An Eye Exam in Psychiatry?

An APA Poster Brief

Bret S. Stetka, MD; Magali Seassau, PhD


June 12, 2013

Editor's Note: While browsing a poster session at the 2013 Annual Meeting of the American Psychiatric Association, Medscape spoke with Magali Seassau, PhD, of the eyeBRAIN Institute in Ivry-sur-Seine, France about her study[1] looking at eye movements as a potential indicator of treatment efficacy in attention-deficit/hyperactivity disorder (ADHD).

Medscape: What is the correlation between eye movements, or oculomotricity, and ADHD, and what was the goal of your study?

Dr. Seassau: The objective of our study was to look at the effect of methylphenidate on ocular movements in patients with ADHD. This was a pilot study looking at oculomotricity in 9 children with ADHD.

There were 2 kinds of tests: automatic attentional tasks, and voluntary attentional tasks. With automatic attentional tasks, you have patients focus on a fixed dot on a computer screen; then another target appears elsewhere on the screen, and they reflexively move their eyes very quickly to the new target. With voluntary attentional tasks, patients again fix their attention on a central dot but have to move their gaze voluntary to a peripheral target; here, we also looked at antisaccades, in which patients are asked to inhibit their reflex and look in the opposite direction from the new target.

The children each performed the tasks twice, once on treatment and once off treatment.

Medscape: And what did you find?

Dr. Seassau: We found that compared with control participants, children on treatment with methylphenidate had normalized automatic attentional tasks. They made fewer directional errors, were more accurate, and had better latency times. However, children with ADHD are still impaired in voluntary attentional tasks both on and off treatment.

These results show a different effect of methylphenidate on attentional process. Methylphenidate improves automatic movements, which are important in daily life, but it has no effect on the attentional disengagement process.

Medscape: So the idea is to use this as a marker of treatment efficacy?

Dr. Seassau: Exactly, to see whether they are responding to the treatment. We plan to run a larger study with more participants.

Medscape: Are you aware of any clinicians in Europe, the United States, or elsewhere using eye-movement evaluation in ADHD management? Are you or your colleagues using this approach clinically, or is it limited to research for the time being?

Dr. Seassau: In Europe, eye movements in a clinical evaluation of ADHD are used in 2 hospitals that I know of. One is the hospital in Rouffach, Alsace, where we conducted this study. Every patient with ADHD (adults and children) undergoes an eye-movement evaluation on and off treatment. In Paris, we also use eye movement to monitor treated children with ADHD at the Robert Debré Hospital.


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