Date of Award

January 2022

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Martha A. Howard



Kevin K. Wang, Marez M. Megalla, and Martha A. Howard. Department of Ophthalmology and Visual Science, Yale University, School of Medicine, New Haven, CT.

Objective: This study aims to examine whether ADHD medication usage is associated with changes in intermittent exotropia in children, and whether such ADHD medication use is associated with prevention of strabismus surgery.

Design/Participants: We conducted a retrospective cohort study of children with both ADHD and intermittent exotropia seen at the Yale Eye Center between 2005 and 2020 who were taking medications for ADHD.

Methods: A list of eligible patients was identified by the Joint Data Analytics Team at Yale University based on presence of ADHD and intermittent exotropia ICD10 code diagnoses. For each patient, the following variables were collected: age, sex, ADHD medications used, dosage of medication, medication start and end dates, date of ADHD diagnosis, date of X(T) diagnosis, dates of strabismus surgeries, and presence of comorbid developmental disorders. For each strabismus appointment recorded for a patient, the following variables were collected: date of appointment, strabismus measurements at near and distance, visual acuity, stereoacuity, presence or absence of amblyopia, grade of X(T) control, presence or absence of symptomatic diplopia, strabismus treatments being used at time of appointment, and presence or absence of refractive correction. The resulting data was qualitatively analyzed for trends in X(T) deviation, stereo-acuity, grade of control, and amblyopia off versus on ADHD medications. Criteria for defining what qualified as a change were: X(T) deviation change of >10 prism diopters (PD), stereo-acuity change of at least two octaves, and grade of control change from 0-2 to 3-5 or vice versa.

Results: Eight patients (5 male, 3 female; ages 7-19 years) were included for analysis. Intermittent exotropia at near remained stable in seven patients following ADHD medication use and worsened in one patient. X(T) at distance remained stable following ADHD medication use in six patients, worsened in one patient, and improved in one patient. Stereo-acuity worsened in two patients and remained stable in five patients who had stereo-acuity data available. Of the four patients with data on grade of control, control remained stable in two and worsened in two patients. One patient had worsening amblyopia while taking ADHD medications. Five of the eight patients required strabismus surgery to correct their intermittent exotropia; three of these patients required surgery while taking medication, and two patients after they had discontinued their ADHD medication.

Conclusions: Our study shows that patients remained predominantly stable in exotropic deviation, stereoacuity, and grade of control when taking ADHD medications. However, three patients required surgical correction of X(T) while taking ADHD medications due to worsening stereoacuity, control, or alignment. Our results show that ADHD medications do not seem to have any consistent effect on preventing strabismus surgery.


This is an Open Access Thesis.

Open Access

This Article is Open Access