Neuronal and vascular changes in the central retina in adult attention deficit hyperactivity disorder

To evaluate structural and vascular changes in the retina in adult attention deficit hyperactivity disorder (ADHD) compared to healthy controls.

Using optical coherence tomography angiography (OCT-A), measurements were obtained from the foveal, parafoveal, and perifoveal regions. Parameters measured included superficial capillary plexus density (SCPD), deep capillary plexus density (DCPD), full-thickness retinal thickness, ganglion cell complex (GCC) thickness, and foveal avascular zone (FAZ) area. These metrics were compared between individuals with ADHD and healthy controls. Additionally, subgroup analysis was conducted to compare newly diagnosed patients and established medication users within the ADHD group.

A total of 39 eyes of 39 ADHD patients and 49 eyes of 49 healthy subjects were included. DCPD values were significantly reduced in all parafoveal quadrants (temporal P=0.001, superior P<0.001, nasal P=0.021, inferior P=0.005) and all perifoveal quadrants (temporal P=0.006, superior P<0.001, nasal P<0.001, inferior P=0.017) in the ADHD group. Receiver operating characteristic (ROC) analysis showed that the perifoveal DCPD over the 6×6mm² area had a sensitivity of 74.4% and specificity of 63.3% for distinguishing ADHD from healthy individuals (P<0.001; AUC=0.717). Parafoveal DCPD showed 61.5% sensitivity and 71.4% specificity (P=0.001; AUC=0.704), while perifoveal DCPD yielded 69.2% sensitivity and 67.3% specificity (P<0.001; AUC=0.717). Foveal SCPD (P=0.026) and DCPD (P=0.024) were significantly lower in established medication users compared to newly diagnosed patients. ROC analysis revealed 87.5% specificity for superficial and deep foveal CPD in distinguishing between newly diagnosed patients and established medication users (P=0.026; AUC=0.714 and P=0.050; AUC=0.689).

Deep capillary plexus density was significantly reduced in adult ADHD patients relative to healthy controls. Moreover, medication use for ADHD treatment was associated with further reduction in foveal SCPD and DCPD. These findings suggest that OCT-A derived vascular density metrics may serve as potential biomarkers for diagnosis, monitoring of treatment response, and disease follow-up in patients with ADHD.