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Eyes and vision with ADHD

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Abstract from ADxS.org
Symptoms
Consequences of ADHD
Origin
Stress
Neurological aspects
Neurophysiological correlates of ADHD symptoms
Aggression in ADHD - neurophysiological correlates
Drive problems in ADHD - neurophysiological correlates
Arousal and activation in ADHD - neurophysiological correlates
Attention problems in ADHD - neurophysiological correlates
Thinking blocks and decision-making problems in ADHD - neurophysiological correlates
Emotional dysregulation - neurophysiological correlates
Frustration intolerance in ADHD - neurophysiological correlates
Hyperactivity in ADHD - Neurophysiological correlates
Impulsivity in ADHD - neurophysiological correlates
Learning problems in ADHD - neurophysiological correlates
Motivation in ADHD - neurophysiological correlates
Organizational and executive function problems in ADHD - neurophysiological correlates
Sleep problems in ADHD - neurophysiological correlates
Social phobia - neurophysiological correlates
Diagnostics
Prevention
Treatment: Guide and Effect size
Treatment: Medication for ADHD
Non-drug treatment
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This and that about ADHD
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Eyes and vision with ADHD

A number of studies have identified various visual problems in children with . These include visuoperceptual problems, convergence insufficiency, impaired stereoacuity, more frequent refractive errors, an increased risk of strabismus and astigmatism, as well as deviations in eye movements and accommodation. is also associated with neurophysiological changes in the optic nerves, genetic s with the 4 dopamine receptor gene and asymmetrical pupil diameters. Visuomotor function, i.e. the coordination of visual perception and the locomotor system, correlates with cognitive abilities such as inhibition and cognitive flexibility.

is characterized by an impaired dopamine system with reduced extracellular dopamine.
is also involved in the visual system.

Reduced visual performance was found in 76% of the children with examined. A meta-analysis of 35 studies with 3,250,905 participants found a 94% increased risk of unspecified visual problems in (OR = 1.94).
Young adults with showed more problems with depth perception, vision and color perception, especially in the blue spectrum, compared to non-affected individuals.

medication improved visual field abnormalities and visual acuity in children with . Another study found no improvements. In a small study, surgical treatment of strabismus improved symptoms in 7 out of 8 persons with in the parent report.
A small study was able to distinguish people with from those without quite well using eye movement tracking.
It is therefore conceivable that eye problems can cause or exacerbate symptoms, just as can cause or exacerbate eye problems.

1. Visuoperceptive problems in (+ 1000 %)

One study found visuoperceptual problems in 21% of children with , compared to only 2% of those not affected.

2. Convergence and (+ 200 % to + 400 %)

One study found convergence insufficiency in 24% of children with , compared with only 6% of those not affected.
Several other studies found children with convergence insufficiency were 3 times more likely to have than those without.
A meta-analysis of 35 studies with 3,250,905 participants found a fivefold risk of a reduced near-convergence point in (OR = 5.02).

3. Stereoacuity (stereotactic vision, depth perception) in (+ 333 %)

Stereoacuity is the ability of a person to recognize objects along different distances as separate entities.

Several studies report impaired stereoacuity in children with . Stereoacuity (depth perception) was impaired in 26% of children with , compared to 6% of non-affected children.

4. Strabismus / heterophoria (strabismus / latent strabismus) in (+ 93 % to + 700 %)

One study found in children with

  • More strabismus (squinting) (17% compared to 2% in non-affected people)
  • More heterophoria (latent strabismus) (27 % compared to 10 % in non-affected people)

One cohort study found a 15% increased risk of with strabismus. Another cohort study found a doubled risk of with strabismus convergens (internal strabismus, esotropia) and a 44% increased risk of with strabismus divergens (external strabismus, exotropia).

A meta-analysis of 35 studies with 3,250,905 participants found a 93% increased risk of strabismus (OR = 1.93) and a 79% increased risk of hyperopia and hypermetropia (OR = 1.79) with .

An evaluation of the KiGGS study (N = 13,488) found strabismus in 8.2% of children with compared to 4.2% of people with who were not affected (OR 2.04).
and hyperopia, myopia, astigmatism and strabismus predicted each other.

5. Astigmatism in (+ 79 % to + 300 %)

One study found astigmatism in 24% of children with , compared to only 6% of those without the condition.
A meta-analysis of 35 studies with 3,250,905 participants found a 79% increased risk of astigmatism in (OR 1.79).

An evaluation of the KiGGS study (N = 13,488) found strabismus in 10.9% of children with compared to 6.9% of people with who were not affected (OR 1.84).
and hyperopia, myopia, astigmatism and strabismus predicted each other.

6. Eye movements (saccades) and

Several studies found slower and more variable saccadic reaction times in children with using the gap/overlap test. One study was able to eliminate this biomarker using warning signals during the test.

An experimental study (n = 16) reported abnormalities of eye movements in as determined by electrooculography (EOG).
Another study found that in children, visual field shifts moderated the relationship between hyperactivity/impulsivity on the one hand and problems focusing attention and taking in information on the other. Visual field shifts increased with a decrease in performance accuracy, although this did not reflect the severity of the symptoms.

Another study found abnormalities in people with in the modulation of the eye vergence response (eye vergence = opposing / disjugate / disjunctive eye movements) during attention tasks. The diagnostic test accuracy was 79 %.

One large study found a between premature anticipatory eye movements and inattention, but not between directional errors and symptoms.

A meta-analysis found evidence that children with

  • made more directional errors in an antisaccade task
  • were slower and performed worse in oculomotor tasks
  • Performed eye movements less precisely

Saccadic eye movements (gaze jumps) are strongly influenced by factors such as attention and inhibition. Since attention and inhibition are impaired in , it seems plausible that saccadic eye movements are abnormal in .
Arbitrary eye movements are controlled by the : The arbitrary control of eye movements is closely linked to attention control. The also houses the working memory, which is typically impaired in .

One study found significantly higher pupillary velocity scores in children with that correlated positively with RNFL measurements of their right eyes.

People with showed increased saccade latency and intensity and shorter fixation time in eye-tracking tasks.
In the antisaccade task, prolonged latencies were found in and even more so in schizophrenia, further in bipolar and with smaller and less robust effect sizes in Obsessive-Compulsive . There appear to be deficits in control in the antisaccade task in all mental disorders, particularly in error rates.

Faster visual orienting due to shorter saccadic reaction times (SRTs) was found on baseline trials compared to overlap trials, for faces compared to non-face stimuli and, more clearly in children without and/or autism, for multimodal compared to unimodal stimuli. There was a linear negative between presaccadic pupil size and SRTs in children with without , and a quadratic in children with without , in whom SRTs were slower when intraindividual presaccadic pupil size was smallest or largest.

The deviations of saccadic eye movements in are said to be improvable through computer training.

Individuals with borderline personality disorder and ADHD showed inadequate response preparation, resulting in reduced visual fixation on task cues and greater variability in saccade responses (i.e., saccade response time and peak speed). Saccadic deficits in borderline as in with borderline do not appear to be due to an inability to perform antisaccades, but rather to inadequate preparation for the task at hand. This could result from abnormal signaling in cortical areas such as the eye fields, parietal cortex and ACC.

7. Macular thickness in

A small study hypothesizes that increased macular thickness in children with AD(H)D may represent the increased ratio of right lobe to cortex thickness in .

8. Accommodation for

Children with showed a reduced accommodative response that was not influenced by the accommodative stimulus. There was no clear effect of medication in on accommodation accuracy. Accommodation refers to the ability of the eye to focus / focus on objects at different distances.
A meta-analysis of 35 studies with 3,250,905 participants found an increased risk for increased delay (Hedge’s g = 0.63 [CI: 0.30, 0.96]) and variability (Hedge’s g = 0.40 [CI: 0.17, 0.64]) of the accommodative response in .

9. Neurophysiological changes in the optic nerves in

One study found smaller optic nerves, smaller neuroretinal rim areas or reduced retinal artery tortuosity more frequently in children with .

10. 4-7R and vision in

The D4 dopamine receptor gene, 4, is significantly involved in the conversion of light into electrical signals in the retina. The transcription of 4 shows a strong circadian pattern.

The 4 7R variant is one of the strongest single-gene risks for . See also ⇒ Candidate genes in ADHD In the chapter ⇒ Origin.
4-7R correlates with a lower ability to reduce the light-sensitive second messenger cyclic adenosine monophosphate () upon illumination.
In addition, 4-7R correlates with higher daytime sleepiness, which could be a consequence of the seesaw between dopamine and melatonin.

11. Pupil diameter and noradrenaline in

Tonic and noradrenal infiring can be recognized by the pupil diameter.
Here, the size of the pupil diameter corresponds to noradrenaline firing and a change in pupil diameter corresponds to noradrenergic activity. A pupil dilation correlated with correct responses, a pupil dilation with periods of low reward value. An increase in baseline pupil diameter correlated with a decrease in task utility and disengagement from the task (exploration), a decrease in baseline pupil diameter with an increase in task-induced dilation correlated with engagement in the task (exploitation)
Pupil dilation is a index of increased arousal and activity of the locus coeruleus.
The pupil diameter in the resting state also reflects the connectivity between fronto, striatal and thalamic brain regions.

Measurements of pupil diameter show abnormalities in the system in .
More on this at Tonic and phasic noradrenaline in ADHD In the article Noradrenaline.

12. Refractive errors and

One study found refractive errors in 83% of the children with examined. A meta-analysis of 35 studies with 3,250,905 participants found no accumulation of refractive errors in (Hedge’s g = 0.08 [CI: -0.26, 0.42]).

Dysfunction of retinal dopamine could affect neurodevelopmental growth of the eye, leading to refractive errors. This could help explain the frequency of refractive errors in .

There is increasing evidence that the worldwide increase in myopia is mediated and related to a lack of daylight.
Between 1981 and 2002, outdoor activities halved from 1 hour 40 minutes per week to 50 minutes per week.

12.1. Farsightedness (hyperopia) (+ 67 %)

An evaluation of the KiGGS study (N = 13,488) found farsightedness in 13.0% of children with compared to 8.2% of people with who were not affected (OR 1.67).
and hyperopia, myopia, astigmatism and strabismus predicted each other.

12.2. Short-sightedness (myopia) (+ 29 %)

An evaluation of the KiGGS study (N = 13,488) found myopia in 16.2% of children with compared to 13.1% of people with who were not affected (OR 1.29).
and hyperopia, myopia, astigmatism and strabismus predicted each other.

13. Retinal nerve fiber layer thickness unchanged

A meta-analysis of 35 studies with 3,250,905 participants found no change in retinal nerve fiber layer thickness in (Hedge’s g = -0.19 [CI: -0.41, 0.02]) .

14. Visuomotor skills correlate with inhibition and cognitive flexibility

Visuomotor skills are the coordination of visual perception and the musculoskeletal system and include eye-hand coordination.

A study reports:
Visuomotor fluency correlated significantly with cognitive inhibition. The ability to perform visually guided, continuous movements fluently correlates with the ability to inhibit the effects of distracting information.
Visuomotor flexibility correlated significantly with cognitive flexibility. The ability to spontaneously use visual information to flexibly change motor responses correlates with the ability to cognitively switch from one state of mind to another.

15. Retinal detachment, retinal fractures

Exposure to retinal detachments and breaks was associated with a 19% increased risk of attention deficit hyperactivity disorder.

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