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N. S. Matta, E. L. Singman, D. I. Silbert; Prevalence of Accommodative Insufficiency in Children With Down Syndrome. Invest. Ophthalmol. Vis. Sci. 2010;51(13):803.
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In this study we will report on the prevalence of accommodative insufficiency (AI) in a cohort of children with Down syndrome. To our knowledge this has not been reported previously.
A retrospective chart review was conducted on children with the diagnosis of Down syndrome. We collected information from the charts including whether accommodative testing was performed, type of accommodative testing, presenting symptoms, cycloplegic refraction, other ophthalmic pathology, if glasses were given and if a bifocal were prescribed
Sixty charts were evaluated; 2 were excluded due to previous surgery for congenital cataracts. Fifty-eight patients were identified fitting our criteria. Thirty-four of the 58 patients were evaluated for AI (59%). Of these, 30 patients were found to have AI. Fifty children were placed in glasses (83%). Six patients were prescribed a bifocal, 4 patients were given glasses for low hyperopia due to the AI, 46 patients were given single vision glasses for significant refractive error and 10 patients were not put into glasses. Other ophthalmic findings include: amblyopia (33), accommodative esotropia (12), high myopia (12), esotropia (9), anisometropia (6), nasolacrimal duct obstruction (6), congenital cataract (5), nystagmus (5), blepharitis (4), trichiasis (4), thyroid disease (3), diabetes (3), exo deviation (3), entropion (2), convergence insufficiency (1), dry eye syndrome (1), and Browns syndrome (1).
Children with Down syndrome have a high incidence of AI. In these children it is often difficult to determine whether they are symptomatic. If the ophthalmologist does not actively perform accommodative testing, many of these children are likely to go untreated. It is advised that accommodative testing be performed routinely for children with Down syndrome and consideration be given to prescribe reading glasses, hyperopic spectacles or bifocals to these children. Of interest we found 12 children with accommodative esotropia and accommodative insufficiency. We suggest that the correlation between these two conditions should be further investigated.
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