title: Children with Down syndrome benefit from bifocals as evidenced by increased compliance with spectacle wear.
abstract: BACKGROUND
  In our experience, children with Down syndrome were noncompliant with spectacle wear, often attributed to their inability to appreciate benefit from the glasses. Studies show that up to 80% of children with Down syndrome have reduced accommodation. The purpose of this study was to evaluate whether the use of bifocals increased compliance with spectacle wear.
  
  
  METHODS
  A retrospective review of medical records from 1983 to 2007 identified 86 children with Down syndrome who were prescribed either bifocal or single vision spectacles. Compliance with spectacle wear was assessed by telephone and was available for 57 children: 27 with bifocals and 30 with single-vision spectacles. Accommodative ability had been assessed by dynamic retinoscopy in 39 of these children.
  
  
  RESULTS
  In the 27 bifocal children, all had poor accommodation on dynamic retinoscopy. Of these 27 children, 24 were compliant with spectacle wear (89%), whereas only 15 of the 30 single-vision spectacle children were compliant (50%). Of the 30 single-vision spectacle children, 18 had not had dynamic retinoscopy, and accommodative ability was thus unknown. Of the 12 who had undergone dynamic retinoscopy, 5 showed poor accommodation. The remaining 7 had good accommodation but showed compliance of only 43% in wearing single-vision glasses. The association between type of spectacle prescribed and compliance with wear was statistically significant by χ(2) testing (P = 0.002).
  
  
  CONCLUSIONS
  In our study cohort, the addition of bifocal segments improved compliance with spectacle wear in children with Down syndrome.
authors.affiliation: The Krieger Children's Eye Center at The Wilmer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Rohit
authors.initials: R
authors.lastname: Adyanthaya
authors.affiliation: The Krieger Children's Eye Center at The Wilmer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Sheena
authors.initials: S
authors.lastname: Isenor
authors.affiliation: The Krieger Children's Eye Center at The Wilmer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Brinda
authors.initials: B
authors.lastname: Muthusamy
authors.affiliation: The Krieger Children's Eye Center at The Wilmer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Kristina
authors.initials: K
authors.lastname: Irsch
authors.affiliation: The Krieger Children's Eye Center at The Wilmer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: dguyton@jhmi.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: Guyton
mesh_terms: D000065:Accommodation, Ocular; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004314:Down Syndrome / Q000150:complications*; D005139:Eyeglasses / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012029:Refraction, Ocular / Q000502:physiology; D012030:Refractive Errors / Q000628:therapy*; D042262:Retinoscopy; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology