- New Zealand National Eye Centre, Department of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand,
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Hussaindeen JR, Murali A. Accommodative Insufficiency: Prevalence, Impact and Treatment Options. CLINICAL OPTOMETRY 2020; 12:135-149. [PMID: 32982529 PMCID: PMC7494425 DOI: 10.2147/opto.s224216] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/05/2020] [Indexed: 05/04/2023]
Abstract
PURPOSE Accommodative insufficiency (AI), defined as the inability to stimulate accommodation in pre-presbyopic individuals, has gained much attention over recent years. Despite the enormity of the available information, there is a significant lack of clarity regarding the criteria for definition, methodology adopted for testing and diagnosis, and the varied prevalence across the globe. This review aims to gather evidence that is pertinent to the prevalence, impact and efficacy of available treatment options for AI. METHODS PubMed, Google Scholar and Cochrane Collaboration search engines were used with the keywords prevalence, accommodative insufficiency, symptoms, plus lens, vision therapy and treatment. Peer-reviewed articles published between 1992 and 2019 were included in the review. After reviewing the studies for study methodology and robustness, 83 articles were chosen for this literature review. RESULTS The prevalence of AI ranges between <1.00% and 61.6% across studies. The prevalence shows considerable variation across ethnicities and age groups. There is significant variation in the study methodology, diagnostic criteria and number of tests performed to arrive at the diagnosis. Not many studies have explored the prevalence beyond 20 years of age. The prevalence of AI is high among children with special needs. There is no high-quality evidence regarding the standard treatment protocol for AI. Both vision therapy and low plus lenses have shown efficacy in independent studies, and no studies have compared these two treatment options. CONCLUSION The understanding of AI prevalence is currently limited owing to the lack of a standard set of diagnostic criteria and wide variations in the study methodology. There is a lack of high-quality evidence suggesting the best possible treatment for AI. The current gaps in the literature have been identified and future scope for exploration is elucidated.
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Affiliation(s)
- Jameel Rizwana Hussaindeen
- Binocular Vision Clinic, Sankara Nethralaya, Unit of Medical Research Foundation, Sankara Nethralaya, Chennai600006, India
- Elite School of Optometry (in Collaboration with SASTRA Deemed University), Unit of Medical Research Foundation, Sankara Nethralaya, Chennai600016, India
| | - Amirthaa Murali
- Elite School of Optometry (in Collaboration with SASTRA Deemed University), Unit of Medical Research Foundation, Sankara Nethralaya, Chennai600016, India
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de Weger C, Boonstra N, Goossens J. Bifocals reduce strabismus in children with Down syndrome: Evidence from a randomized controlled trial. Acta Ophthalmol 2020; 98:89-97. [PMID: 31313886 PMCID: PMC7003890 DOI: 10.1111/aos.14186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 06/11/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE Children with Down syndrome (DS) more often have strabismus, refractive errors, accommodative lags and reduced visual acuity (VA) than typically developing children. In this study, we compare the effects of bifocal glasses with those of unifocal glasses in children with DS. Changes in angle of strabismus, accommodation and refractive error were analysed in this paper. METHODS In a multicentre randomized controlled trial, 119 children with DS, aged 2-16, were randomly allocated for bifocal or unifocal glasses (with full correction of refractive error in cycloplegia). The 15 centres, all in the Netherlands, followed the participants for 1 year. Changes in refractive error, accommodative accuracy, strabismus, binocularity and stereopsis were compared across 4 subsequent visits. RESULTS Refractive errors and accommodative errors showed no significant change throughout the course of our study in either intervention group. The manifest angle of strabismus, however, reduced significantly in the bifocal group. This improvement was observed shortly after the children received their new correction (~6 weeks) (linear regression: t = 3.652, p < 0.001) and remained present in the final measurements after 1 year (linear regression: t = 3.604, p < 0.001). The percentage of children with positive binocularity and stereo tests showed no significant differences between the groups. CONCLUSION Bifocals with full correction of refractive error reduce the manifest angle of strabismus within a few weeks. No effects on accommodation, refractive error, stereopsis and binocularity occurred over the course of 1 year.
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Affiliation(s)
- Christine de Weger
- Donders Institute for BrainCognition and BehaviourDepartment of Cognitive NeuroscienceRadboud University Medical Centre NijmegenNijmegenThe Netherlands
- BartiméusInstitute for the Visually ImpairedZeistThe Netherlands
| | - Nienke Boonstra
- Donders Institute for BrainCognition and BehaviourDepartment of Cognitive NeuroscienceRadboud University Medical Centre NijmegenNijmegenThe Netherlands
- Royal Dutch VisioNational Foundation for the Visually Impaired and BlindHuizenThe Netherlands
| | - Jeroen Goossens
- Donders Institute for BrainCognition and BehaviourDepartment of Cognitive NeuroscienceRadboud University Medical Centre NijmegenNijmegenThe Netherlands
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Weger C, Boonstra N, Goossens J. Effects of bifocals on visual acuity in children with Down syndrome: a randomized controlled trial. Acta Ophthalmol 2019; 97:378-393. [PMID: 30367541 PMCID: PMC6587837 DOI: 10.1111/aos.13944] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/04/2018] [Indexed: 11/28/2022]
Abstract
Purpose Children with Down syndrome (DS) typically have reduced visual acuity (VA) and accommodation lag, but it is unclear whether prescribed glasses should correct both distance VA (DVA) and near VA (NVA) due to the lack of RCTs. We therefore conducted a multicentre RCT to compare the effects of bifocals designed to correct both DVA and NVA with distance‐correcting unifocal glasses in children with DS. Methods A total of 119 children with DS, aged 2–16, were randomly allocated for bifocal or unifocal glasses (with full correction of refraction error in cycloplegia) in 14 Dutch hospitals and followed during 1 year. VA data were analysed in relation to baseline VA with ancova. Results Treatment groups showed no differences at baseline. Shortly after receiving new corrections (~6 weeks), uncrowded NVA (bifocals 0.18 ± 0.33 LogMar; unifocals 0.09 ± 0.19 LogMar) and crowded NVA with bifocals (bifocals 0.13 ± 0.36 LogMar; unifocals 0.08 ± 0.33 LogMar) were significantly better than at baseline, but these short‐term improvements in NVA were not significantly different between the two treatments (p > 0.151). The 1‐year treatment differences were as follows: significantly larger improvement for bifocals compared to unifocals in both uncrowded NVA (bifocals 0.23 ± 0.29 LogMar, unifocals 0.12 ± 0.30 LogMar, p = 0.045) and crowded NVA (bifocals 0.31 ± 0.28 LogMar; unifocals 0.16 ± 0.30 LogMar, p = 0.017). Improvements in DVA were comparable (bifocals 0.07 ± 0.21 LogMar, unifocals 0.08 ± 0.22 LogMar, p = 0.565). Children with poor baseline VA improved more. Accommodation lag stayed unchanged. Conclusion After one year, bifocals with full correction of ametropia led to significantly larger improvement of both uncrowded NVA and crowded NVA in children with DS with accommodation lag compared to unifocals.
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Affiliation(s)
- Christine Weger
- Department of Cognitive Neuroscience Donders Institute for Brain, Cognition and Behaviour Radboud University Medical Centre Nijmegen Nijmegen The Netherlands
- Bartiméus Institute for the Visually Impaired Zeist The Netherlands
| | - Nienke Boonstra
- Department of Cognitive Neuroscience Donders Institute for Brain, Cognition and Behaviour Radboud University Medical Centre Nijmegen Nijmegen The Netherlands
- Royal Dutch Visio National Foundation for the Visually Impaired and Blind Huizen The Netherlands
| | - Jeroen Goossens
- Department of Cognitive Neuroscience Donders Institute for Brain, Cognition and Behaviour Radboud University Medical Centre Nijmegen Nijmegen The Netherlands
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Near vision in individuals with Down syndrome: a vision screening study. Eye (Lond) 2019; 33:1254-1260. [PMID: 30914784 DOI: 10.1038/s41433-019-0402-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Children with Down syndrome are known to have reduced focusing ability for near vision (hypoaccommodation). Through a vision screening study we investigated the correlation between hypoaccommodation and near visual acuity in individuals with Down syndrome. METHODS A cross-sectional vision screening study was conducted on individuals with Down Syndrome. The screening was done in 4 city schools and 1 screening was conducted as a part of the Special Olympics Bharat program. In addition to the conventional vision screening tests, Nott dynamic retinoscopy was also performed. Both adults and children (age < 18 years) were included. RESULTS A total of 55 participants (33 children: age 6 to 17 years, 22 adults: age 18 to 41 years) with Down syndrome were screened. Twenty-two participants had visual impairment. Accommodative accuracy was assessed in 29 children and 13 adults. Accommodative lag ( ≥1.00D) was present in 12 children (41.37%) and 7 adults (53.84%). No correlation was found between the lag of accommodation and near visual acuity (ρSpearman = 0.15, p = 0.54). LogMAR near visual acuity was inversely correlated (ρSpearman = -0.841, p < 0.001) to the near viewing distance. CONCLUSION Near visual acuity by itself is not a sensitive indicator of accommodative dysfunction. In addition, a closer viewing distance may not indicate adequate amplitude of accommodation. These findings strongly suggest the need for including dynamic retinoscopy in the clinical practice while examining individuals with Down syndrome.
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Wan YT, Chiang CS, Chen SCJ, Wang CC, Wuang YP. Profiles of visual perceptual functions in Down syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 37:112-118. [PMID: 25460225 DOI: 10.1016/j.ridd.2014.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/11/2014] [Indexed: 06/04/2023]
Abstract
The primary purpose of this study was to investigate the visual perceptual functions measured by the Test of Visual Perceptual Skill-Third Edition (TVPS-3) in Down syndrome (DS). Seventy individuals with DS, seventy with typical development (TD), and forty mental-age-matched participants with intellectual disabilities (ID) were recruited for the assessment session. Significant between-group differences in TVPS-3 were observed between either DS or ID and TD groups. There was no significant difference on TVPS-3 between DS and ID groups. Implications for clinical professionals and recommendations for further research are discussed.
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Affiliation(s)
- Yi-Ting Wan
- Department of Occupational Therapy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Sui Chiang
- Department of Occupational Therapy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sharon Chia-Ju Chen
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Chung Wang
- Department of Rehabilitation Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Yee-Pay Wuang
- Department of Occupational Therapy, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Rehabilitation Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.
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Bosch DGM, Boonstra FN, Reijnders MRF, Pfundt R, Cremers FPM, de Vries BBA. Chromosomal aberrations in cerebral visual impairment. Eur J Paediatr Neurol 2014; 18:677-84. [PMID: 24912731 DOI: 10.1016/j.ejpn.2014.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 02/06/2014] [Accepted: 05/13/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cerebral visual impairment (CVI) is a disorder in projection and/or interpretation of the visual input in the brain and accounts for 27% of the visually impaired children. AIM A large cohort of patients with CVI was investigated in order to ascertain the relevance of chromosomal aberrations in the etiology of this disorder. METHODS 607 patients with CVI and a visual acuity ≤0.3 were assessed for the presence of a chromosomal aberration retrospectively. The observed aberrations were classified for pathogenicity. RESULTS A total of 98 chromosomal aberrations were found in 79 persons (13%) of the cohort. In nine persons it was not possible to classify the clinical implication of the aberration, due to lack of detailed information. In 70 persons it was possible to classify the aberration for causality: in 41 patients the aberration was associated with CVI, in 16 it was unknown and in 13 the aberration was unlikely to be associated with CVI. For four aberrations, present in 26 patients, the association with CVI has been reported before: trisomy 21, 1p36 deletion syndrome, 17p13.3 deletion syndrome (Miller-Dieker syndrome) and 22q13.3 deletion syndrome (Phelan-McDermid syndrome). The chromosomal aberrations in another 15 patients were for the first time associated with CVI. CONCLUSIONS Chromosomal aberrations associated with CVI were found in 7% (41/607) of patients, of which 37% (15/41) have not been reported before in association with CVI. Therefore, in patients with CVI chromosomal investigations should be routinely performed to warrant a good clinical diagnosis and counseling.
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Affiliation(s)
- Daniëlle G M Bosch
- Bartiméus, Institute for the Visually Impaired, Zeist, The Netherlands; Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands; Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud university medical center, Nijmegen, The Netherlands
| | - F Nienke Boonstra
- Bartiméus, Institute for the Visually Impaired, Zeist, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud university medical center, Nijmegen, The Netherlands
| | - Margot R F Reijnders
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Rolph Pfundt
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - Frans P M Cremers
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands; Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Bert B A de Vries
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud university medical center, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands.
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Children with Down syndrome benefit from bifocals as evidenced by increased compliance with spectacle wear. J AAPOS 2014; 18:481-4. [PMID: 25263260 DOI: 10.1016/j.jaapos.2014.07.158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 07/15/2014] [Accepted: 07/18/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND In our experience, children with Down syndrome were noncompliant with spectacle wear, often attributed to their inability to appreciate benefit from the glasses. Studies show that up to 80% of children with Down syndrome have reduced accommodation. The purpose of this study was to evaluate whether the use of bifocals increased compliance with spectacle wear. METHODS A retrospective review of medical records from 1983 to 2007 identified 86 children with Down syndrome who were prescribed either bifocal or single vision spectacles. Compliance with spectacle wear was assessed by telephone and was available for 57 children: 27 with bifocals and 30 with single-vision spectacles. Accommodative ability had been assessed by dynamic retinoscopy in 39 of these children. RESULTS In the 27 bifocal children, all had poor accommodation on dynamic retinoscopy. Of these 27 children, 24 were compliant with spectacle wear (89%), whereas only 15 of the 30 single-vision spectacle children were compliant (50%). Of the 30 single-vision spectacle children, 18 had not had dynamic retinoscopy, and accommodative ability was thus unknown. Of the 12 who had undergone dynamic retinoscopy, 5 showed poor accommodation. The remaining 7 had good accommodation but showed compliance of only 43% in wearing single-vision glasses. The association between type of spectacle prescribed and compliance with wear was statistically significant by χ(2) testing (P = 0.002). CONCLUSIONS In our study cohort, the addition of bifocal segments improved compliance with spectacle wear in children with Down syndrome.
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Felius J, Beauchamp CL, Stager DR. Visual acuity deficits in children with nystagmus and Down syndrome. Am J Ophthalmol 2014; 157:458-63. [PMID: 24315291 DOI: 10.1016/j.ajo.2013.09.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 09/23/2013] [Accepted: 09/23/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the association between visual acuity deficits and fixation instability in children with Down syndrome and nystagmus. DESIGN Prospective cross-sectional study. METHODS setting: Institutional. study population:Sixteen children (aged 10 months-14 years) with Down syndrome and nystagmus, and a control group of 93 age-similar children with unassociated infantile nystagmus. observation procedures: Binocular Teller acuity card testing and eye-movement recordings. Fixation stability was quantified using the nystagmus optimal fixation function (NOFF). An exponential model based on results from the control group with unassociated infantile nystagmus was used to relate fixation stability to age-corrected visual acuity deficits. main outcome measures: Binocular grating visual acuity and NOFF. RESULTS Visual acuity was 0.2-0.9 logMAR (20/30-20/174 Snellen equivalent) and corresponded to a 0.4 logMAR (4 lines) mean age-corrected visual acuity deficit. Fixation stability ranged from poor to mildly affected. Although visual acuity deficit was on average 0.17 logMAR larger (P = .005) than predicted by the model, most children had visual acuity deficit within the 95% predictive interval. CONCLUSIONS There was a small mean difference between the measured visual acuity deficit and the prediction of the nystagmus model. Although other factors also contribute to visual acuity loss in Down syndrome, nystagmus alone could account for most of the visual acuity deficit in these children.
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Affiliation(s)
- Joost Felius
- Retina Foundation of the Southwest, Dallas, Texas.
| | | | - David R Stager
- Pediatric Ophthalmology and Center for Adult Strabismus, Dallas, Texas
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Williams C, Northstone K, Borwick C, Gainsborough M, Roe J, Howard S, Rogers S, Amos J, Woodhouse JM. How to help children with neurodevelopmental and visual problems: a scoping review. Br J Ophthalmol 2013; 98:6-12. [PMID: 24158842 PMCID: PMC4030252 DOI: 10.1136/bjophthalmol-2013-304225] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Children with visual impairment and a condition affecting their neurodevelopment (children with VND) may require extensive and specialised help but evidence on the most effective strategies for visual improvement is lacking. We defined a PICO format (Population, Intervention, Comparator, Outcome) for a scoping review and systematically searched 13 databases. Two reviewers assessed the abstracts for inclusion and a third arbitrated in cases of disagreement. We abstracted data from included studies. We found 4450 abstracts from which we identified 107 papers for inclusion. Of these, 42 related to interventions involving a change in visual input or function: 5 controlled trials, 8 before and after studies and 29 case reports. The strongest evidence supported the provision of spectacles to improve distance or near vision and the use of ultraviolet light as environmental modification for training. Less strong but suggestive evidence supported training/practice routines to improve acuity or oculomotor control. Interventions exist to help children with VND and current recommendations that they are assessed by a vision specialist are supported by the evidence. More information is needed on the effectiveness of training/practice programmes which may promote improved function, and of environmental modifications to facilitate engagement of children with VND with the surroundings.
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Affiliation(s)
- C Williams
- School of Social and Community Medicine, University of Bristol, , Bristol, Somerset, UK
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Candy TR, Gray KH, Hohenbary CC, Lyon DW. The accommodative lag of the young hyperopic patient. Invest Ophthalmol Vis Sci 2012; 53:143-9. [PMID: 22125280 DOI: 10.1167/iovs.11-8174] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To determine the accommodative accuracy of infants and young children before they had had any form of clinical intervention or treatment, in an attempt to determine the difference between 'normal' and 'abnormal' visual experience for these individuals. METHODS Nott retinoscopy was performed on 111 subjects in binocular viewing conditions at a viewing distance of 50 cm. The target was a naturalistic cartoon image with a broadband spatial frequency amplitude spectrum. RESULTS Accommodative accuracy was not related to age (4-90 months). In the group found to have no apparent clinical abnormality (n = 71), the mean lag in the more hyperopic meridian of the least ametropic eye was 0.34 diopters (D). When considering the group as a whole, those with less than approximately 4 D of hyperopia demonstrated similar lags, while those with higher hyperopia, amblyopia, or strabismus had more variable lags. An ROC analysis designed to detect hyperopia >5 D in any meridian, amblyopia and/or strabismus had an area under the curve of 0.90 (95% confidence interval [CI], 0.82 to 0.95), and for a lag criterion of 1.3 D had a sensitivity of 83.3% and a specificity of 96.5%. CONCLUSIONS These data from a relatively small but broad sampling of age and clinical status suggest that clinically normal young infants and children with low amounts of hyperopia have similar lags of accommodation from the first few months after birth. Subjects with greater than 4 D of hyperopia, or amblyopia or strabismus, have more variable lags and therefore evidence of abnormal visual experience.
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Affiliation(s)
- T Rowan Candy
- Indiana University School of Optometry, Bloomington, Indiana 47405, USA.
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Nandakumar K, Evans MA, Briand K, Leat SJ. Bifocals in Down syndrome study (BiDS): analysis of video recorded sessions of literacy and visual perceptual skills. Clin Exp Optom 2011; 94:575-85. [PMID: 21950779 DOI: 10.1111/j.1444-0938.2011.00650.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE In this longitudinal study, a group of school children with Down syndrome (DS) and reduced accommodation were prescribed bifocals and followed to investigate the impact of bifocal spectacles on early literacy and visual perceptual skills. The natural progression of early literacy skills in this population along with the changes with bifocals, described by monthly subtest scores and the time taken to complete literacy and visual perceptual tasks, are reported. METHODS Fourteen children with DS, aged eight to 18 years, were followed for five months with single vision lenses; 11 were prescribed bifocals based on their accommodative ability and followed for another five months. A battery of reading and visual perceptual tests was administered before and after prescription of bifocals. Monthly subtests of similar tasks were administered to measure progress. All the visits were videotaped to determine the time taken for the child to complete each task. RESULTS There was no significant measurable natural progression of early literacy skills in this group of participants on the Word Identification (WI) subtest (Repeated Measures ANOVA, F [4, 24]=1.377, p = 0.271) and Dolch sight words (RMANOVA F [4, 24]= 0.344, p = 0.846). In contrast, once bifocals were prescribed there was significant improvement in the scores of the monthly subtests (p = 0.050, 0.025 and 0.023 for WI, Dolch sight words and numbers, respectively) and the rate of progress in monthly scores improved for WI (p = 0.008). Repeated measures Analysis of Variance showed a significant decrease in the completion times with bifocals for the WI test in the full battery of tests (p = 0.0015). There was significant correlation between the improvement in focus with bifocals and the decrease in completion time for the WI task (p = 0.004). CONCLUSIONS This study demonstrates no significant natural progression over a five-month period in the group of participants with Down syndrome; however, with bifocals, faster and improved performance on some literacy skills was observed. We recommend that bifocals be considered in children with Down syndrome presenting with inadequate accommodation to optimise their educational potential.
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Affiliation(s)
- Krithika Nandakumar
- School of Optometry, University of Waterloo, School of Optometry, Ontario, Canada.
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