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WHAT IS DOWN SYNDROME?

Your genes hold the keys to how your body looks and works. They’re behind everything from your hair colour to how you digest your food. So if something goes wrong with them, it can have far-reaching effects.

Down syndrome is a lifelong condition. Although it can’t be cured, doctors know more about it now than ever. If your child has it, getting the right care early on can make a big difference in helping him live a full and meaningful life.

People with Down syndrome are born with an extra chromosome. Chromosomes are bundles of genes, and your body relies on having just the right number of them. With Down syndrome, this extra chromosome leads to a range of issues that affect you both mentally and physically. And one major area it affects is the eyes.

DO MOST CHILDREN WITH DOWN SYNDROME NEED GLASSES?

Refractive error (the need for glasses) is much more common in children with Down syndrome than in the general population. This refractive error can be hyperopia (farsightedness), astigmatism, or myopia (nearsightedness).

Another problem is weak accommodation (difficulty changing the focusing power of the eye from distance to near). This can easily be detected if the child is seen by an eye doctor (Optometrist or Ophthalmologist). If the child is presented with this accommodative problem, bifocal glasses can be prescribed. Some patients have difficulty adjusting to glasses, but once they get accustomed to having the glasses on their face, their vision is significantly better and often their eye alignment improves as well.

WHAT ARE THE MORE SEVERE EYE PROBLEMS THAT MIGHT DEVELOP?

Some researchers believe that it is congenital cataracts (lack of clearness to the lens of the eye). If visually significant cataracts are present early in a child’s eye, then a clear image is not delivered to the brain and therefore the brain can never “learn” to see. This is a severe form of amblyopia known as deprivational amblyopia.

Unlike in adults that the cataract is allowed to mature before removing it, significant cataracts present very early in a child’s life that is not removed can result in lifelong poor vision. In that situation, even if the cataract is removed when the child is older, the vision never improves significantly. This is what makes early detection of cataracts in infants and children so important.

A child with Down syndrome will be evaluated by the paediatrician at birth, and referred to an Optometrist/Ophthalmologist if something abnormal is detected. There is also a unique form of cataract seen in Down syndrome patients. However, depending on how developmentally delayed the person is, they may not be able to communicate that they can’t see. It is therefore recommended that all patients with Down syndrome, no matter what age, have a complete eye examination if they are starting to show reduced cognitive function, or changes in their normal activities.

WHAT IS THE RECOMMENDED EYE CARE FOR CHILDREN WITH DOWN SYNDROME?

The American Academy of Pediatrics (AAP) and the Down Syndrome Medical Interest Group (DSMIG) recommend evaluation of the red reflex of the eyes at birth to look for cataracts, as well as to assess the eyes for strabismus or nystagmus. The red reflex is essentially the “red eye” seen in photography, which is the normal reflex of the retina when struck by direct light.

The UK Down’s Syndrome Medical Interest Group suggest the following basic minimum eye checks for babies and children with Down’s syndrome:
• Birth to 6 weeks – Newborn routine check including congenital cataract check
• Age 18 to 24 months – Formal eye and vision examination including check for squint, and refraction for long or short sight
• Age 4 years – Formal eye and vision examination including check for squint. Refraction and assessment of near and distant vision and visual acuity
• School age – Repeat vision test every 2 years, or more frequently if recommended by optometrist or ophthalmologist
• Teenagers and adults – should have a full assessment by an Optometrist/Ophthalmologist every 2 years.

Contact us for more information on Down syndrome, its effects on the eyes and how best to manage it.