Near vision in individuals with Down syndrome: a vision screening study

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 (ρ Spearman = 0.15, p = 0.54). LogMAR near visual acuity was inversely correlated (ρ Spearman = −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.

Comparison of subjective and objective accommodation amplitude values

“…Decreased with age, AA presents with blurry vision and eye fatigue when looking at near objects around the age of 40. In addition, diabetes mellitus, Down syndrome, drug use such as topiramate may cause early deterioration in AA and trigger early presbyopia (9)(10)(11)(12).…”

Clinical Utility of ‘Peekaboo Vision’ Application for Measuring Grating Acuity in Children with Down Syndrome

“…Children with Down syndrome are noted to have hypoaccommodation. (Satgunam et al, 2019) The nature of the tests (print vs. digital) could have influenced the accommodation, differently. This was not investigated as part of this study.…”

Tablet‐based ‘ON/OFF’ pathway test can distinguish between rod‐ and cone‐dominated diseases

“…Near visual acuity was converted to logMAR values as specified previously. 28 Receiver-operating characteristic (ROC) curves were generated to identify the outcome variable that was most sensitive to detect a rod-dominated disease. Typically, sensitivity refers to the detection of a disease when it is present and specificity refers to the correct identification of negative cases when the disease is absent.…”

“…The Mann–Whitney U test was used to compare the outcome variables for the two groups of diseases. Near visual acuity was converted to logMAR values as specified previously 28 . Receiver‐operating characteristic (ROC) curves were generated to identify the outcome variable that was most sensitive to detect a rod‐dominated disease.…”