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

## TL;DR

This study finds that eye disorders are linked to a higher risk of developing ADHD/ADD, especially in children and females.

## Contribution

The study is the first to show a nationwide association between specific eye disorders and ADHD/ADD development using a large health database.

## Key findings

- Individuals with eye disorders had a 40% higher risk of developing ADHD/ADD compared to those without.
- Strabismus, hyperopia, astigmatism, amblyopia, and myopia were all significant risk factors for ADHD/ADD.
- The association was stronger in females and children under 18 years old.

## Abstract

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.