Should bifocal spectacles be prescribed to paediatric patients with Down’s Syndrome as routine clinical management?

By Jane Frampton FBDO (Down’s Syndrome Association, 2016) and in 1959 the condition was linked to an extra copy of part or all of chromosome 21 (Mégarbané et al., 2009). Down’s syndrome (DS) is associated with physical and intellectual disability, including hypotonia, hearing and ocular problems, and development is often slower than for a typical child (NHS, 2015). Ocular issues include refractive errors, keratoconus, reduced accommodation, strabismus, nystagmus, failure in the emmetropisation process, blepharitis, and cataract. Young children with typical development have facial characteristics differing to those of adults, and the facial characteristics develop in a non-standard way to typical children (Woodhouse et al, 1993). Previous studies identified that the majority of paediatric DS patients under-accommodate, focusing behind a near object, making near tasks difficult and hampering academic progress (Woodhouse et al, 1997). It has been shown that a refractive correction for distance does not improve accommodation at near, and also demonstrated that while presbyopic adults endeavour to increase accommodative response as working distance is reduced, the paediatric DS patient does not show an increase in accommodative response (Cregg et al, 2001). This study aims to investigate whether bifocal spectacles should be prescribed and dispensed to paediatric patients with DS as routine clinical management, rather than on a purely case-by-case basis. *These articles are kindly provided by the Association of British Dispensing Opticians.*

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