The impact of visual impairment on adults with an intellectual disability

Over forty years ago, the Danish ophthalmologist Mette Warburg was the fi rst to ask attention for the increased risk of visual impairment in people with intellectual disabilities (Warburg, 1963, 1975). She based this on her clinical experience and fi rst evaluations in groups of adults in Danish day care centers. She claimed in an early stage that the risk increased with more severe levels of intellectual disability (Warburg, 1983). Warburg has long remained a voice in the wilderness. Incidental colleagues, among them Lena Jacobson in Sweden, performed ophthalmological evaluations in larger groups and reported an overrepresentation of ocular pathologies (Jacobson, 1988). However, problems with assessment of visual function in people who were not able to cooperate with Snellen or picture card acuity tests, remained a barrier to identify those with impairments. Gradually, acuity tests using matching cards, developed for assessment in young children by Sheridan & Gardiner (1970) and by Lea Hyvärinen (Hyvärinen et al., 1980), started to be applied in children and adults with moderate intellectual disabilities. In the United States, Davida Teller developed the preferential looking card for assessment of visual acuity in babies and toddlers (Dobson et al., 1978; Teller, 1979), after which Jackie van Hof-van Duin successfully applied this card in Dutch children and adults with severe or profound intellectual disabilities (Mohn & Hof-van Duin, 1983). Th e next academic group systematically addressing visual functioning in this population, specifi cally people with Down syndrome, was the optometry department of Cardiff University in Wales, led by Margareth Woodhouse (Woodhouse et al., 1993). Next to the Teller card, this group developed the Cardiff card, with line pictures in stead of stripes (Woodhouse et al., 1992; Adoh et al., 1992). In this way, visual acuity assessment became feasible in principally all persons with intellectual disabilities who are not able to cooperate with routine diagnostics.

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