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M.C. Andersson–Gronlund, E. Aring, M. Landgren, A. Hellstrom; Ophthalmological Findings in Children With Attention Deficit Hyperactivity Disorder (AD/HD) – With and Without Stimulants . Invest. Ophthalmol. Vis. Sci. 2005;46(13):680.
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Purpose:Attention Deficit Hyperactivity Disorder (AD/HD) is commonly seen among children and adolescents and affects their psychosocial development. The disorder is treated with stimulants (amphetamine or methylphenidate) when pedagogical and psychosocial support are not satisfactory and when inattention, hyperactivity, and/or impulsivity seriously affect learning and/or the social behavior. The aim of this study was to investigate whether visual function and eye motility are affected in children with AD/HD. Also we aimed to establish whether treatment with stimulants is reflected in the functioning of the visual system. Methods: Forty–two children (37 boys, mean age 12 years) with AD/HD who are being treated with stimulants at the pediatric outpatient clinic in Mariestad, Sweden participated in the study. An ophthalmological evaluation without and with stimulants was performed including visual acuity (VA), ocular motility, and stereovision. Thereafter, refraction in cycloplegia, a slit lamp examination, ophthalmoscopy, fundus photographs, and a structured history taking regarding visuoperceptual problems were performed. Data were compared with data for an age– and sex–matched reference group ("ref") (n=50). Results:83% had VA of the best eye <0.1 logMAR without stimulants (ref 98%); p=0.032 and 90% reached the same VA with stimulants; n.s. Strabismus was found in 6/42 when tested without medication (ref 3/50); n.s. and subnormal stereo acuity (>60") in 26% (ref 6%); p=0.016. 16/42 children without stimulants and 20/42 children with stimulants (ref 5/50) (p=0.003, p<0.001 respectively) showed heteroforia. No significant difference between with and without stimulants was found. Ten children (ref n=5) were hyperopic (≥2.0 D SE); n.s, and eight children (ref n=7) were myopic (≥0.5 D SE); n.s. Astigmatism (≥1.0 D) was found in 24% (ref 6%); p=0.03. 31% wore glasses (ref 14%); n.s. Signs of visuoperceptual problems were recorded in 21% (ref 2%); p=0.007. Conclusions: These children with AD/HD had a lower VA without, but not with, stimulants compare with age– and sex–matched controls. They had also an increased porportion of heteroforia, worse stereo acuity, more astigmatism and showed signs of increased visuoperceptual problems. However, no significant difference between with and without stimulants was found.
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