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Eyes & Down's Syndrome: FAQ's PDF Print E-mail
Written by Dr Amanda Perry & Dr Maggie Woodhouse Wednesday, 09 June 2010

Pair of Glasses

What visual problems can people with DS have?

They are more prone to refractive errors (long-sight, short-sight, astigmatism); squint; accommodation (near-focusing) difficulties; difficulty seeing fine detail even when wearing corrective glasses, and difficulty seeing contrast. Refer to the download: Vision in Children with Down’s Syndrome

What special eye checks are needed?
In addition to standard assessments for refractive errors and squint, both Dr Maggie Woodhouse from Cardiff University, and the Down’s Syndrome Medical Interest Group recommend that dynamic retinoscopy is used to assess near-focusing (accommodation) at every eye assessment in a child or adult with DS.

I’ve heard about children with DS benefitting from bifocals, why is this?
Over 70% of children with DS have near-focusing difficulties, whether or not they have other visual problems. In trials at Cardiff University, these children have been found to benefit from bifocals.

Are these standard bifocals?
The top of the bifocal should lie across the centre of the pupil, which is higher than usual.

When should bifocals be prescribed?
Once any refractive error has been corrected, and at any age after the child has begun to engage in near tasks (ie looking down).

When should the bifocals be worn?
In school and/or during near activities. Once the child is used to them, they may choose to wear them full time.

Will my child always need bifocals if he needs them now?
Not necessarily; there is evidence that wearing bifocals for a year or two may train the eyes to focus better in close-up work (in 40%).

What is the difference between an Optometrist, an Optician, an Orthoptist and an Ophthalmologist?

  • Optometrists used to be called Ophthalmic opticians, so are still sometimes known as opticians. They are qualified to carry out eye examinations, advise on eye care and recognise eye problems. They prescribe and fit glasses, contact lenses and low vision appliances (such as magnifying aids). They work in private practices in high streets, hospital eye departments or health centres/community clinics.
  • Opticians (sometimes called dispensing opticians) are qualified to fit and adjust glasses. Some are also qualified to fit contact lenses. They also give out low vision appliances from a prescription supplied by an ophthalmologist or optometrist. They work in high street premises or hospital eye departments.
  • Orthoptists are trained in binocular vision problems (squints etc) and particularly in the development if vision in children. They usually work in hospital eye departments. Ophthalmologists are medical professionals specialising in eye problems, usually hospital-based.

What does a Behavioural Optometrist do?
A behavioural optometrist is a qualified optometrist who has chosen to specialise in this field. He/she will offer vision assessments beyond a conventional eye examination, looking at aspects of coordination, visual perception and so on. If deficits are found, he/she will offer therapy sessions. It is important to be aware that behavioural optometry is not available through the NHS, so there will be fees. The therapies are not considered to be evidence-based, so think of behavioural optometry as akin to complementary or alternative therapies.

My child is under a local hospital Eye Unit but they don’t routinely perform assessment of near-focusing. What do I do now?

There are High Street Optometrists able to provide services for those with learning disabilities.

Many are happy to see children, and to provide near-focusing testing through dynamic retinoscopy, and to provide bifocals. A list of those in the Sutton & Merton, and wider South East, area, who have agreed to appear on this website, can be found here. Alternatively, the Vision Research Unit at Cardiff University can arrange an appointment and free NHS assessment http://www.cardiff.ac.uk/optom/eyeclinic/downssyndromegroup/downssyndromemain.html

What advantages do hospital eye units have over High Street Optometrists?
Staff at hospital clinics usually have a great deal of experience with young children, and, of course, offer treatment for eye conditions such as conjunctivitis, blepharitis or surgery for squint. Unless a child is being actively treated for an eye condition, there is nothing to be gained by older children staying with a hospital eye unit. Many hospital clinics will discharge children at around 7 years anyway. High Street Optometrists will refer back to the hospital if they detect an eye condition. Of course parents may wish to stay with both, which is fine.

What happens if my child is very young, has speech difficulties, can’t read, or is unco-operative?

A skilled optometrist specialising in learning disability should be able to measure how well someone can see whatever their age and ability.

What sort of frames would suit a child with DS?

Most importantly, an optometrist / optician should spend the time to ensure glasses fit properly, as slipping can be a problem in those with DS, due to some differences in facial features. Curl sides and straps should generally be avoided, except in babies.

My child is reluctant to wear her glasses, what can I do?

Refer to the download: Encouraging your child to wear glasses

What special measures need to be put in place in the classroom for any child with DS?

Visual material must be made as clear as possible, and the teacher should acknowledge that, even then, a child may have difficulty with fine detail. Writing lines should be readily visible and pencil should not be used. Ideally, children should be registered with the LA’s Visual Impairment Support Service who can provide advice at home and at school.

How often should a person with DS have an eye assessment?

Very young children may need to be seen quite frequently (6 monthly, depending on the findings). Older children who wear glasses should be seen annually. Older children and adults who have no eye defects may be seen every two years. These guidelines can vary quite a lot for individual children, especially if they are undergoing treatment, so take the advice of the optometrist / orthoptists. If your child wears glasses, call into the optometrist /optician regularly to check the fit and have adjustments