Down Syndrome & Vision

Down syndrome has effects on the developing eye which can impact the appropriate development of vision. Eye disorders or problems are reported in over half of patients with Down syndrome, varying from much less serious problems such as tear duct abnormalities to vision threatening diagnoses such as early age cataracts. Specific emphasis ought to be provided to vision issues in patients with Down syndrome.


What is different about the Eyes in Patients with Down syndrome?

As any relative/guardian of a patient with Down syndrome recognizes, there are characteristic features about the eyes. This includes upward slanting of the eyelids, noticeable folds of skin between the eye and the nose, and little white spots existing on the iris (the colored part of the eye) called Brushfield’s areas. These spots are harmless, and also can be seen in patients without Down syndrome


Do Most Kids with Down Disorder Need Glasses?
Refractive error (the need for glasses) is much more common in youngsters with Down syndrome than in the general populace. This refractive error can be hyperopia (farsightedness), astigmatism, or near-sightedness (myopia. One more issue is weak accommodation (trouble changing the focusing power of the eye from distance to near). This can be checked this easily in the clinic, and also if found, eyeglasses that are bifocal can be recommended. Some patients have trouble getting used to glasses, but once they get accustomed to having the eyeglasses on their face, their vision is dramatically better as well as usually their eye alignment improves also.

What common, but Less Significant, Eye Abnormalities Affect Patients with Down syndrome?
Along with the need for spectacles, several children with Down syndrome have tear duct problems. Members of the family will find this as a regular discharge and tearing from the eyes, worsened by colds. Usually, firm massage is recommended over the space between the eye and the nose (tear cavity region) 2-3 times a day to attempt to open up the tear duct. If this continues beyond a year of age, the tear ducts might require to be opened up by a surgical procedure.
Strabismus (eye misalignment) is likewise a lot more usual. Members of the family might observe that the eyes do not line up well with each other, but usually the strabismus can be subtle, also to the paediatrician. The folds of skin stated above, between the eyes as well as the nose can also conceal the underlying strabismus, or make the eyes look like if they are crossing even if they are not. It is important to diagnose strabismus or cross eyes or misaligned eyes as a child, as cross eyes can result in more serious vision threatening problems like amblyopia (loss of vision also referred to as lazy eye) and loss of stereopsis (using the two eyes together, or depth perception).

Exactly how can the Strabismus be treated?
Occasionally, just eyeglasses alone are enough to align eyes with strabismus. If glasses are needed, doctors always start there. If the eyes continue to have strabismus in spite of the appropriate set of glasses, then strabismus surgical treatment (eye muscle surgery) is recommended. This is a one to two hours treatment, which can commonly be done as an outpatient treatment unless there are other factors due to which the patient would certainly require to be admitted, such as a serious heart disease. Unfortunately, patients with Down syndrome are more likely to call for more than one surgical procedure to straighten their eyes as they don’t always react as predictably to strabismus surgical treatment as the general populace with strabismus would.

What are the more serious eye problems that might develop?
The biggest concern is congenital cataracts (absence of clearness in the lens of the eye). If visually significant cataracts are present early in a child’s eye, then a clear image is not provided to the brain and therefore the mind can never “learn” to see. This is a serious kind of amblyopia called deprivational amblyopia. While we may not immediately need to get rid of a cataract in an adult patient and can wait to let it develop fully, as opposed in a child significant cataract need to be removed immediately otherwise, they may cause poor vision or even loss of vision. In that situation, even if the cataract is removed when the child is older, the vision never ever improves significantly. This is what makes very early discovery of cataracts in infants and youngsters so essential. A child with Down syndrome will be evaluated by the doctor at birth, and referred to an eye doctor if something unusual is detected. There is additionally a distinct kind of cataract in Down syndrome patients that have actually been found in research. Nevertheless, depending upon exactly how developmentally delayed the patient is, they might not have the ability to communicate that they cannot see. For this reason, any type of patient with Down syndrome, who is recommend to an eye doctor, no matter at what age, a complete eye assessment is done if they are beginning to show lowered cognitive function, or they show changes in their normal activities.

What other Eye Issues exist in Down syndrome That Can Cause Loss of vision?
As earlier pointed out, one is amblyopia (generally called “lazy eye” which is lowered vision) which can be caused by various different eye problems such as strabismus, extreme ptosis (eyelid droop), cataracts, or perhaps uncorrected refractive errors, especially if one eye needs a much more powerful eyeglass prescription than the other. Ptosis is generally simpler to appreciate but strabismus as well as substantial refractive error can be extremely difficult for the paediatrician to detect. There are other additional rare issues which can occur with the optic nerve or retina of the eye which can often cause vision loss as well as unfortunately, are usually not treatable. Nystagmus (a rhythmic shaking of the eyes) can also occur.

What is the Recommended Eye care for children with Down syndrome?
The American Academy of Pediatric Medicine (AAP) and also the Down Syndrome Medical Interest Group (DSMIG) suggest analysis of the red reflex of the eyes at birth to look for cataracts, in addition to evaluating the eyes for strabismus or nystagmus. The red reflex is basically the “red eye” seen in digital photography, which is the typical reflex of the retina when struck by straight light. If the eyes don’t look normal, then the child/baby should be referred to a paediatric ophthalmologist – a doctor that has actually completed specialized training in clinical and surgical monitoring of the children’s eyes. It is usually recommended that a child with Down syndrome has their very first eye examination by an eye doctor experienced in people with special disabilities (for example, a paediatric eye doctor), when six months old. Afterwards, children with Down syndrome, even if they lack symptoms, ought to see an eye doctor every one to 2 years. If any kind of eye problems is found, they should be certainly followed up more frequently.

What Sort of symptoms might we see if a child has an Eye problem?
Regrettably, children with Down syndrome typically do not complain about their eye issues, either since they do not notice the issue or due to the fact that they cannot connect the issue well enough. Indications to look for include squinting or shutting one eye closed, an unusual head tilt, crossing or wandering of one or both eyes, or light sensitivity. In some severe instances, the indicator of vision problems might be a regression in overall function or loss of developmental milestones. Ptosis will certainly be seen as an eyelid droop, and a blocked tear duct will result in daily tearing and discharge.

Any thoughts for Moms and Dads of a child with Down Disorder Who Are Concerned About their child’s eyes or vision?
Getting routine eye examinations done is really essential in children with Down syndrome due to the fact that eye disorders are so usual and also are tough for the doctor to diagnose. Because the examination can be tough for both the youngster and the eye doctor, it is best to actually have the assessment done by an eye doctor skilled in handling children with developmental delays. Do not be surprised to discover your child needs glasses; and if needed, the glasses will certainly help with vision, and potentially the eye alignment, in addition to helping in the development of normal vision pathways in the brain. This will help with your child’s learning as well as working. Many research studies are looking at simply how usual eye problems are in Down syndrome, as well as the progression of cataracts in these patients.

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