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Mary Cregg, J. Margaret Woodhouse, Valerie H. Pakeman, Kathryn J. Saunders, Helen L. Gunter, Margaret Parker, William I. Fraser, Prema Sastry; Accommodation and Refractive Error in Children with Down Syndrome: Cross-Sectional and Longitudinal Studies. Invest. Ophthalmol. Vis. Sci. 2001;42(1):55-63.
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purpose. To examine the relationship between defective accommodation and refractive
errors in children with Down syndrome.
methods. Children with Down syndrome aged 4 to 85 months were seen at their
homes as part of an ongoing study of visual development. Seventy-five
children contributed cross-sectional data and 69 children longitudinal
data. Accommodation was measured using a modification of Nott dynamic
retinoscopy technique, and refractive error measurements were obtained
using Mohindra retinoscopy.
results. Accommodation was poor, regardless of the refractive error present. The
total accommodation produced by the children was related to the
refractive error at the time of the test, with the degree of
accommodation deficit increasing with the amount of positive refractive
error. The longitudinal results showed that although children with Down
syndrome did not accommodate accurately, the amount of accommodation
elicited did not reflect their maximum amplitude of accommodation. Each
child showed a consistent degree of underaccommodation for a given
stimulus. Spectacles to correct hypermetropia did not improve the
conclusions. In children with Down syndrome, underaccommodation is substantial, even
when there is no, or a fully corrected, refractive error. The
accommodation system of children with Down syndrome may have the
physical capacity to respond to a given stimulus, but the neural
control of the system has an anomalous set point. Spectacles do not
remedy the situation. This has important implications, especially for
children in a learning environment, because near vision is consistently
out of focus.
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