Umfress AC, et al. - Via reviewing medical records for 689 patients with trisomy 21, researchers conducted this retrospective cohort study to ascertain if children who have a normal first examination need to have formal reevaluation by an ophthalmologist. This investigation took place between 2012 and 2017 at the Vanderbilt Eye Institute. To determine whether new abnormalities developed at subsequent visits, ocular and refractive abnormalities present on initial screening were recorded and follow-up data were reviewed. Strabismus, significant refractive error, and eyelid abnormalities (including ectropion and accessory puncta) were the most common abnormalities seen on initial screening examination. Findings suggested that ocular pathology occurs at a much higher prevalence than the general population in trisomy 21, therefore, these children should initially have an extensive eye exam. Although the development of new ocular pathology in a child with trisomy 21 and an earlier normal examination is not unusual, most of these new anomalies can be identified with automated vision screening techniques or direct visual inspection of the eyes and ocular adnexa. Therefore, once a child has a normal examination, a formal vision screening could replace a formal ophthalmological examination.