Association between ADHD and vision problems. A systematic review and meta-analysis

Alessio Bellato; John Perna; Preethi S Ganapathy; Marco Solmi; Andrea Zampieri; Samuele Cortese; Stephen V Faraone

doi:10.1038/s41380-022-01699-0

Association between ADHD and vision problems. A systematic review and meta-analysis

Mol Psychiatry. 2023 Jan;28(1):410-422. doi: 10.1038/s41380-022-01699-0. Epub 2022 Aug 5.

Authors

Alessio Bellato^#^{1

2}, John Perna^#^{3

4}, Preethi S Ganapathy⁵, Marco Solmi^{6

7

8

9

10

11}, Andrea Zampieri¹², Samuele Cortese^{10

13

14

15

16}, Stephen V Faraone¹⁷

Affiliations

¹ School of Psychology, University of Nottingham Malaysia, Semenyih, Malaysia.
² Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
³ Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA.
⁴ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
⁵ Department of Ophthalmology & Visual Sciences, SUNY Upstate Medical University, Syracuse, NY, USA.
⁶ Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
⁷ Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.
⁸ Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada.
⁹ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁰ Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
¹¹ Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
¹² Vittorio Emanuele III Hospital, Montecchio Maggiore, Vicenza, Italy.
¹³ Solent NHS Trust, Southampton, UK.
¹⁴ Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK.
¹⁵ Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA.
¹⁶ Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
¹⁷ Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA. sfaraone@childpsychresearch.org.

^# Contributed equally.

Abstract

Aim: To conduct the first systematic review and meta-analysis assessing whether attention-deficit/hyperactivity disorder (ADHD) is associated with disorders of the eye, and/or altered measures of visual function.

Method: Based on a pre-registered protocol (PROSPERO: CRD42021256352), we searched PubMed, Web of Knowledge/Science, Ovid Medline, Embase and APA PsycINFO up to 16th November 2021, with no language/type of document restrictions. We included observational studies reporting at least one measure of vision in people of any age meeting DSM/ICD criteria for ADHD and in people without ADHD; or the prevalence of ADHD in people with and without vision disorders. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS). Random effects meta-analyses were used for data synthesis.

Results: We included 42 studies in the narrative synthesis and 35 studies in the meta-analyses (3,250,905 participants). We found meta-analytic evidence of increased risk of astigmatism (OR = 1.79 [CI: 1.50, 2.14]), hyperopia and hypermetropia (OR = 1.79 [CI: 1.66, 1.94]), strabismus (OR = 1.93 [CI: 1.75, 2.12]), unspecified vision problems (OR = 1.94 [CI: 1.38, 2.73]) and reduced near point of convergence (OR = 5.02 [CI: 1.78, 14.11]); increased lag (Hedge's g = 0.63 [CI: 0.30, 0.96]) and variability (Hedge's g = 0.40 [CI: 0.17, 0.64]) of the accommodative response; and increased self-reported vision problems (Hedge's g = 0.63 [CI: 0.44, 0.82]) in people with ADHD compared to those without ADHD (with no significant heterogeneity). We also found meta-analytic evidence of no differences between people with and without ADHD on retinal nerve fiber layer thickness (Hedge's g = -0.19 [CI: -0.41, 0.02]) and refractive error (Hedge's g = 0.08 [CI: -0.26, 0.42]) (with no significant heterogeneity).

Discussion: ADHD is associated with some self-reported and objectively ascertained functional vision problems, but not with structural alterations of the eye. Further studies should clarify the causal relationship, if any, between ADHD and problems of vision.

Trial registration: PROSPERO registration: CRD42021256352.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Attention Deficit Disorder with Hyperactivity* / complications
Attention Deficit Disorder with Hyperactivity* / epidemiology
Cross-Sectional Studies
Eye Diseases* / complications
Eye Diseases* / epidemiology
Humans
Prevalence