MAR 2014

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/276058

Contents of this Issue


Page 21 of 210

E W NEWS & OPINION 1 9 Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel, found significant ametropia but infrequent het- erotropia in their group of 51 chil- dren with ADD/ADHD. 2 In fact, 83% of those studied had significant ametropia, although investigators did not find a higher rate of conver- gence insufficiency or heterotropia —two areas of concern previously mentioned in ADD/ADHD vision- related research. "Although it was thought that ADHD kids have more hyperopia and strabismus, we found that they were absolutely no different from the general population," said co-in- vestigator Tamara Wygnanski-Jaffe, MD, Goldschlager Eye Institute, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. Refractive error differences may not be the major concern with chil- dren diagnosed with ADD/ADHD, but other ocular issues may arise, said Marita Andersson Gronlund, MD, associate professor, senior con- sultant in pediatric ophthalmology, Institute of Neuroscience and Physiology/Ophthalmology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden. In previous work from Dr. Gronlund, more children with ADHD had astigmatism compared with age- and sex-matched controls. However, she believes that refractive errors may be less of an issue in these children than visual-percep- tual problems. One of Dr. Gronlund's studies in this area, published in 2008, com- pared the visual acuity and visual fields of 18 children with ADHD and the effect of psychostimulant med- ication compared with a control group. 3 Investigators found a larger difference in visual field results be- fore medication use in the ADHD group compared with controls. However, once the children with ADHD used medication, there was no longer a significant difference in their visual field results. Children in the ADHD group also had a significant difference in their best corrected visual acuity after medication use. Investigators theorized that the visual field test differences may relate to the medication's effect on prefrontal lobe function and atten- tion. "The positive effect of stimu- lant treatment may imply improved cerebral processing of visual infor- mation, which may be hypotheti- cally beneficial in everyday activities," they concluded. Dr. Gronlund also found it interesting that the children in her 2007 study had subtle morphologi- cal changes of the optic nerve and retinal vasculature—specifically, smaller optic disc areas and neu- roretinal rim areas—compared with controls, which she said indicates an early disturbance of the develop- ment of neural and vascular tissues in the central nervous system. 4 Practical implications The studies mentioned here are not a comprehensive review of research in the area of visual issues and pedi- atric ADD/ADHD. Still, clinicians who work frequently with this con- dition said these papers help point t o future research avenues. "There should be more research focusing on eye motility, such as fix- ation, smooth-pursuit, and saccades with and without stimulants and what impact it may have on every- day activities, such as reading ability and capacity," Dr. Gronlund said. "We know an uncorrected r efractive error, heterotropia, convergence insufficiency, or struc- tural abnormality in the eye itself Changes in the fundus found among children with ADHD (changes in the small optic disc area, small neuroretinal rim area, and decreased tortuosity of retinal arteries) Source: Marita Andersson Gronlund, MD March 2014 How occupational therapists play a role in vision care for ADD/ADHD I t takes a team of professionals to evaluate and treat a child with ADD/ADHD who is struggling in school and has visual challenges. Occupational therapists can be an integral part of that team. Occupational therapists help clients manage their day-to-day "occupations"— in other words, daily roles and activities. In the case of a child with ADD/ADHD, an important occupation is to stay on task at school, said Rondalyn Whitney, PhD, OTR/L, interim co-chair and interim program director, DrOT program, University of the Sciences, Philadelphia. She has frequently worked with ophthalmologists and optometrists to provide services for children with ADD/ADHD. She will use a standardized visual-motor integration test to help pinpoint certain visual impairments (unrelated to refractive errors) that the client may have. She will also review with clients and parents the great number of visual demands that kids face nowadays, ranging from small phone screens to computers to the large quantity of visual tasks completed at school. "Children get this visual information and they have to attend to it. However, can they then discriminate among the information and regulate it?" Dr. Whitney said. The latter two areas can be challenging for children with ADD/ADHD. A child with ADD/ADHD who has visual problems may struggle with motor planning skills, visual perception, visual memorization, as well as attention-span challenges. "They often just want to get the work done as fast as possible," she said. Occupational therapists help to provide practical solutions. For example, a child with ADHD and visual challenges may receive a worksheet of addition and subtraction problems but not pay attention to the mixed plus and minus symbols. Occupational therapists help teach them tricks like highlighting the symbols before they do the work, to assist with visual focusing. When cleaning their room, Dr. Whitney may coach parents and their child with ADD/ADHD to tidy up by focusing on one item group at a time—all books, then all round things, then all Legos, or whatever items contribute to the mess. "These chil- dren don't get the same internal visual cues that other children may have," she said. A number of children with ADD/ADHD may take medication to treat their condi- tion. The medication is well known to make kids less hungry. Dr. Whitney will remind these children and their parents about the importance of hydrating well even if they are not that hungry—and how dehydration can compound eye problems. Dr. Whitney has also seen "wonderful results" from vision therapy, used with children who have ADD/ADHD and visual perception problems. These problems may prevent the child from performing well on reading, writing, and math tasks that be- come more demanding as grade levels progress; this therapy is usually offered in conjunction with developmental optometrists. continued on page 22 18-47 News_EW March 2014-DL2 copy_Layout 1 3/6/14 2:45 PM Page 19

Articles in this issue

Archives of this issue

view archives of Eyeworld - MAR 2014