Sunday, October 5, 2014

Bifocals in children with Down syndrome

Bifocals in children with Down syndrome


"...[Introduction]...the aim of this study was to investigate the impact of bifocals on the educational 
attainment of children and young adults with DS who have reduced accommodation and monitor 
their performance longitudinally. ...

[Key Findings]...Accommodation accuracy was found to improve with bifocals.... bifocals do have an impact on the children‘s visual and school performance....there was a statistically significant overall improvement in word recognition tests and in some visual perceptual skills. .... This improvement in reading performance and visual perceptual tasks is expected to transfer into improvements in academic attainments...... the children were readily using the bifocals and adapted to them quicker than expected. In fact, they appeared to adapt to them more readily than the SV glasses, wearing them for the majority of their waking time. ..... On average the children performed the WI test faster with bifocals at both the main visits and after bifocal provision. Faster performance was also seen with the Dolch and the number writing test in the monthly probes.....

.[Conclusion]...This was also one of the few studies that assessed reading, printing and perceptual skills together with measures of literacy administered every month. To conclude, this thesis provides evidence of improved near visual acuity, accommodative accuracy and improved performance and rate of performance on tests of literacy with bifocals. Indirect measures of compliance also showed improved compliance with bifocal lenses compared to single vision lenses. Thus the clinical standard of care must change for individuals with DS. The clinical standard of care should include the measurement of accommodation and that clinicians be more ready to prescribe bifocals to children and young adults with DS who present with reduced 
accommodation. More studies are required to understand the long term impact of bifocals in 
individuals with DS and in similar populations....."

Comments: This is a dissertation by Krithika Nandakumar a PhD candidate at the University of Waterloo, in Canada. It appears to be a well designed and thought out study.

If these findings are in fact accurate and the outcomes are reliable, why does the medical/scientific community accept the fact that bifocals can do all these wonderful things in children with Down Syndrome and then scoff at the improved outcomes (similar to those noted above) noted for children without Down Syndrome when functional optometrists use bifocals and/or vision therapy to improve accommodative function in their patients?

Could it be that functional optometry has been right all along and the non-OD community is embarrassed for their shortsightedness in so many areas (pun intended!)? 

Functional optometrists were right when we said amblyopia could be treated at any age.

Functional optometrists were right when we said in office vision therapy is an effective mode of treatment for binocular vision disorders.

Functional optometrists were right when we said the environment affects the development of refractive error.

Are functional optometrists also right when we say that learning related vision problems can affect academic performance and with vision therapy we can improve school performance? 

Stay tuned for the outcomes of the Office-based Vision Therapy for Improving Reading and Attention in Children With Convergence Insufficiency (CITT-ART) clinical trials. I'm betting we are right about this too!!! DM

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