Alterations in Corneal Morphology and Thickness Associated with Methylphenidate Treatment in Children with
1Department of Ophthalmology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize 53100, Türkiye.
Insights
Six months of methylphenidate treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) in children showed significant changes in corneal endothelial cells and increased intraocular pressure (IOP). Routine eye exams are recommended during ADHD stimulant therapy.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Pharmacology
Background:
- Methylphenidate is a common ADHD treatment, but its long-term ocular effects are unclear.
- The cornea's sensitivity suggests potential subclinical changes from medication.
- This study investigates methylphenidate's impact on corneal endothelium and IOP in children.
Purpose of the Study:
- To assess the effects of a six-month methylphenidate regimen on corneal endothelial morphology.
- To evaluate changes in intraocular pressure (IOP) following methylphenidate treatment in pediatric ADHD patients.
- To correlate ADHD symptom severity with ocular parameter changes.
Main Methods:
- Prospective observational study comparing 100 ADHD children on methylphenidate with 100 healthy controls.
- Ophthalmologic assessments including specular microscopy and corneal topography at baseline and after six months.
- Measurements included endothelial cell density (ECD), cell area, thickness (CCT), and IOP; ADHD symptoms assessed via Turgay scale.
Main Results:
- Methylphenidate treatment led to significant decreases in ECD and increases in CCT, cell area variability (CV, AVE, SD).
- Intraocular pressure (IOP) showed a statistically significant increase, remaining within physiological limits.
- Weak correlations observed between inattention scores and ECD/corneal volume.
Conclusions:
- Chronic methylphenidate use in children with ADHD may induce measurable changes in corneal microstructure and IOP.
- Routine ophthalmologic monitoring is advised during stimulant therapy for ADHD.
- Further large-scale, long-term studies are needed to understand neuro-ophthalmologic implications.
Abstract:
Background/Objectives: Although methylphenidate is a first-line pharmacological agent in the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD), its long-term effects on ocular tissues, particularly the corneal endothelium, remain poorly understood. Given the cornea's metabolic sensitivity, subclinical changes may occur even in the absence of overt ophthalmologic symptoms. This study aims to evaluate the impact of six-month methylphenidate treatment on corneal endothelial morphology and intraocular pressure (IOP) in pediatric patients with ADHD. Methods: This prospective observational study included 100 treatment-naive children with ADHD and 100 age- and sex-matched healthy controls. All participants underwent comprehensive ophthalmologic assessment at baseline. In the ADHD group, follow-up evaluations were performed after six months of methylphenidate therapy. Endothelial cell density (ECD), average cell area (AVE), standard deviation (SD), coefficient of variation (CV), hexagonality index (6A), central corneal thickness (CCT), and IOP were measured using specular microscopy and corneal topography. ADHD symptom severity was evaluated using the Turgay DSM-IV-Based Rating Scale. Results: Significant reductions in ECD and increases in CCT, CV, AVE, and SD were observed following treatment (p < 0.001). IOP also showed a statistically significant increase while remaining within normal physiological limits. Weak but significant correlations were found between inattention scores and ECD (r = 0.222), and between inattention and corneal volume (r = -0.248). Conclusions: Chronic methylphenidate use may be associated with measurable changes in corneal endothelial microstructure and IOP in children with ADHD. These findings highlight the need for routine ophthalmologic monitoring during stimulant therapy and underscore the importance of further large-scale, long-term studies exploring the neuro-ophthalmologic implications of pediatric psychopharmacological treatment.
