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Brinda Muthusamy, Rohit Adyanthaya, Sheena Isenor, Kristina Irsch, Kathryn Klein, David Guyton; Down Syndrome and Accommodation: The Added Advantage of Bifocals. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5684.
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Traditionally most children with Down syndrome have been non-compliant with spectacle wear, often attributed to their inability to cooperate. Recent studies have documented that approximately 80-92% of children with Down syndrome have reduced accommodation. The purpose of this study was to evaluate whether the use of bifocals increased spectacle compliance in these children.
Records from 1983 to 2007 were retrospectively reviewed of 86 Down syndrome children who were prescribed either bifocals with +3.00 D high flat-top adds or single vision spectacles (“non-bifocal” children). Compliance with spectacle wear was assessed by telephone and was available for 59 children: 33 with bifocals and 26 with single vision spectacles. Accommodative ability had been assessed by dynamic retinoscopy in 44 of these children.
In the 33 bifocal children, all had poor accommodation on dynamic retinoscopy. Only 11 of the 26 non-bifocal children had dynamic retinoscopy (9 had good accommodation and 2 had poor accommodation). Of the 33 non-bifocal children, 28 were compliant with spectacle wear (84.8%), while only 12 of the 26 non-bifocal children were compliant (46.2%). This association between type of spectacle prescribed and compliance with wear was statistically significant by chi square testing (p value = 0.002). Even among the 9 non-bifocal children with known good accommodation, the compliance was only 44%, indicating that children with Down syndrome have inherent difficulties with single vision spectacles.
Our study provides evidence that the extra spectacle power for near is appreciated, and improves compliance of spectacle wear in these children. Dynamic retinoscopy helps identify children with poor accommodation. Improved spectacle compliance will likely aid management of strabismus and amblyopia that is common in these children.
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