Abstract
Purpose: To determine the relationship of attention-deficit hyperactivity disorder (ADHD) with myopia among school children.
Methods: Children aged six to eight years in Hong Kong were recruited through a stratified, clustered randomized sampling frame and subsequently invited to undergo cycloplegic autorefraction and axial length measurements between 2016 and 2021. ADHD diagnoses were made by qualified physicians according to ICD-10 criteria. ADHD symptoms were assessed using the Strengths and Weaknesses of ADHD-symptoms and Normal-behaviors Questionnaire.
Results: Totally 474 children with ADHD and 9950 control children were included. The age- and sex-adjusted myopia prevalence was lower in ADHD group (21%) versus controls (26%; P = 0.02). Multivariable regression analysis showed less myopia (odds ratio [OR] = 0.75; P = 0.03), higher spherical equivalent refraction (SER) (β = 0.13; P = 0.04), and shorter axial length (AL) (β = −0.07; P = 0.03) in children with ADHD. Specifically, ADHD with oral methylphenidate (MPH) treatment had less myopia (OR = 0.61, P = 0.04), higher SER (β = 0.36; P < 0.001) and shorter AL (β = −0.25; P < 0.001) compared to controls. Each additional month of MPH treatment was associated with a higher SER (β = 0.02; P = 0.01) and shorter AL (β = −0.01; P = 0.01). For each one-point increase in attention-deficit scores, children were found to be less myopic (OR = 0.88, P = 0.01), having higher SER (β = 0.07; P = 0.003) and shorter AL (β = −0.04; P = 0.001). The prevalence of myopia among ADHD increased to 32% during COVID-19 pandemic compared with 23% before COVID-19 pandemic (P = 0.04).
Conclusions: This cross-sectional study found that ADHD is associated with reduced myopia prevalence, more hyperopic SER, and shorter AL. Of note, the observed effect sizes of these associations were small; therefore the interpretation of the clinical meaning needs to be cautious.
Methods: Children aged six to eight years in Hong Kong were recruited through a stratified, clustered randomized sampling frame and subsequently invited to undergo cycloplegic autorefraction and axial length measurements between 2016 and 2021. ADHD diagnoses were made by qualified physicians according to ICD-10 criteria. ADHD symptoms were assessed using the Strengths and Weaknesses of ADHD-symptoms and Normal-behaviors Questionnaire.
Results: Totally 474 children with ADHD and 9950 control children were included. The age- and sex-adjusted myopia prevalence was lower in ADHD group (21%) versus controls (26%; P = 0.02). Multivariable regression analysis showed less myopia (odds ratio [OR] = 0.75; P = 0.03), higher spherical equivalent refraction (SER) (β = 0.13; P = 0.04), and shorter axial length (AL) (β = −0.07; P = 0.03) in children with ADHD. Specifically, ADHD with oral methylphenidate (MPH) treatment had less myopia (OR = 0.61, P = 0.04), higher SER (β = 0.36; P < 0.001) and shorter AL (β = −0.25; P < 0.001) compared to controls. Each additional month of MPH treatment was associated with a higher SER (β = 0.02; P = 0.01) and shorter AL (β = −0.01; P = 0.01). For each one-point increase in attention-deficit scores, children were found to be less myopic (OR = 0.88, P = 0.01), having higher SER (β = 0.07; P = 0.003) and shorter AL (β = −0.04; P = 0.001). The prevalence of myopia among ADHD increased to 32% during COVID-19 pandemic compared with 23% before COVID-19 pandemic (P = 0.04).
Conclusions: This cross-sectional study found that ADHD is associated with reduced myopia prevalence, more hyperopic SER, and shorter AL. Of note, the observed effect sizes of these associations were small; therefore the interpretation of the clinical meaning needs to be cautious.
| Original language | English |
|---|---|
| Article number | 36 |
| Number of pages | 8 |
| Journal | Investigative Ophthalmology and Visual Science |
| Volume | 66 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - 14 Jul 2025 |
Bibliographical note
Copyright © The Authors. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.Funding
Supported in part by the General Research Fund (GRF), Research Grants Council, Hong Kong (14102422 [ JCY]); Health and Medical Research Fund (HMRF), Hong Kong (11220206 [ JCY], 10210246 [YZ], 09202466 [LJC]), National Natural Science Foundation of China (82425017 & 82171089 [ JCY]); Strategic Impact Enhancement Fund, The Chinese University of Hong Kong (WW/SC/rc/SIEF2324/0366/24vw & TL/JF/rc/SIEF2223/0759/23vw [JCY]); the CUHK Jockey Club Children’s Eye Care Programme (No grant number); and the CUHK Jockey Club Myopia Prevention Programme (No grant number).
Keywords
- COVID-19 pandemic
- attention-deficit hyperactivity disorder
- myopia