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

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.