Different visual development: norms for visual acuity in children with Down's syndrome

BACKGROUND:  Visual acuity is known to be poorer in children with Down's syndrome than in age-matched controls. However, to date, clinicians do not have access to norms for children with Down's syndrome that allow differential discrimination of healthy from anomalous visual development in this population.

METHODS: The Down's Syndrome Vision Research Unit at Cardiff University has been monitoring visual development in a large cohort of children since 1992. Cross-sectional data on binocular visual acuity were retrospectively analysed for 159 children up to 12 years of age in order to establish binocular acuity norms. Longitudinal binocular acuity data were available for nine children who were seen regularly over the 12 years age-range. Monocular acuity was successfully recorded less often in the cohort, but analysis of scores for 69 children allowed assessment of inter-ocular acuity differences and binocular summation.

RESULTS: In comparison with published norms for the various acuity tests used, binocular acuity was consistently poorer in children with Down's syndrome from the age of three years and stabilised at around 0.25 logMAR from the age of four years. Inter-ocular acuity difference and binocular summation were both 0.06 logMAR, which is similar to the reported values in children without Down's syndrome.

CONCLUSIONS: The study provides eye-care practitioners with the expected values for binocular acuity in children with Down's syndrome and demonstrates the visual disadvantage that children with Down's syndrome have when compared with their typically developing peers. The results emphasise the responsibility that practitioners have to notify parents and educators of the relatively poor vision of children with Down's syndrome, and the need for classroom modifications.