Ophthalmologic characteristics andneuropediatric findings. With special emphasis on children adopted from eastern Europe

Abstract

Aim: To evaluate and relate visual function and ocular features to neuropediatric findings in a population-based group of children adopted from eastern Europe (Papers I-III) and in children with attentiondeficit hyperactivity disorder (AD/HD), with and without treatment with stimulants (Paper IV).Methods: 99 children born 1990 1995 in eastern Europe and adopted to western Sweden during1993 1997 were invited to participate. 77% participated in a retrospective cohort study (Paper I), and73% (mean age 7.5 years, 31 girls) were examined by a multidisciplinary team (Papers II-III). Medicalrecords from birth countries, examination at arrival, and from medical reports done during a mean postadoptionperiod of 5 years were evaluated. Data were compared with data on an age- and sex-matchedreference group (ref). A detailed ophthalmologic evaluation without and with stimulants was performedin 42 children (mean age 12 years, 37 boys) with AD/HD, and compared with a reference group (PaperIV).Results: Paper I: 48% of the adoptees had low birth weight (LBW). Congenital malformations werefound in 22%, and 34% had a perinatal diagnosis related to the central nervous system. 33% of thechildren had a history of suspected prenatal alcohol exposure. Upon arrival in Sweden, almost 50% ofchildren had subnormal weight, length, and head circumference. At 5 years after adoption, 92% of thechildren had a medical diagnosis and 46% had at least one neurodevelopmental or behavioral disorder.Paper II: 78% of the adoptees had abnormal ocular findings, with 26% (ref 4%) having a subnormalvisual acuity (VA) (p=0.0001). 10% (ref 1%) were myopic (p=0.03) and astigmatism was found in 51%(ref 23%) (p=0.004). 32% (ref 2%) had strabismus (p<0.0001). Four adoptees had bilateral optic nervehypoplasia. Signs of visuoperceptual problems were reported in 38% (ref 1%) (p<0.0001). Paper III:Small neuroretinal rim area was related to LBW (p<0.04), small head circumference (p<0.04) and fetalalcohol syndrome (FAS) (p<0.005). Large optic cups were correlated with lower perceptual organization(p<0.02). FAS was correlated with low VA (p<0.02). Paper IV: 83% of the children with AD/HD had VA >0.8 without treatment (ref 98%; p=0.032) and heterophoria was found in 29% (ref 10%;p=0.038). Astigmatism was observed in 24% (ref 6%; p=0.03) and signs of visuoperceptual problemsin 21% (ref 2%; p=0.007). We found smaller rim areas (p<0.0001) and decreased tortuosity of retinalarteries (p=0.0002) compared with controls.Conclusion: The children adopted from eastern Europe had a high frequency of ophthalmologic abnormalities.Adverse prenatal and perinatal factors, congenital malformations, and post-adoption neurodevelopmentalas well as behavioral disorders were common. Correlations were found between ophthalmologicand neuropediatric findings, especially those arising from prenatal adverse events. Therefore,an ophthalmologic examination may serve as a supporting diagnostic tool and an ophthalmologic examinationshould be performed in these children after arrival in their new home country. Children withAD/HD had a high frequency of ophthalmologic findings, which were not significantly improved withstimulants. They presented subtle morphological changes of the ocular fundus indicating an early prenataldisturbance of the development of these structures.