Redondo Beatríz, Molina Rubén, Vera Jesús, Muñoz-Hoyos Antonio, Barrett Brendan T, Jiménez Raimundo
Department of Optics, Faculty of Science, University of Granada, Campus de la Fuentenueva 2, 18001, Granada, Spain.
Paediatrics Service, Faculty of Medicine, University of Granada, Granada, Spain.
Graefes Arch Clin Exp Ophthalmol. 2020 Jun;258(6):1299-1307. doi: 10.1007/s00417-020-04645-4. Epub 2020 Mar 14.
There are claims that ocular accommodation differs in children with attention deficit hyperactivity disorder (ADHD) compared to typically developing children. We examined whether the accommodation response in ADHD children is influenced by changing the stimulus to accommodation in an attempt modify the level of attentional engagement or by medication for the condition.
We measured the accommodative response and pupil diameter using a binocular, open-field autorefractor in non-medicated and medicated children with ADHD (n = 22, mean age = 10.1 ± 2.4 years; n = 19; mean age = 11.0 ± 3.8 years; respectively) and in an age-matched control group (n = 22; mean age = 10.6 ± 1.9 years) while participants were asked to maintain focus on (i) a high-contrast Maltese cross, (ii) a frame of a cartoon movie (picture) and (iii) a cartoon movie chosen by the participant. Each stimulus was viewed for 180 s from a distance of 25 cm, and the order of presentation was randomised.
Greater lags of accommodation were present in the non-medicated ADHD in comparison to controls (p = 0.023, lags of 1.10 ± 0.56 D and 0.72 ± 0.57 D, respectively). No statistically significant difference in the mean accommodative lag was observed between medicated ADHD children (lag of 1.00 ± 0.44D) and controls (p = 0.104) or between medicated and non-medicated children with ADHD (p = 0.504). The visual stimulus did not influence the lag of accommodation (p = 0.491), and there were no significant group-by-stimulus interactions (p = 0.935). The variability of accommodation differed depending on the visual stimulus, with higher variability for the picture condition compared to the cartoon-movie (p < 0.001) and the Maltese cross (p = 0.006). In addition, the variability yielded statistically significant difference for the main effect of time-on-task (p = 0.027), exhibiting a higher variability over time. However, no group differences in accommodation variability were observed (p = 0.935).
Children with ADHD have a reduced accommodative response, which is not influenced by the stimulus to accommodation. There is no marked effect of medication for ADHD on accommodation accuracy.
有观点认为，与发育正常的儿童相比，患有注意力缺陷多动障碍（ADHD）的儿童的眼调节功能存在差异。我们研究了ADHD儿童的调节反应是否会受到改变调节刺激以尝试改变注意力参与程度的影响，或者受到针对该病症的药物治疗的影响。
我们使用双目开放式自动验光仪测量了未用药和用药的ADHD儿童（分别为n = 22，平均年龄 = 10.1±2.4岁；n = 19，平均年龄 = 11.0±3.8岁）以及年龄匹配的对照组（n = 22；平均年龄 = 10.6±1.9岁）的调节反应和瞳孔直径，同时要求参与者专注于（i）高对比度的马耳他十字，（ii）卡通电影画面（图片），以及（iii）参与者选择的卡通电影。每个刺激从25厘米的距离观看180秒，呈现顺序是随机的。
与对照组相比，未用药的ADHD儿童存在更大的调节滞后（p = 0.023，调节滞后分别为1.10±0.56D和0.72±0.57D）。用药的ADHD儿童（调节滞后为1.00±0.44D）与对照组之间（p = 0.104）或用药和未用药的ADHD儿童之间（p = 0.504）在平均调节滞后方面未观察到统计学上的显著差异。视觉刺激并未影响调节滞后（p = 0.491），并且没有显著的组×刺激交互作用（p = 0.935）。调节的变异性因视觉刺激而异，与卡通电影相比，图片条件下的变异性更高（p < 0.001），与马耳他十字相比也更高（p = 0.006）。此外，调节变异性在任务时间的主效应上产生了统计学上的显著差异（p = 0.027），随着时间推移变异性更高。然而，在调节变异性方面未观察到组间差异（p = 0.935）。
ADHD儿童的调节反应降低，这不受调节刺激的影响。ADHD药物治疗对调节准确性没有显著影响。
