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(Investigative Ophthalmology and Visual Science. 2003;44:1023-1030.)
© 2003 by The Association for Research in Vision and Ophthalmology, Inc.
DOI:  10.1167/iovs.01-0131
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Development of Refractive Error and Strabismus in Children with Down Syndrome

Mary Cregg,1 J. Margaret Woodhouse,1 Ruth E. Stewart,1 Valerie H. Pakeman,1 Nathan R. Bromham,1 Helen L. Gunter,1 Lidia Trojanowska,1 Margaret Parker,1 and William I. Fraser2

1From the Department of Optometry and Vision Sciences, Cardiff University, Cardiff, Wales, United Kingdom; and the 2Welsh Centre for Learning Disabilities, University of Wales College of Medicine, Cardiff, Wales, United Kingdom.

PURPOSE. To investigate the development of refractive errors and strabismus in a cohort of children with Down syndrome.

METHOD. Data for 55 children with Down syndrome who are participating in this longitudinal study of visual development, first examined by us when aged less than 2 years and on at least two other occasions, were analyzed. Mohindra retinoscopy was used to measure refractive error. Ocular alignment was assessed using the Hirschberg test and, when possible, the cover test.

RESULTS. Despite the high prevalence of large refractive errors in children with Down syndrome, longitudinal data showed that these are not always present in early infancy. Twenty-one (38%) of the children were emmetropic throughout the study. Of the 24 children with a significant refractive error at the outset, only 6 (25%) showed emmetropization. The others retained or increased their refractive errors. The remaining 10 children were emmetropic at the outset, but then had a significant refractive error develop. There is a high prevalence of strabismus in children with Down syndrome (29% of the total group), which cannot be attributed to the presence of hypermetropia or anisometropia.

CONCLUSIONS. The retention or development of infantile refractive errors in many children with Down syndrome indicates a failure of emmetropization. All children were at risk of strabismus whatever the refractive error. The findings have implications for timing of screening programs.




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J.-A. Little, J. M. Woodhouse, J. S. Lauritzen, and K. J. Saunders
The Impact of Optical Factors on Resolution Acuity in Children with Down Syndrome
Invest. Ophthalmol. Vis. Sci., September 1, 2007; 48(9): 3995 - 4001.
[Abstract] [Full Text] [PDF]


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