Information for Parents
Q: Is my child likely to have eye problems?
A: Your child is more likely to have an eye problem than a child who does not have Down’s syndrome; he/she is 10 times more likely to need to wear glasses and 7 times more likely to have a squint (eye turn). Our work has shown that the majority of children with Down’s syndrome (about 73%) also have reduced accommodation (near focusing).
Your child is also more likely to suffer from eye infections (for example, blepharitis), nystagmus (wobbly eyes), and as he/she gets older, cataract (cloudy lens) and keratoconus (progressive thinning and steepening of the front of the eye). Even if your child does not have any of these problems, our work shows that he/she will not have as good detail vision as a child of the same age without Down’s syndrome.
Q: How will I know if my child has an eye problem?
A: Some problems will be obvious (for example, nystagmus). If these conditions are not picked up at medical checks, ask your doctor to refer your child to an eye specialist (Ophthalmologist). Other problems (such as long or short sight and poor accommodation) may be less obvious to you. So, take your child for regular eye examinations either at the hospital or to a local Optometrist/Optician. Our finding, that most children with Down’s syndrome have poor near focusing, is fairly recent, so you may need to ask for your child’s near vision and focusing to be checked. (If you wish, take this page along with you).
Q: How often should my child have his/her eyes checked?
A: Your child should have regular eye checks as soon as possible if you suspect any problems. Even babies as young as 6 months can have their eyes checked successfully by an experienced professional. The earlier an eye problem is detected the better. The Down’s Syndrome Medical Interest Group recommends a full eye examination at 18 months to 2 years for ALL children with Down’s syndrome. The eye care professional looking after your child will then decide how often his/her eyes need checking, but don’t leave it longer than 2 years between eye tests.
Q: What can be done if my child has an eye problem?
A: Some eye conditions are treatable, for example, if your child is long or short sighted glasses can be prescribed to help him/her see better. We know now that poor focusing can be greatly helped by bifocals. However, it is not possible to treat all eye conditions (e.g. nystagmus) and your child may need extra support if vision is affected. If your child is in school in the UK, your Education Authority has a support service especially for children with vision problems (Visual Impairment or VI support service). We recommend that all children with Down's syndrome are referred to their VI support service. If this hasn't happened, the school can ask the service to see your child.
Q: What is an eye care professional?
A: An eye care professional is someone who is trained to examine eyes. He/She will be able to tell if your child needs to wear glasses and if the eyes are healthy. Your child may see the following people: Ophthalmologist (specialist hospital eye doctor), Optometrist / Ophthalmic Optician (prescribes glasses and checks eye health), Orthoptist (checks vision and eye alignment and manages binocular vision anomalies, usually in a hospital or clinic), Dispensing Optician (helps choose and fit glasses).
Q: Which eyecare professional should I take my child to see?
A: If you have been referred by a GP to an Ophthalmologist then your child will be seen at your local Hospital Eye Department. Your child will be under the care of a nominated Ophthalmologist but may also be seen regularly by an Optometrist and/or an Orthoptist at the Hospital. The Ophthalmologist, Optometrist and Orthoptist will work together to provide appropriate eye care for your child. Alternatively, you may be advised to take your child to a local Optometrist. The website LookUP (run by SeeAbility and RNIB) has a list of UK Optometrists who are happy to test people with learning disability. Simply go to http://www.lookupinfo.org/ and follow the links to ‘services near you’. Or ask other parents to recommend an optometrist whom they have found to be good with children. And we are, of course always delighted to see any child or adult with Down’s syndrome in our clinic here in Cardiff.
Q: What can I do if my child won't wear his/her glasses?
A: There could be many reasons why your child won’t wear the glasses prescribed. The first thing you should do is have the fit of the glasses checked; no one wants to wear glasses that are uncomfortable. Next, have the prescription checked by the person who prescribed the glasses. If the glasses fit properly and the prescription is correct then it may be that the feel of the glasses, and seeing clearly are simply unfamiliar experiences. It may be asking too much to expect your child to wear the glasses all of the time in the early stages. May sure that you understand what the glasses are for, and when it is most important for your child to wear them. You can then encourage your child to wear his/her glasses in a number of ways:
put the glasses on when he/she is doing an activity with you that is enjoyable. This way your child will learn to associate wearing glasses with a pleasant experience. If necessary, make it a short experience, and build up time gradually.
put the glasses on in front of a mirror so that your child sees themselves with the glasses on. Children like looking at their own reflection and often forget they have glasses on.
if you or another member of the family wears glasses, make a big show of putting them on for particular tasks. Most children love to copy others.
if your child won’t wear their glasses at home then perhaps he/she will wear them at school. Chat to the class teacher and ask for his/her help in trying to persuade your child to keep the glasses on.
Some children do not like objects near their face. Others do not like change. But once your child learns that the glasses will not hurt and gets used to seeing more clearly, he/she will be happy to wear them. Start slowly and build up the wearing time gradually. If your child still refuses to wear his/her glasses, don’t turn it into a battle. Children learn quickly that a great way to get attention from parents is to throw their glasses across the room. What a great game! Most children grow out of their reluctance to wear glasses. Continue to take your child for regular eye checks and discuss any concerns with the eye care provider..
Guidance on how to encourage your child to wear glasses, published by the School of Optometry and Vision Sciences at Cardiff University in Cardiff, Wales, UK.
Q: How much do glasses cost?
A: In the UK, for children under 16 years old, eye examinations and vouchers for glasses are free. If your child is over 16 years old he/she will have to pay for his/her eye examination and glasses, unless he/she falls into any of the following categories:
Full time student aged 16, 17 or 18
Receives Income Support
Receives Income-based Jobseeker’s Allowance
Named on a Working Families Tax Credit NHS Exemption Certificate
Named on a Disabled Person’s Tax Credit NHS Exemption Certificate
Named on an HC2 certificate
Have been prescribed complex lenses under the NHS optical voucher scheme
A voucher is intended to cover the cost of ‘basic’ glasses and most opticians carry a range of frames under the voucher scheme. You may have to pay extra if you want a ‘designer’ frame.
If your child is over 16 years old and falls into any of the following categories he/she will not have to pay for his/her eye examination but will have to pay for glasses:
Registered blind/partially sighted
Suffer from diabetes/glaucoma
Considered to be at risk of glaucoma by an ophthalmologist
Aged 40 or over and the parent/brother/sister/child of a person who has or had glaucoma
Q: What happens if my child breaks His/Her glasses?
A: If your child (under 16) is entitled to a voucher for glasses then, he/she is also entitled to free repairs or replacements. Over 16, a repair/replacement voucher can be issued if it can be shown that the breakage was due entirely to the learning disability – the optometrist / optician will need to write a justification.
A voucher for a spare pair can be issued only in special circumstances, such as a very high prescription (rendering the child handicapped without the spectacles) and disability that makes breakages more likely. Again the optometrist / optician will need to write a justification.
Q: What can my child see?
A: Even if your child is wearing glasses, or has no eye problems, he/she will not see fine detail or small contrast changes as well as other children.
A document showing a garden scene as seen by a 'normally-sighted' person compared with that seen through the eyes of a person with Down's syndrome.
An example of how your child’s vision might be affected. Activities that require good detail vision, like reading, will be affected most. But, more general activities, like outdoor play will not be affected as much.