ESCRS 2026: The eye as a window into ADHD: emerging evidence and practical implications

A new review conducted by Polish investigators showed that evidence obtained using various modalities has taken center stage in quantifying ocular changes in attention deficit/hyperactivity disorder (ADHD). Optical coherence tomography (OCT), OCT angiography (OCTA), portable eye tracking with machine learning, neuro glasses, and stimulant-related anterior-segment changes all contributed to the knowledge base on the effects of ADHD on the ocular structures, according to Sylwia Kijewska, OD, from the Polish Optometric Association, Poznan. She presented the findings at the 2026 annual meeting of the European Society of Cataract and Refractive Surgeons in London, UK.

The investigators drew on peer-reviewed studies published between 2023 and 2025 that compared ophthalmic or oculomotor outcomes in children and adults with ADHD with controls without ADHD. The researchers extracted effect estimates across refractive error, strabismus, near point of convergence, stereoacuity, accommodative function, ocular surface metrics, and eye-tracking indices, then descriptively pooled findings from recent systematic reviews and key case-control cohorts, interpreting the results through a pediatric ophthalmology lens.

What the investigation found

In adults, OCT showed thinning of the central macula, inner plexiform layer, and ganglion cell complex in ADHD compared with controls without ADHD. OCTA adds a vascular dimension, revealing reduced macular thickness, thinning of the peripapillary retinal nerve fiber layer, and broader macular vascular rarefaction. The observations together pointed to a combined structural-vascular retinal signature associated with ADHD.

In children, the data on methylphenidate treatment pointed to a different, anterior-segment concern, ie. reduced corneal endothelial cell density and altered cell morphology, despite that the macular and retinal nerve fiber layer parameters remained preserved. This suggests that the cornea and not just the retina may warrant monitoring in pediatric patients on stimulant therapy.

On the behavioral side, a portable eye-tracking model paired with machine learning achieved an area-under-the-curve value of 0.965 and 90.8% accuracy in classifying ADHD in children. Separately, vision-based neuromodulation devices, the so-called neuro glasses, improved inattentive symptoms and executive-function measures in adults, with good ocular tolerability.

What it means for clinical practice

Taken together, the investigators explained, these findings indicate that ADHD is accompanied by reproducible patterns of retinal thinning, vascular change, and distinctive eye-movement behavior, and that structured visual stimulation may offer a beneficial, low-risk way to modulate symptoms. The results strengthen the case for viewing the eye as an accessible readout of brain circuitry in ADHD and potentially as a therapeutic entry point, not just a diagnostic one.

For ophthalmologists, the authors argue for selective, targeted use of retinal imaging, anterior-segment monitoring, and simple eye-tracking tasks, integrated into multidisciplinary ADHD care. They caution, however, that rigorous validation is still needed before any ocular or digital biomarker is adopted as a routine, stand-alone screening tool for ADHD.

Kijewska commented, “Comprehensive ophthalmic screening is vital for patients with ADHD to treat co-occurring visual disfunction, but ocular standalone diagnosis still remains in the area of science-fiction.”