Appendix 24 – Ophthalmology pathway
The Down Syndrome Medical Interest Group provides evidence-based guidelines for many of the health problems that can affect children. This is part of the guidance on vision:
Distance and near functioning vision should be checked at every review whenever developmentally possible and a prescription for near correction or bifocals considered at all ages
https://www.dsmig.org.uk/wp-content/uploads/2015/09/Guideline-vision-revision-2012.pdf
Many hospitals routinely refer to ophthalmology after the baby is born, either following an admission to the neonatal unit or at the postnatal baby check by the paediatrician or midwife. Either way, there MUST be clear documentation that the eyes have been checked formally for cataracts, squints, nystagmus and visual behaviour. Any concerns identified refer immediately.
If the baby has not been referred routinely after birth, in Barnet we have decided to refer routinely to ophthalmology at the 12 month review in order for the child to be seen at 18 months by the Paediatric Ophthalmology team at Barnet hospital. DSMIG guidelines say to refer around age 2-3 years, but in discussion with the team they would like to see these infants within the 2nd year of life and not wait till 2yrs+. Referral by letter to Consultant Ophthalmologist at Barnet hospital (discuss with the team directly if you have urgent concerns or want the child to be seen urgently, do not just send a letter as it may not be triaged as urgent without contacting the consultant ophthalmologist).
Community paediatrician to check vision, visual behaviour and development at every review including checking for cataracts, nystagmus, squints and refer earlier if any concerns.
Research updates:
There is some discussion about bifocals from the age of 2 in children with Down Syndrome.
"So now we prescribe bifocals routinely for all children with Down Syndrome who have the focusing defect once their long or short sight is corrected. Almost all of the children take to bifocals very readily, and most make their own choice to wear their bifocals all of the time. The children are clearly demonstrating to us that they benefit from bifocals. Our criterion is that, if a child is old enough to sit at a table and do near tasks (whether work or play), he or she is old enough for bifocals. Once we started to fit bifocals routinely, we found something quite unexpected. Some of the children began to focus accurately over the top of their bifocal (using just the part of the lens that corrects long or short sight). After, on average, two years of wear, they were able to come out of bifocals and return to ordinary lenses. Quite what is happening, we don’t yet know, but it is clear that the bifocals are ‘teaching’ the children to use their own focusing. So far, 40% have stopped needing bifocals, and none have ‘relapsed’ into needing them again. What the above outcomes of our research tell us is this: it was never the case that the children couldn’t focus properly; it was the case that they didn’t. When they wore their bifocals they learned how to do it by themselves. Why 25% of children with Down Syndrome do it anyway, and how the bifocals teach others to do so, we simply don’t know."
Maggie Woodhouse, Cardiff University.
Specialist Teams
D&HS (Deaf & Hearing Support Team)
PD&CN (Physical Disability & Complex Needs Support Team)
SSTV (Specialist Teaching Team, Vision)
(BELS) Barnet Education and Learning Service, 3rd Floor, 2 Bristol Avenue, Colindale, London NW9 4EW
D&HS email: D&HS.Team@barnet.gov.uk
PD&CN email: pd.team@barnet.gov.uk
STTV email: VI.Team@barnet.gov.uk
(secure emails only)
