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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.

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Background: Self-medication has been defined as the taking of drugs, herbs, or home remedies on one’s own initiative and advice from another person without consulting a medical specialist. The objective of the study was to identify the pattern of self-medication in ophthalmic emergencies in patients attending the emergency department in a peripheral rural setup in south India. Materials and Methods: This was a descriptive, cross–sectional, questionnaire-based observational study. The patients selected were above 18 years of age. Informed consent was taken. A questionnaire on the demographic characteristics, level of literacy, history of the ophthalmic condition for which the patient had self-medicated, type of self-medication resorted to , reasons for resorting to ocular self–medication, and the adverse effects reported were all noted in the study. Results: The study included 100 subjects. Fifty-three percent were male and 47% were female. Among the 100 subjects, 10% of the individuals were educated above primary school level. Thirty-five percent had only primary school level education and the remaining 55% had not been to a formal school and had no basic education. Among our respondents, the most commonly used self-medication was antibiotic drops (24%), followed by expired medication (23%). 20% used steroid drops. 15% had tried traditional eye medication (TEM). Herbal and other indigenous medications were used by 12% of the responders. 7% used oral nonsteroidal anti-inflammatory drug agents. None of the responders were aware of the adverse effects of self-medication. The most common ophthalmic emergency symptoms faced by our responders were excessive watering (37%), pain (28%), foreign body in the eye (14%), redness and discharge (12%), decreases vision (5%), and pain in the eye (4%). The common reasons given by our responders for not accessing health-care facilities were distance (living far from health-care facilities), advice from family and friends, belief if local healers, lack of finances and poverty, and lack of prioritizing health care. Following self–medication, 30% of the patients had infectious keratitis, 28% had conjunctivitis, 25% had epithelial defects, and 17% glaucoma. Conclusion: Irrational long-term use of drugs/traditional eye medicine or even the usage for ophthalmic emergencies can have dangerous visual outcomes. The study highlights the need of effective execution and establishment of high-quality accessible primary eye care services and health-care referral network in rural India.

Purpose: Ocular and refractive defects are common amongst people with Down's syndrome. We are conducting a long‐term study of the development of refraction, accommodation and acuity in infants with Down's syndrome, from 12 weeks of age, in order to identify age of onset and possible consequences of such defects. Methods: To date, 54 children have entered the study. All measurements are made during home visits, and comprise Mohindra and dynamic retinoscopy, and Preferential Looking. Results: Cross‐sectional data suggest that acuity lies within normal ranges in infancy, and falls behind the norms only from the age of 2 years. Refractive errors in the general population decrease in infancy (the process of emmetropisation). Our data show that the opposite happens in children with Down's syndrome. The prevalence of refractive errors is higher in the preschool and school‐age children, than amongst the infants. Accommodation is defective from the earliest age of testing. Infants and young children with Down's syndrome consistently under‐accommodate to near targets, even when visual acuity and refractive errors are normal. Conclusions: The implication of accommodative dysfunction on emmetropisation is considered, and the possible association between visual and cognitive development explored.