Near vision in individuals with Down syndrome: a vision screening study

Children with Down syndrome are known to have reduced focusing ability for near vision (hypoaccommodation). Through a vision screening study we investigated the correlation between hypoaccommodation and near visual acuity in individuals with Down syndrome.

A cross-sectional vision screening study was conducted on individuals with Down Syndrome. The screening was done in 4 city schools and 1 screening was conducted as a part of the Special Olympics Bharat program. In addition to the conventional vision screening tests, Nott dynamic retinoscopy was also performed. Both adults and children (age < 18 years) were included.

A total of 55 participants (33 children: age 6 to 17 years, 22 adults: age 18 to 41 years) with Down syndrome were screened. Twenty-two participants had visual impairment. Accommodative accuracy was assessed in 29 children and 13 adults. Accommodative lag ( ≥1.00D) was present in 12 children (41.37%) and 7 adults (53.84%). No correlation was found between the lag of accommodation and near visual acuity (ρ_Spearman = 0.15, p = 0.54). LogMAR near visual acuity was inversely correlated (ρ_Spearman = -0.841, p < 0.001) to the near viewing distance.

Near visual acuity by itself is not a sensitive indicator of accommodative dysfunction. In addition, a closer viewing distance may not indicate adequate amplitude of accommodation. These findings strongly suggest the need for including dynamic retinoscopy in the clinical practice while examining individuals with Down syndrome.