Accommodation deficit in children with Down syndrome: Practical considerations for the Optometrist.

Julie-Anne Little School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, UKAbstract: Down syndrome is the most common cause of intellectual impairment, and life expectancy in this group has increased in recent decades, meaning that health care is increasingly focused on quality of life and the management of treatable illnesses. There are frequent problems associated with vision in Down syndrome, including refractive errors, strabismus, reduced vision, and reduced accommodative ability. This review will discuss the importance of accommodative ability; describe the prevalence and nature of accommodative deficits in Down syndrome, which are found in approximately 55%–76% of individuals; discuss the management of this deficit with the prescription of bifocal correction; and summarize the possible etiologies of hypoaccommodation in Down syndrome. Finally, the review will consider practical considerations for the optometrist managing accommodative deficits in patients with Down syndrome. Keywords: Down syndrome, accommodation, accommodative deficits, dynamic retinoscopy, bifocals, refractive erro

Archaeological Testing at the John Brice II (Jennings-Brice) House, 18AP53, 195 Prince George Street, Annapolis, Maryland

In the fall of 1989, emergency excavation was undertaken in conjunction with restoration work at the John Brice II (Jennings-Brice) House, 18AP53. The exact date of construction for this brick home is problematic, and it was hoped that archaeological investigation could provide conclusive evidence to firmly establish the structure's date of construction. Excavation of one 5 X 5 ft. unit revealed the presence of 10 separate soil layers and four features of note, described in detail below. Unfortunately, no builders trench or similar feature by which we might date the house's construction was recovered. Future plans and possibilities for excavation at the property are outlined with the hopes of performing subsequent work at this rich site. We anticipate a focus on the arrangement and changes in use of the houselot, amassing evidence to support the presence of a vernacular garden on the property during the 18th century, as well as researching refuse disposal patterns, and clues to changing lifeways through the 18th century

Trying to see, failing to focus:near visual impairment in Down syndrome

The majority of individuals with Down syndrome (DS) do not exhibit accurate accommodation, with the aetiology of this deficit unknown. This study examines the mechanism underlying hypoaccommodation in DS by simultaneously investigating the ‘near triad’ – accommodation, vergence and pupillary response. An objective photorefraction system measured accommodation, pupil size and gaze position (vergence) under binocular conditions while participants viewed an animated movie at 50, 33, 25 and 20 cm. Participants were aged 6–16 years (DS = 41, controls = 76). Measures were obtained from 59% of participants with DS and 99% of controls. Accommodative response was significantly less in DS (p < 0.001) and greater accommodative deficits were associated with worsening visual acuity (p = 0.02). Vergence responses were as accurate in DS as in controls (p = 0.90). Habitual pupil diameter did not differ between groups (p = 0.24) but reduced significantly with increasing accommodative demand in both participants with and without DS (p < 0.0001). This study is the first to report simultaneous binocular measurement of the near triad in DS demonstrating that hypoaccommodation is linked to poor visual acuity. Vergence responses were accurate indicating that hypoaccommodation cannot be dismissed as a failure to visually engage with near targets, but rather is a consequence of underlying neurological or physiological deficits

The participatory experiences of pupils with vision impairment in education

While there has been a long-term commitment to inclusion in mainstream schools for pupils with special educational needs, including vision impairment (VI), the position of these pupils in an inclusive school environment, and the extent to which their educational, social, and emotional needs are met, continues to be problematic. This study investigates the experience of children and young people with VI accessing the curriculum and education, through evaluating the perceived quality of their participation in terms of rights, efficiency, and development. The methodology employed a qualitative approach, comprising face-to-face focus group interviews with pupils with VI. Three focus group sessions took place with 13 pupils with VI aged 8–18 years from primary and post-primary schools. Regarding pupils’ participatory rights, many reported challenges experienced in terms of equal access to education. In some instances, obstacles emerged due to lack of proper engagement with the pupil, or teachers’ actions were seen to reinforce pupil difference, undermining opportunities for more inclusive practice. In terms of development, this was chiefly evidenced by frequent descriptions of ‘missing out’, particularly on the social and peer engagement aspects of school life. Pupils unanimously reported that participation could be more efficient if there was increased awareness of their lived experiences with VI, and positive aspects of empowerment emerged when pupils felt included in decision-making about their needs. This study highlights key challenges for pupils with VI regarding how they access education in Northern Ireland, including issues surrounding their inclusion, everyday discrimination, and a lack of awareness of VI. Although these children and young people demonstrated appeasement and understanding, when insensitivities arose, pupils with VI, while resilient and generally positive about their experience, are faced with challenges that diminish their access, participation, and enjoyment of education

Use of complementary and alternative medicine in pediatric otolaryngology patients attending a tertiary hospital in the UK

Objective: Little data is available on complementary and alternative medicine (CAM) use in children attending otolaryngology services. We investigated the prevalence and pattern of CAM use among children attending the pediatric otolaryngology department in a tertiary pediatric teaching hospital in Scotland. Design: A cross-sectional survey conducted by administering an anonymous questionnaire to the parents accompanying patients attending the pediatric otolaryngology department. Elective admissions and clinic attendees were included over a 3-month period in 2005/2006. Setting: Academic tertiary care referral centre in North-East Scotland. Patients: Five hundred and fifty-four consecutive patients aged less than 16 years were eligible. The response rate was 59% (n = 327). Main outcome measures: Prevalence of CAM use in children. Secondary measures include types of CAM used, indications for use and communication with family physicians. Results: Based on 327 responses, 93 patients (29%) had ever used CAM, 20% within the last year. Commonly used CAM preparations were cod-liver oil, echinacea, aloe vera, cranberry, primrose oil and herbal vitamin supplements. The popular non-herbal CAM included homeopathy, massage, aromatherapy, chiropractic, yoga and reiki. Nineteen percent used CAM for their admission illness. Sixty-one percent of parents thought that CAM was effective and 65% would recommend it to others. Fifty-one percent of parents stated that the family physician was unaware of CAM use by the child. Conclusions: Despite concerns regarding the efficacy, safety and cost effectiveness of complementary and alternative medicine, its use among the pediatric otolaryngology population is more common than many providers may realize. This has implications for all healthcare workers involved in their care