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This study provides a thorough meta-analysis of the relationship between vision problems and ADHD, with findings that could impact ADHD diagnosis methods.

To date, there has been no systematic review and meta-analysis regarding the possible relationship between attention-deficit/hyperactivity disorder (ADHD) and disorders of the eye or altered visual function. This study, published in Molecular Psychiatry, provides such a review, based on data taken from a variety of studies totalling more than 3.25 million participants. Data up to November 16, 2021 were included, focusing on observational studies that reported at least one measure of vision in people of any age that met the DSM/ICD criteria for ADHD, as well as individuals without ADHD. Random effects meta-analyses were used to synthesize the data.

Some Evidence Found for Increased Risk of Certain Vision Problems and ADHD

The authors found meta-analytic evidence of an increased risk of astigmatism, hyperopia and hypermetropia, strabismus, reduced near point of convergence, increased lag and variability of the accommodative response, and increased self-reported vision problems in individuals with ADHD compared to those without, with no significant heterogeneity. No difference was found between those with or without ADHD for retinal nerve fiber layer thickness and refractive error. Overall, the increase in vision problems did not correspond to an increase in problems with the structural elements of the eye.

Vision Problems May Exacerbate Cognitive Issues in Those with ADHD

There are many ways in which vision can impact existing ADHD symptoms. In children, untreated visual impairment may exacerbate neurocognitive symptoms of ADHD. Additionally, the intertwined relationship between visual perception and high-level cognitive functions can contribute to ADHD symptoms related to sensory processing. Children with vision problems are often misdiagnosed with ADHD, and some vision disorders have an impact on attention that may result in overdiagnosis of ADHD in children with vision issues. Because vision problems can have an effect on attention, these vision problems may represent an under-targeted area of treatment for those that exhibit both vision and attentional issues. Further studies are needed to better understand the causal relationship between ADHD and vision impairments. 

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Bellato, A., Perna, J., Ganapathy, P. S., Solmi, M., Zampieri, A., Cortese, S., & Faraone, S. V. (2023). Association between ADHD and vision problems. A systematic review and meta-analysis. Molecular Psychiatry, 28(1), 410-422. https://doi.org/10.1038/s41380-022-01699-0