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

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