Refractive errors and ocular findings in children with intellectual disability: A controlled study

Abstract

PURPOSE To evaluate the ocular findings and refractive errors in children with intellectual disability and in controls of average intellectual development of similar socioeconomic backgrounds. METHODS The study was conducted at Diskapi Children’s Hospital in Ankara, Turkey: 724 subjects with intellectual disability and 151 control subjects were evaluated. The subjects with intellectual disability were subdivided into mild (IQ 50–69, n = 490), moderate (IQ 35–49, n = 164), and severe (IQ <34, n = 70) groups, and syndromic (n = 138) versus nonsyndromic (n = 586) disability. All children underwent cycloplegic autorefraction or retinoscopy, slit-lamp biomicroscopy, and dilated fundus examination. Ocular alignment was assessed by Hirschberg, Krimsky, or prism cover test. The main outcome measure was the prevalence of refractive errors and ocular findings. RESULTS Seventy-seven percent of subjects with intellectual disability, and 42.4% of controls, had ocular findings. The children with intellectual disability had significantly more nystagmus, strabismus, astigmatism, and hypermetropia than controls. Children with syndromic intellectual disability had significantly more nystagmus, strabismus, astigmatism, and hypermetropia than subjects with nonsyndromic intellectual disability. Increasing severity of intellectual disability was related to higher prevalence of nystagmus, strabismus, astigmatism, hypermetropia, and anisometropia. CONCLUSIONS From a public health perspective, evaluation and treatment of ocular and refractive findings in children with moderate, severe, and syndromic intellectual disability categories is urgently needed and likely to be highly effective in alleviating future health and social care costs, as well as improving the productive lives of individuals with intellectual disability.

Changes in causes of low vision between 1988 and 2009 in a Dutch population of children

“…The increase in hyperopia and nystagmus found in 21 years is probably related to the increase in referral of children with mental impairments. According to Akinci et al (2008), 77% of subjects with intellectual disability had ocular findings. They had significantly more nystagmus, strabismus, astigmatism and hyperopia.…”

Validation of plusoptiX S04 photoscreener as a vision screening tool in children with intellectual disability

“…( J AAPOS 2011;15:476-479) T he prevalence refractive errors, strabismus, and cataract in children with intellectual deficiency (ID) is reported to be markedly higher than in normal children. [1][2][3][4][5] According to the guidelines of International Association for the Scientific Study of Intellectual Disabilities (IASSID), all children with ID should receive at least five ophthalmological evaluations during childhood. 6 Vision screening programs and visual acuity testing aimed at detecting treatable sight-threatening eye conditions can sometimes fail in children with ID due to lack of cooperation.…”

Behavior disorders in children with significant refractive errors

“…High refractive errors in children may be associated with blurred vision, eye strain, ocular pain, headache, and even amblyopia and strabismus 6 . Children with high refractive errors may have intellectual disabilities, incompatibility in school and society, and less interest for education 6, 7.…”

“…Children with high refractive errors may have intellectual disabilities, incompatibility in school and society, and less interest for education 6, 7. Previous studies have reported a higher incidence of child behavioral disorders in visually impaired children and those with convergence insufficiency 5, 7, 8.…”