Association between eye disorders and the development of ADHD/ADD: a nationwide retrospective cohort study

To study and assess the association of various eye disorders with the development of attention-deficit hyperactivity disorder (ADHD/ADD).

A nationwide, retrospective cohort-study, utilising anonymised electronic medical records (EMR) data on all insured individuals aged 5-30 in Maccabi Health Services (MHS), the second largest health maintenance organisation in Israel, during 2010-2022.

The final analysis included 665,121 individuals from an initial cohort of 1,686,128 after applying selection criteria and propensity score matching. Of these, 68,976 (10.4%) developed ADHD/ADD. ADHD/ADD was more common and developed faster in those with eye disorders (HR = 1.40, 95% CI: 1.38-1.42 and 4.5 versus 4.9 years, p < 0.001, respectively). All evaluated eye disorders served as significant risk factors (strabismus: HR = 1.64, 95% CI: 1.49-1.80; hyperopia: HR = 1.52, 95% CI: 1.47-1.56; astigmatism: HR = 1.52, 95% CI: 1.48-1.56; amblyopia: HR = 1.40, 95% CI: 1.27-1.54; myopia: HR = 1.30, 95% CI: 1.28-1.33). Similar findings were evident when assessing combinations of eye disorders. These associations were far more pronounced in females and the paediatric population (p < 0.001 and p = 0.044, respectively).

Eye disorders serve as risk factors for the development of ADHD/ADD, particularly in females and in the paediatric population.