Age at diagnosis of strabismus or amblyopia and neurodevelopmental outcomes in children

To evaluate whether age at diagnosis of strabismus or amblyopia is associated with patterns in the clinical recognition of neurodevelopmental conditions in children.

This retrospective cohort study included children with a first diagnosis of strabismus or amblyopia, categorized into early (3-6 years) and late (7-12 years) diagnosis cohorts. Primary outcomes included developmental delay, learning disorders, and speech or language disorders. Hazard ratios (HRs) were estimated at 1-, 3-, and 5-year follow-up intervals. Kaplan-Meier analyses were used to evaluate event-free probability. Sensitivity analyses assessed 1-year outcomes using age-stratified control cohorts, age-matched control comparisons, and conjunctivitis comparator analyses.

Children in the early-diagnosis cohort had higher detection of developmental delay (HR, 2.38; 95% CI, 2.05-2.76) and speech or language delay-related outcomes (HR, 2.72; 95% CI, 2.40-3.09), whereas children in the late-diagnosis cohort demonstrated higher detection of learning disorders (HR, 0.70; 95% CI, 0.61-0.81). Differences in developmental delay and speech or language delay-related outcomes between early- and late-diagnosis cohorts emerged early and persisted across follow-up intervals (log-rank P < .001). Differences in learning disorders attenuated over the 5-year follow-up (log-rank P = .38). Sensitivity analyses demonstrated age-related patterns in controls and consistent enrichment of outcomes in children with strabismus or amblyopia compared, but not in conjunctivitis comparators.

Age at diagnosis of strabismus or amblyopia was associated with distinct patterns in the clinical recognition of neurodevelopmental conditions. Ophthalmologic encounters may represent clinically relevant opportunities to identify co-occurring developmental concerns during routine care.