Down syndrome impacts the developing eye and proper vision development. Eye disease is reported in over 50% of individuals with Down syndrome, from less severe tear duct abnormalities to vision-threatening diagnoses such as early age cataracts. Medical professionals recommend particular attention to vision in people with Down syndrome.

There are characteristic features about the eyes of a person with Down syndrome. This includes upward slanting of the eyelids, prominent folds of skin between the eye and the nose, and small white spots present on the iris (the colored part of the eye) called Brushfield’s spots. These spots are harmless and can be seen in people without Down syndrome.

Some problem signs that indicate an issue with vision include:

  • Squinting or closing one eye
  • Unusual head tilt
  • Crossing or wandering of one or both eyes
  • Light sensitivity
  • Looking out the corner of the eye

In some severe cases, the sign of vision problems may denote a regression in overall function or loss of developmental milestones.

In addition to the physiological issues with vision, people with Down syndrome may also experience challenges with visual perception, which refers to the brain’s ability to make sense of what the eyes see. This is not the same as visual acuity, which refers to how a person sees. Good visual perceptual skills are vital for everyday skills such as:

  • Reading
  • Writing
  • Completing puzzles
  • Cutting/drawing
  • Dressing

Problems with visual perception can include difficulties with:

  • Academic performance: the ease and skill with which they can complete academic tasks
  • Attention and concentration: sustained effort, doing activities without distraction and being able to hold that effort long enough to get the task done
  • Self-regulation: the ability to obtain, maintain and change one’s emotion, behaviour, attention and activity level appropriate for a task or situation
  • Behaviour: they may avoid or refuse to participate in activities that require visual perceptual skills
  • Frustration: with precise eye and hand tasks
  • Avoidance: prefer to get others to perform tasks for them under their direction, rather than doing themselves (e.g. “Can you draw me a house,” or “build me a rocket,” with refusal to do it themselves)
  • Organization: they may have difficulty keeping track of and organizing belongings

 The final component to consider is visual motor integration, translating a visual image, or a visual plan, into an accurate motor action. Problems with visual-motor integration can include:

  • Trouble recognizing patterns and completing hands-on math problems
  • Difficulty catching or kicking a ball
  • Clumsiness
  • Difficulty with fastening buttons/zippers, tying shoelaces
  • Difficulty drawing and copying pictures or shapes/colouring within the lines
  • Difficulty copying block forms
  • Difficulty with puzzles
  • Difficulty keeping place when reading and writing

At DSRF, occupational therapy can help with improving visual perceptual and motor integration skills while also helping with adherence to wearing eyeglasses, preparing for eye exams, and improving overall functioning in school, at home, and in the community.

DSRF Resources

The LowDOWN Podcast, Episode 5-5: Dr. Ken Nischal – I Can See Clearly Now: Vision and Down Syndrome (Apr. 20, 2022)

The LowDOWN Podcast, Episode 5-6: Debra Legge – Eye Spy: Vision Therapy for People with Down Syndrome (Apr. 27, 2022)

Tips for Wearing Glasses

Other Resources

Vision and Down Syndrome (NDSS)

Down Syndrome Center at UPMC Children’s Hospital of Pittsburgh Podcast: Pediatric Ophthalmology

American Association for Pediatric Ophthalmology & Strabismus: Down Syndrome

Caring for the Eyes of Children with Developmental and Intellectual Disabilities