Clinical Study
Eye (2007) 21, 494–502. doi:10.1038/sj.eye.6702240; published online 3 March 2006
Visual function and ocular features in children and adolescents with attention deficit hyperactivity disorder, with and without treatment with stimulants
M A Grönlund1, E Aring1, M Landgren2 and A Hellström1
- 1Section of Ophthalmology, Institute of Clinical Neuroscience, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
- 2Department of Paediatrics, The Hospital of Skaraborg, Skövde, Sweden
Correspondence: MA Grönlund, Department of Paediatric Ophthalmology, Section of Ophthalmology, Institute of Clinical Neuroscience, The Queen Silvia Children's Hospital, The Sahlgrenska University Hospital/Östra, SE 416 85 Göteborg, Sweden. Tel: +46 31 343 4688; Fax: +46 31 848 952; E-mail: marita.gronlund@neuro.gu.se
Received 5 July 2005; Accepted 29 November 2005; Published online 3 March 2006.
Abstract
Aims
To investigate visual function and ocular features in children with attention deficit hyperactivity disorder (AD/HD) and establish whether treatment with stimulants is reflected in functioning of the visual system.
Methods
Detailed ophthalmologic evaluations without and with stimulants were performed in 42 children (37 boys) with AD/HD, mean age 12 years, and compared with a reference group (ref; n=50; mean age 11.9 years; 44 boys). For a comparison between two groups, Mann–Whitney's U-test was used for ordered and continuous variables; for dichotomous variables, Fisher's exact test was used. For paired comparison (with and without treatment), sign test was used.
Results
In all, 83% had visual acuity of >0.8 (<0.1 logMAR) without treatment, 90% with stimulants (ref 98%; P=0.032 and n.s., respectively). Heterophoria was found in 29% without, and in 27% with, stimulants (ref 10%; P=0.038 and n.s., respectively) and subnormal stereovision (>60 s of arc) in 26% (ref 6%; P=0.016) without stimulants, and in 27%, with (P=0.014). Abnormal convergence (>6 cm or absent) was noted in 24% (ref 6%; P=0.031) without treatment and in 17%, with (n.s.). Astigmatism (
1.0 D) was observed in 24% (ref 6%; P=0.03), and signs of visuoperceptual problems in 21% (ref 2%; P=0.007). We found smaller optic discs (n=8/38) and neuroretinal rim areas (n=7/38) (P<0.0001) and decreased tortuosity of retinal arteries (n=6/34) (P=0.0002) than that of controls.
Conclusions
Children with AD/HD had a high frequency of ophthalmologic findings, which were not significantly improved with stimulants. They presented subtle morphological changes of the optic nerve and retinal vasculature, indicating an early disturbance of the development of these structures.
Keywords:
attention deficit hyperactivity disorder (AD/HD), stimulant medications, visual function, ocular features
