Julie-Anne Little School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, UKAbstract: Down syndrome is the most common cause of intellectual impairment, and life expectancy in this group has increased in recent decades, meaning that health care is increasingly focused on quality of life and the management of treatable illnesses. There are frequent problems associated with vision in Down syndrome, including refractive errors, strabismus, reduced vision, and reduced accommodative ability. This review will discuss the importance of accommodative ability; describe the prevalence and nature of accommodative deficits in Down syndrome, which are found in approximately 55%–76% of individuals; discuss the management of this deficit with the prescription of bifocal correction; and summarize the possible etiologies of hypoaccommodation in Down syndrome. Finally, the review will consider practical considerations for the optometrist managing accommodative deficits in patients with Down syndrome. Keywords: Down syndrome, accommodation, accommodative deficits, dynamic retinoscopy, bifocals, refractive error