Previous reports confirm the high incidence of eye abnormalities in DS adults [Hestnes et al., 1991]. Normal ocular findings in DS adults are considered to be an exception, and the possibility of ocular pathologic conditions should be actively investigated. Diagnosis of early cataracts and keratoconus may be difficult in marginally cooperative patients.
In childhood, the chief concerns for DS individuals are congenital cataracts, refractive errors, strabismus, and amblyopia. With increasing age, adult-onset cataracts are common [Pueschel, 1990; Evenhuis, 1991]. Among the Woodlands patients, refractive errors (32.4%, 13/38), usually myopia, and strabismus (36.8%, 14/38) are common. Adultonset cataracts are present in 33% of our middle age and in 65% of our elderly DS adults. Even though cataract removal is possible, visual problems related to aphakia and poor compliance with use of bifocals result in significant visual disability even in those who are treated.
Keratoconus is another condition frequently reported in adults with DS. The pathogenesis of this condition is not known. Hestnes et al.  reports on 9 DS patients with keratoconus, two of whom developed phthisis bulbi. Keratoconus is more common in our elderly (20%) than in our middleaged (11%) DS adults. Only one of ou adults with keratoconus developed phthisis bulbi. Frantz et al.  reports favourable results of keratoplasty in individuals with DS.
Careful selection of patients and individual nursing during the postoperative period are recommended. Whether adults with Down syndrome are living in the
community or in residential care, a program of anticipatory health care screening and early detection of health problems is recommended.