Optometrists who rely on auto-refractors could be losing vital skills for preserving eye health in individuals with Down’s syndrome and other learning disabilities, according to a new study.
Research released by the Down’s Sydrome Association this week found using retinoscopy on a daily basis was crucial in spotting early keratoconus, which affects as many as 1 in 10 individuals with Down’s syndrome.
Optometrist Stephanie Campbell from Down’s syndrome Vision Research Unit, Cardiff, said: ‘Just as in many spheres of life, optical practitioners are being seduced by technology, and in many optometric practices, the retinoscope is being replaced by auto-refractors. This poses dangers for individuals with Down’s syndrome whereby early keratoconus can pass un-noticed, or difficulty in obtaining a result with an auto-refractor can be attributed to the patient’s learning disability.’
The study of a group of 45 young people with Down’s syndrome, aged 13 to 26 years, 11 of whom had keratoconus, also found that eye-rubbing did not seem to be a cause of keratoconus, that measuring astigmatism does not distinguish those individuals at risk of keratoconus.
It also found measuring visual acuity and examining the eye under magnification does not distinguish between healthy eyes and early keratoconus, but the quality of the retinoscopy reflex does.
In the study, all eyes with keratoconus had an abnormal retinoscopy reflex and all healthy eyes had a smooth reflex. This technique therefore, which all optometrists are trained to use, ‘is the obvious key to detecting keratoconus in young people with Down’s syndrome’, added Campbell.
Dr Maggie Woodhouse, OBE, senior lecturer at Cardiff University’s School of Optometry & Vision Sciences, added: ‘I am very concerned that many optometrists are not using retinoscopy on a daily basis, and therefore losing this invaluable skill. Obviously, for people with Down's syndrome, it means that treatable conditions like keratoconus are inevitably going to be missed, but it also means that optometrists can't offer eye examinations to young children or anyone with learning disabilities who cannot use hi-tech instrumentation. It's as if optometrists are deliberately choosing to deny eye care to the most vulnerable members of our population.’