DUANE SYNDROME
Definition
Duane syndrome is a genetic disorder that affects eye movement. People with this syndrome have difficulties moving their eyes outward (toward the ear) and inward (toward the nose). When people with Duane syndrome look inward, the eyelids tend to partially close as the eyeball is pulled back into the socket. Normally only one eye is affected at a time and is usually diagnosed by age 10. Duane syndrome manifests in three designated types, based on which movement of the eye is affected most. This can include inward movement, outward movement or both.
Research shows that diverse ethnic groups are the most susceptible for Duane syndrome. As a genetic disorder, there are both autosomal dominant and autosomal recessive forms the syndrome, manifesting more in females than males (about 60:40). Because of this, reduced penetrance (skipping a generation) and variable expressiveness of the syndrome have been documented. Although cases of Duane syndrome are sporadic and rather rare there are many of accommodations and treatments available for people with Duane syndrome.
Instructional Strategies
Useful Websites
Classroom Accommodations for Students with Visual Issues
https://www.bouldervt.com/wp-content/uploads/sites/478/2015/12/227-Course-Handout-CCIRA-2016.pdf
Texas School for the Blind and Visually Impaired: Specific Eye Conditions, Corresponding Impact on Vision, And Related Educational Considerations
https://www.tsbvi.edu/eye-conditions
Boston Children’s Hospital: What is Duane syndrome and how it is cared for
http://www.childrenshospital.org/conditions-and-treatments/conditions/d/duane-syndrome
National Center for Advancing Translational Sciences: Genetic and Rare Disease Information Center
https://rarediseases.info.nih.gov/diseases/10763/duane-syndrome-type-1
Healthline: Types, Surgery Information and Symptoms
Research
Current research focuses on different facets of treatment regarding Duane’s syndrome. A recent paper from the University of Iowa looked at a simplified approach to treatment. Traditional methods include surgery, attempting to correct the medial rectus muscle and treat the abnormal head position. This paper looked at the effectiveness of a specific surgery. Interestingly enough, of the 59 patients that were tested 93% reported horizontal muscle recession (success). The article states that unilateral or bilateral horizontal rectus muscle recession showed to be a simple and effective surgical option for eliminating the abnormal head position associated with Duane Syndrome. (Barbe ME, Scott WE, Kutschke PJ A simplified approach to the treatment of Duane’s syndrome British Journal of Ophthalmology 2004;88:131-138.)
Additional research looks at the various causes of Duane syndrome through mouse studies. A research article from the American Journal of Human Genetics looked at the relationship between MAFB (MAF BZIP Transcription Factor B) and the development of Duane syndrome. The study found that mutations in the MAFB gene causes Duane retraction syndrome. (Park, Jong G., et al. "Loss of MAFB Function in Humans and Mice Causes Duane Syndrome, Aberrant Extraocular Muscle Innervation, and Inner-Ear Defects." The American Journal of Human Genetics, vol. 98, no. 6, 2016, pp. 1220-1227.).
An article from the Taiwan Journal of Ophthalmology focuses on the different therapy styles surrounding Duane syndrome. The paper focuses on the pros and cons of the different corrective surgeries that are currently available for Duane syndrome. The article stated that although there is no complete “cure”, typically surgical intervention yields positive, “successful” results. (Özkan, Seyhan B. "Pearls and Pitfalls in the Management of Duane Syndrome." Taiwan Journal of Ophthalmology, vol. 7, no. 1, 2017, pp. 3-11.)
Other
Fascinating case presentation about Duane syndrome.
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Accommodations for limited head movemen/Eyesight
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Placing a student with Duane syndrome closer to the teacher could help reduce the eye strain or head movement. Environments can be better tailored by reducing the amount of peripheral visual stimuli in the classroom.
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Prescribed Prisms
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Since some cases of Duane syndrome can severely inhibit perception, some people are prescribed prisms to attach to glasses. These prisms can be used to alter the pathway of light into the individual’s eyes, allowing them to see at a different angle.
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Additional Time
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Additional time for the student to read and understand the material could prove to be quite beneficial. Other accommodations often paired with additional time include paper with raised lines, larger print, fewer items on the page and
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