Corneal graft and cataract surgery in patients with moderate to severe intellectual disability

Background Intraocular surgery in patients with intellectual disability can be hazardous. Our aim was to determine the outcomes of surgery on all such patients seen in a consultant-led service, and to assess the overall risks and benefits. Materials and Methods A retrospective chart review of patients with moderate to severe intellectual disability, operated upon over a 9-year period was undertaken. Thirty-four eyes of 21 patients were operated upon and procedures included four penetrating keratoplasties, five combined penetrating keratoplasties with cataract extractions, and 25 cataract extractions alone. Results Most patients achieved a beneficial outcome, noted by their carers, such as better mobility and social interaction. Three patients had major post-operative complications, all associated with corneal grafts. Only seven patients were, within the context of conventional busy outpatient clinics, deemed capable of co-operating with a formal visual acuity assessment either pre- or post-operatively. Conclusions Cataract and corneal graft surgery in individuals with intellectual disability is beneficial, and referral to an ophthalmologist should be considered as intellectual disability need not necessarily be a contraindication for surgery. The authors recommend that these patients should be assessed in a dedicated ophthalmology clinic setting for the intellectually disabled, where there should be better facilities for appropriate visual assessment tailored to the patients' abilities.