People with Down's syndrome and eye conditions
Research shows that people with Down’s syndrome are at higher risk of having significant sight problems, many of which may correctable or treatable.There are still many people with Down’s syndrome not receiving regular eye checks or appropriate help for an eye condition. It is important that carers and supporters recognise the importance of eye care for people who have Down's syndrome.
Getting the correct help for people is vital. If people with Down's syndrome are to reach their full potential it is vital that they receive ongoing eye care from optometrists and other eye care and sensory specialists. Many people with Down's syndrome will experience a deterioration in their eye sight as they age and supporters will need to be vigilant and be aware of how to support people to make maintain their skills and interests.
The eye conditions described below can also be found amongst people who do not have Down’s syndrome. However, for reasons not always known about, the evidence shows that there is an increased risk of these eye conditions occurring in children and adults with Down’s syndrome.
Sight Problems usually correctable with glasses
Refractive errors and Visual Acuity.
Refractive Errors refer to conditions that affect focusing and are usually resolved by the person wearing glasses. Refractive errors occur up to ten times more frequently amongst people with Down’s syndrome than in the general population. Many people with Down's syndrome will have difficulty with their visual acuity, meaning that they may have difficulty seeing things clearly and in focus.
Long sight (hypermetropia)
- Long sightedness results in the person having more difficulty in seeing things that are close up than far away, although both can be affected.
- This condition can be corrected with prescription lenses.
Short sight (myopia)
- Short sightedness results in the person having difficulty in seeing things that are in the distance. This condition can also be corrected with prescription lenses.
- Astigmatism occurs when the curve of the cornea is irregular in shape
- It can occur alongside long sight and short sight and results in the person having blurred vision at all distances.
- Astigmatism is treated with prescription lenses that are designed to counteract the irregular shape of the cornea.
- This condition (which means ‘old eye’) affects all of us as we get older, whether we wear glasses or not in our youth or middle age.
- The lens, which is flexible when we are younger, loses its ability to change shape so that focusing on near tasks becomes difficult or impossible.
- Affecting most of us at around the age of forty-five, presbyopia may happen at a younger age in people with Down’s syndrome.
- ‘Reading glasses’ or bifocals are usually prescribed, and it is important to remember that people who do not read may benefit from glasses for near tasks like work, crafts/hobbies, looking at photos, signing and eating.
- Nystagmus is an involuntary movement of the eyes - usually the yes move side to side, but sometimes the eyes move or flicker up and down or in a circular motion.
- This affects about 15% of people with Down’s syndrome. Nystagmus is not part of Down's syndrome and should be considered as a visual impairment that someone has in addition to Down’s syndrome.
- Detail vision will be poorer if a person has nystagmus.
- Unfortunately, there is no cure for nystagmus. It is important that any other eye condition that is present is treated, for example, a person should still wear glasses for short sight, even though they will not help the nystagmus.
Squint ( strabismus)
- Squint is quite common amongst people with Down’s syndrome.
- This condition arises because of a lack of muscle co-ordination between the eyes and causes the eyes to seem to look in different directions. As a result of squint people may experience double vision, vision in one eye only, loss of depth perception and eyes that appear uncoordinated their movement.
- Squints can often be effectively treated in children, however if the problem is left into adulthood it can be harder to rectify, as the person will have usually developed ways to compensate.
Cataracts occur when the clear lens within the eye becomes unclear, restricting the amount of light that can enter the eye. If untreated cataracts can lead to severe visual impairments. People with Down's syndrome may develop cataracts at an earlier age than the general population.
For more information about cataracts and surgery please follow the links at the end of this factsheet.
- Although keratoconus is a fairly rare condition and the cause is unknown, evidence shows an increased risk amongst people with Down’s syndrome. Weaknesses within the clear cornea of the eye leads to the cornea becoming mis-shapen or 'pointed'. For many people treatment may commence in later childhood with spectacles, then progress to the wearing of specialist contact lenses - and if required, corneal surgery. Keratoconus will markedly affect vision and can lead to serious eye health problems. Always seek advice and support from an optometrist.
- For more information about keratoconus please follow the links at the end of this factsheet.
Due to a number of factors, people with Down’s syndrome are often prone to eye infections such as conjunctivitis and blepharitis.
Blepharitis is the inflammation of the eye lids and can be very common amongst people with Down’s syndrome; this shows as:
- small flakes of debris along the eye lashes, and sometimes red rims to the eyes.
- it can lead soreness and irritation
- It is easily managed by keeping eyes clean by bathing them.
Conjunctivitis is inflammation of the very front layer of the eye. It can lead to soreness, pain and irritation. The eye will appear read and sore. It is important that allergies, such as hay-fever are treated as this may lead to painful eye inflammations and infections.
Local optometrists or GP's can offer advice in most cases, and it is only the most persistent cases that require medical referral.
Ageing and Down’s Syndrome
- Many of the above eye conditions which are also common in the wider population due to the aging process, can and do occur amongst people with Down’s syndrome at an earlier age.eg. Cataracts generally occur in early 60’s onwards for wider population but for people with Down’s syndrome onset can begin in mid to late 30’s
- Alzheimer’s disease is more likely to affect people with Down’s syndrome, and at an earlier age than the general population. It is important to recognise at early stages of diagnosis that many features of dementia such as:
- Misplacing things
- Not recognising familiar places or faces
However these changes to behaviour can also be attributed to an eye condition such as cataracts. It is as important that up to date sight tests are obtained and treatment sought in order to have full idea of individuals skills and abilities.
- Obtaining correct help and support when an individual can still learn to wear glasses or undergo surgery will also help during later stages of dementia, if individual still has good or useful sight.
If you have any concerns about a person's sight contact a local optometrist, a GP or your local authority Sensory Services Team.
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