Eye Conditions in adults with Down’s syndrome

There are certain eye conditions that are more common in adults, but it must be stressed these conditions also occur in the general population, they are not unique to adults with Down’s syndrome.

Some people may develop problems with their sight, more typically seen in older people in the general population, at an earlier stage in their lives.

It is really important for adults to have their sight checked at least every two years.

Many adults will be able to go along to their high street opticians, but they may need a longer examination time.  If you feel an adult who you support needs more time and understanding to enable them to have their eyes tested you may like to try and find an optometrist with an interest in patients with a learning disability (take a look at the SeeAbility website which has a register of optometrists ).

Anyone with an unexplained change in behaviour and/or a loss of skills should have an eye examination to rule out a loss of/changes to their vision as a cause for their behaviour or skill loss.

Here are some of the eye conditions that adults can have:

Refractive errors

Refractive errors are vision problems that happen when the shape of the eye stops you from focusing well and leads to blurred vision. The cause could be the length of the eyeball (longer or shorter), changes in the shape of the cornea, or ageing of the lens. The main refractive errors are Myopia (near-sightedness), Presbyopia (long-sightedness) and astigmatism. Refractive errors are more likely in adults with Down’s syndrome and tend to be more severe.  Near-sightedness may   get worse in adulthood if a person develops cataracts and/or keratoconus.

Presbyopia

Presbyopia is the loss of accommodation (near focusing) which happens as we get older due to loss of elasticity of the lens of the eye. In the general population this typically happens at around 45 years of age; in adults with Down’s syndrome it may be that presbyopia happens earlier. Presbyopia is often ignored in adults with learning disabilities, perhaps because of the common use of the term ‘reading glasses’; if a person does not read, it may be that family and carers do not consider spectacles for other near tasks. Many adults with Down’s syndrome do read, and others will have jobs or hobbies that require good near vision, so need ‘near’ glasses.

Blepharitis

Blepharitis is a common condition which is caused by bacterial infection or skin conditions. If a person has blockage of the tear duct, dry eyes or a skin disease there is an increased chance of developing Blepharitis. The signs to look out for are red and irritable eyelids; dry flakes on the eyelid and the person may experience a burning feeling in their eye. In most cases keeping the eyelids clean and supporting a person not to rub their eyes is usually all that is needed to deal with this condition. However, some people will need a referral to a hospital eye clinic if the problem persists. Your local optometrist can advise you if a person you support develops Blepharitis. More information about the condition is available here

Conjunctivitis

Conjunctivitis is an inflammation of the membrane covering the eye and it is usually caused by bacterial or viral infection. Sometimes it can happen because of an allergy, something in the eye or excessive use of contact lenses. It causes redness of the eyes and sometimes itchiness, stickiness and watering of the eyes. Mild cases should be referred to an optometrist who can usually determine the type of conjunctivitis and advise accordingly. The condition would only rarely require hospital referral.

Keratoconus

This is a condition in which the cornea (the clear, curved part at the front of the eye) becomes thin and fragile and steepens into an abnormal protruding conical shape. Usually there is no known cause for the condition but it can happen if a person rubs their eyes a lot. The protrusion gets worse over time and causes an increase in short-sight and distortions of vision that cannot be corrected with spectacles.

It can be managed with contact lenses, and people with Down’s syndrome should be offered the same opportunity to try contact lenses as those in the general population. There are many cases of very successful lens wearers with Down’s syndrome. In late-stage progressive keratoconus, corneal transplant is the standard treatment and is as successful in people with Down’s syndrome as it is in the general population. New therapies are becoming available that aim to halt the progression of keratoconus; the most well established one is collagen cross-linkage. This therapy is only viable in the early stages, and therein lies a challenge. The normal cornea in people with Down’s syndrome is thinner and steeper than average, which can lead to misdiagnosis of keratoconus.  Recognition of early true keratoconus in people with Down’s syndrome is reliant on progression over time. Because keratoconus seems to happen from adolescence onwards there is an argument for more frequent eye examinations during teenage years in order to pick up the condition early.

Cataracts

Cataracts appear in much younger adults than would be expected in the general population. A cataract is a clouding over of the lens of the eye which can affect one or both eyes. Signs that an adult is developing cataracts may include obvious clouding of a person’s eye, turning of the head to look at things out of the sides of the eye, emotional or behaviour changes and a loss of daily living skills. A person’s ability to see may appear to fluctuate; they may be able to perform a task in some situations and not in others. The frustration of fluctuating vision can cause behaviour changes.

Adults with cataracts should visit an ophthalmologist regularly so that the growth of the cataract can be monitored. If a cataract is small and not blocking vision, it is usually just monitored. Understanding the condition is the key to managing it in early stages. Preventing glare by rearranging lighting and household furniture, increasing contrast of tasks and the simple provision of a wide-brimmed hat for outdoor use can make a big difference to quality of life.

Cataract removal is a highly successful operation; people with Down’s syndrome may benefit from an earlier referral for an operation so that they can become familiar with the hospital clinic and so that appropriate planning for aftercare can be put in place in plenty of time.

Vision and getting around

Some adults with Down’s syndrome struggle with stairs and steps and mistake changes in floor covering for a step. This leads to loss of confidence when walking and can be quite debilitating. If an adult begins to struggle with these things make sure they have an eye examination. There may be other causes such as anxiety, but it is important to rule out vision problems as a potential cause for these difficulties.  If a loss or change in vision is not the reason then book an appointment with the person’s GP for further investigation.

Age related eye conditions

Adults with Down’s syndrome are probably prone to exactly the same age related eye conditions as the general population.

Conditions such as entropian and ectropian can occur (in-turned and out-turned eye lids) and are usually due to changes in the eyelid that come with age making it lax. If you notice these conditions, take the person to their GP for investigation.

Age related macular degeneration can happen in someone with Down’s syndrome as they get older. This causes loss of central vision usually in both eyes and vision becomes increasingly blurred. Reading may become more difficult, colours appear less vibrant and faces become more difficult to recognise.

Glaucoma, an increase in the pressure within the eye leading to impaired vision, can happen very gradually in adults.

Final note – Be vigilant

  • These conditions may not be immediately obvious to those supporting an adult
  • Look for changes big and small that might indicate that someone has a vision problem
  • Changes to an adult’s vision may occur gradually over time and the person may be unable to tell you what has changed
  • People with Down’s syndrome need regular eye examinations throughout their adult life

For more information and free resources, please visit the DSA Vision pages