Abstract
Purpose :
There is a higher incidence of ADHD in patients with strabismus, yet, no studies specifically describe patients with both diagnoses. Other studies note that the ADHD diagnosis rate is lower for children with immigrant caretakers. This is a retrospective, cross sectional study of patients at a single academic center to further elucidate disease characteristics within this specific cohort where most patients speak a language other than English at home and many live below the poverty level.
Methods :
The EMR was searched for all patient charts aged <=18 years with relevant diagnostic codes and formal diagnoses of ADHD and strabismus. Patients with developmental/cognitive delays were excluded. Data included sex, age, disease subtype, ADHD treatment, visual acuity, refractive error, stereopsis, and ophthalmic treatment at initial visit. Charts were subsequently reviewed to determine if the patient later required surgery. Deviations were divided into exodeviations (convergence insufficiency, exophoria, exotropia, intermittent exotropia) and esodeviations (esotropia, esophoria, intermittent esotropia).The Mann-Whitney test and Fisher's exact test were used for continuous and categorical variables, respectively.
Results :
A total of 208 charts were included for analysis: exodeviations (n=137) and esodeviations (n=71). There was no significance between ADHD subtype and deviation. Patients with esodeviation were diagnosed with ocular misalignment at a younger age than the exodeviation group (p=0.04). Patients with esodeviation were also diagnosed with ADHD at a younger age (p=0.06). The order of which diagnosis came first was not significant. Initially, observation was recommended for most patients with exodeviation while glasses were recommended for most patients with esodeviations. More patients in the esodeviation group underwent eventual surgical repair (p=0.004). There was no significant difference between the stereopsis in the two groups and no difference between the patients who were, and were not, pharmacologically treated for ADHD.
Conclusions :
This study reports differences in the ages of diagnoses as well as the treatment plans among patients with differing deviations, highlighting the importance of multidisciplinary pediatric care along with the need to establish preferred practice patterns, particularly in an underserved population that may benefit from such guidelines.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.