Visual impairment in people with low intellectual abilities

Institute de Brink in the North of The Netherlands is a residence people with profound to severe intellectual disabilities (ID) and severe visual impairment (VI). Ophthalmologic records from all residents were kept over the passed 30 years. We have reviewed and classified 160 records according to the classification of F. Meire [1] [F.M. Meire. Genetics in ophthalmology. Bull. Soc. Belge Ophtalmol. 269 (1998) 3-4]. Data on visual acuity, refractive errors, strabismus and ocular diagnoses were assembled as well as ophthalmic problems met during residency. Also additional handicaps were recorded. In the whole group, 155 records were complete for use. 64% of the residents appeared to be functionally blind (WHO category 0020 vision < 0.05). In the group with functional vision, N = 55, nystagmus and strabismus were more frequently seen as compared with the normal population. Optic atrophy was found most of the time as an end stage of Cerebral Visual Impairment (CVI). Classification of the causes of the ophthalmic problems showed that in the nongenetic group pre- and perinatal problems were the main causes of VI and in the genetic group syndromal anomalies. Severe and profound ID are seen in combination with other handicaps like deafness and motor handicaps which ask for special care. In this group, residents with congenital cataract had a bad prognosis. Eye poking was another problem with complications leading to blindness. Behavioural therapy and stimulation of the resident may prevent this behaviour.