Elsevier

Ophthalmology

Volume 111, Issue 8, August 2004, Pages 1457-1463
Ophthalmology

Original article
Prevalence of ocular diagnoses found on screening 1539 adults with intellectual disabilities

https://doi.org/10.1016/j.ophtha.2003.12.051Get rights and content

Abstract

Objective

To study the prevalence of ocular disorders in adults with intellectual disabilities (IDs) in the Netherlands.

Design

Cross-sectional survey.

Subjects

A stratified random sample (for age more than 50 years and Down syndrome [DS]) of 1598 participants drawn from a base population of 9012 adult users of ID services with mild to profound intellectual disabilities in the Netherlands.

Methods

Participants underwent on-site visual screening on the basis of a protocol. Results were related to degree of ID, occurrence of DS, age, and a diagnosis of visual impairment or blindness. Referral to ophthalmologists followed when visual impairment was diagnosed.

Main outcome measures

Diagnosis of ocular disorders and their prevalence.

Results

Refractive errors were most prevalent (60.6%), followed by strabismus (44.1%) and lens opacities (18.1%). Besides these, in participants diagnosed as visually impaired, cerebral visual impairment was the most common untreatable disorder (12.6%), followed by macular degeneration (5.4%). Compared with known figures from general populations, the prevalence of ocular diagnoses in adults with ID was significantly higher. The occurrence of refractive errors and strabismus was significantly related to DS (odds ratio [OR], 2.16; 95% confidence interval [CI], 1.56 to 3.00; and OR, 2.47; 95% CI, 1.93 to 3.17, respectively). Lens opacities had an independent relation with age more than 50 years (OR, 4.23; 95% CI, 3.04 to 5.88) and DS (OR, 8.27; 95% CI, 5.95 to 11.49). Keratoconus was independently related to DS (OR, 7.65; 95% CI, 3.91 to 14.96) and degree of ID (OR, 5.56; 95% CI, 2.79 to 11.06). Corneal opacities also were related to DS (OR, 2.70; 95% CI, 1.41 to 5.18) and degree of ID (OR, 5.53; 95% CI, 2.66 to 11.48). The risk of ocular hypertension was increased by age more than 50 years (OR, 2.54; 95% CI, 1.16 to 5.57) and severe or profound ID (OR, 4.86; 95% CI, 2.06 to 10.63); DS decreased the risk (OR, 0.21; 95% CI, 0.05 to 0.94).

Conclusions

In 1539 adults with ID in the Netherlands, high prevalences of ocular disorders were found. Adults with ID in general have an increased risk of severe myopia, strabismus, and lens opacities; DS, older age, or severe ID further increase the risk of specific ocular disorders.

Section snippets

Population

The design of the Dutch multicenter study on visual and hearing impairment in adults with ID has been described elsewhere.8 In summary, from a background population of 9012 adult users of ID services (aged 18 years and older), a random sample of 2100 adults was drawn. Stratification was applied for age 50 or more and DS, which are both risk factors for visual impairment, to obtain subgroups large enough to yield valid information on subgroup prevalence and relative risks. The degree of ID

Description of the study population

Of the 1598 selected persons, 1539 took part in the visual screening. The other 59 dropped out for various reasons (deceased, ill, removal, withdrawal of permission). The distribution of age, presence of DS, and degree of ID is shown in Table 1. There were 862 males in the group (56.0%); age range was 20.2 to 88.7 years (mean, 45.7 years). Visual impairment or blindness was diagnosed in 261 participants.

Cooperation

The duration of the assessments was not monitored precisely, but the mean examination time

Discussion

Screening of a large adult population with ID revealed that specifically trained general physicians and orthoptists were able to assess most of this population. It was feasible to perform most of the assessments in 72% of the participants. Tonometry proved to be a problem, being assessable only in 26% of participants. Because of the nature of the screenings and participants' aversion to eyedrops, ophthalmoscopy was not performed. This assessment required ophthalmologic expertise, which was not

Acknowledgements

The authors thank the following optometrists, who assessed the selected participants: G.M.H.J. Arentz, M. Oostenbrink, and K. Spruyt. The authors also thank the following ophthalmologists, who assessed the referred patients: L.A.K. Bastiaensen, MD, PhD, Tilburg; J.R.M. Cruysberg, MD, PhD, Nijmegen; J.T.H.N. de Faber, MD, Rotterdam; M.M. van Genderen, MD, Zeist; F.D. Koole, MD, Amsterdam; J.W.R. Pott, MD, PhD, Groningen; C.M.C Schweitzer, MD, Almelo; M. Swart-van den Berg, MD, Leiden; N.T.

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  • Cited by (0)

    Manuscript no. 230418.

    Supported by the Netherlands Organization for Scientific Research, The Hague, The Netherlands (grant no.: 940-33-029); the Dr Fischer Foundation, Amsterdam, The Netherlands; De Bruggen Intellectual Disability Center, Zwammerdam, The Netherlands; and Bartiméushage, Doorn, The Netherlands.

    The authors have no commercial interests in any products described in this article.

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