Ciliary muscle and anterior segment characteristics in pre-presbyopic adults with Down syndrome

Valldeflors Vinuela-Navarro*, Fiona Jane Baker, J. Margaret Woodhouse, Amy L. Sheppard

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Previous research has shown that accommodation deficits are common in individuals with Down syndrome (DS), but the origin and mechanisms behind these deficits are still unknown. The aim of this study was to investigate the characteristics of different ocular structures involved in accommodation, in particular the ciliary muscle (CM), in a population of individuals with DS to further understand this deficit and its mechanisms.

Thirty-two volunteer participants of pre-presbyopic age with (n = 16) and without DS (n = 16) were recruited. Temporal and nasal images of the CM were acquired using anterior segment optical coherence tomography (AS-OCT) while participants fixated an eccentrically located target. Analysis of CM parameters was undertaken using validated semi-automated software. Axial length, anterior chamber depth, lens thickness and corneal curvature were obtained with the Topcon Aladdin Optical Biometer and Corneal Topographer. Non-cycloplegic refractive error and accommodative ability were obtained with an open-field autorefractor and dynamic retinoscopy, respectively. Independent t-tests were conducted to determine differences in CM and other anterior segment parameters between participants with and without DS.

No significant differences were found in the CM parameters studied between participants with and without DS (p > 0.05). In contrast, significant differences were found in visual acuity (p < 0.001), accommodative response (p < 0.001) and corneal curvature (K1 p = 0.003 and K2 p < 0.001) between participants with and without DS.

Conclusions: Despite having poorer accommodation, pre-presbyopic adults with DS do not have a different CM morphology to that found in typically developing adults. These findings suggest that the accommodative deficit found in this population is not due to a mechanical deficit of the CM.

Original languageEnglish
Pages (from-to)483-490
Number of pages8
JournalOphthalmic and Physiological Optics
Issue number3
Early online date19 Feb 2024
Publication statusE-pub ahead of print - 19 Feb 2024

Bibliographical note

Copyright © 2024 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists. This is an open access article under the terms of the Creative Commons Attribution License (, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Data Access Statement

The data that support the findings of this study are available from the corresponding author (VVN) upon reasonable request.


  • accomodation
  • anterior segment OCT
  • ciliary muscle
  • Down syndrome


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