We also found meta-analytic evidence of no differences between people with and without ADHD on retinal nerve fiber layer thickness (Hedge’s g = −0.19 ) and refractive error (Hedge’s g = 0.08 ) (with no significant heterogeneity). We found meta-analytic evidence of increased risk of astigmatism (OR = 1.79 ), hyperopia and hypermetropia (OR = 1.79 ), strabismus (OR = 1.93 ), unspecified vision problems (OR = 1.94 ) and reduced near point of convergence (OR = 5.02 ) increased lag (Hedge’s g = 0.63 ) and variability (Hedge’s g = 0.40 ) of the accommodative response and increased self-reported vision problems (Hedge’s g = 0.63 ) in people with ADHD compared to those without ADHD (with no significant heterogeneity).

We included 42 studies in the narrative synthesis and 35 studies in the meta-analyses (3,250,905 participants). Random effects meta-analyses were used for data synthesis. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS). We included observational studies reporting at least one measure of vision in people of any age meeting DSM/ICD criteria for ADHD and in people without ADHD or the prevalence of ADHD in people with and without vision disorders.

Methodīased on a pre-registered protocol (PROSPERO: CRD42021256352), we searched PubMed, Web of Knowledge/Science, Ovid Medline, Embase and APA PsycINFO up to 16th November 2021, with no language/type of document restrictions. To conduct the first systematic review and meta-analysis assessing whether attention-deficit/hyperactivity disorder (ADHD) is associated with disorders of the eye, and/or altered measures of visual function.

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