. 2023 Nov 8;13:19397. doi: 10.1038/s41598-023-46206-9

Table 2.

Descriptive characteristics of included studies.

Author and year	Design	Diagnostic methods	Participants characteristics	Device	Refraction error SE (diopter)	Parameters	Main findings
Aslan et al.²² (2020, Turkey)	Case–Control	K-SADS-PL-T: DSM-IV	ADHD: 32 (M-72%) TD: 43 (M-72%)	ADHD:9.19 ± 1.93 TD: 9.35 ± 1.65	Cirrus OCT: Sirius 3D rotating Scheimpflug camera topography	NA	Pupillary light reflex velocity RNFL thickness PLRV and RNFL Correlation	PLRV and RNFL are Correlated (P = 0.003)
Ayyildiz et al.²³ (2019, Turkey)	Case–Control	K-SADS-PL	ADHD: 30 (M-63%) TD: 30 (M-50%)	ADHD:142.89 ± 24.31 (Month) TD:153.13 ± 24.73 (Month)	Spectralis OCT	NA	RNFL thickness Macula thickness Anterior segment structure	Increase in axial length (P = 0.04) Decrease in Corneal curvature Radius (P = 0.03) Increase in Central corneal thickness (P = 0.005)
Bae et al.²⁴ (2019, South Korea)	Case–Control	K-ARS	ADHD: 12 (M-33%) TD: 13 (M-15.38%)	ADHD:9.8 ± 2.1 TD: 10.6 ± 1.9	Cirrus OCT: Philips MRI scanner	ADHD: − 1.5 ± 2.1 (right) − 1.2 ± 2.2 (left) TD: − 1.9 ± 1.7 (right) − 2.0 ± 1.6 (left)	Macular thickness	Increase in macular thickness inner ETDRS ring (P = 0.04) and Outer ETDRS ring (P = 0.05, right; and P = 0.02, left)
Bodur et al.²⁵ (2018, Turkey)	Case–Control	K-SADS-PL-T: DSM-IV	ADHD: 16 (M-81%) TD: 31 (M-15.38%)	ADHD:111.62 ± 27.05 (Month) TD: 127.19 ± 24.39 (Month)	iVUe 100	NA	RNFL GCL ONT	Decrease in ganglion cell layer (P = 0.0001, right eye; P = 0.002, left) Decrease in optic nerve thicknesses (P = 0.015, left)
Daluwatte et al.²⁶ (2013, USA)	Case–Control	ADOS: DSM-IV	ASD: 152 (M-89%) NDD: 36 (M-75%) TD: 107 (M-74%)	ASD: 10.7 ± 3.4 NDD: 9.9 ± 3.0 TD: 10.9 ± 2.9	The binocular Pupillography recording system	NA	Resting pupil diameter, PLR latency, constriction, Constriction time, Redialation time, constriction velocity, Redialation velocity, heart rate	Increase in PLR latency (P < 0.0001) Decrease in constriction time (P = 0.0007) Decrease in redialation time (P = 0.01)
Fan et al.²⁷ (2009, USA)	Case–Control	PDD-NOS	ASD: 24 (M-92%) TD: 44 (M-48%)	ASD: 12.9 ± 4.3 TD: 10.4 ± 2.7	A binocular pupillogram recording system	NA	Pupillary light reflex latency PLR constriction Anisocoria Contraction anisocoria	Decrease in pupillary light reflex latency (P = 0.013)
Garcia-Medina et al.²⁸ (2017, Spain)	Case–Control	DSM-V	ASD: 27, TD:31 ASD: 27, TD:62	ASD: 13.70 ± 3.03 TD: 13.70 ± 3.03	Spectralis OCT TruTrack Active Eye Tracking	< 6 spherical diopters and < 2.5 cylinder diopters	Total retina	In pRNFL measurement increase in temporal inferior (P = 0.03), nasal inferior (P = 0.01), inferior (P = 0.01). In macular measurement increase in total retina (P = 0.04), total inner retina (P = 0.04)
Garcia-Medina et al.²⁹ (2020, Spain )	Case–Control	DSM-IV	ASD: 13 (M-77%) TD:14 (M-71%)	ASD: 16.615 ± 2.987 TD: 16.857 ± 4.055	Cirrus 5000 device with Angioplex	NA	Full retina thickness Peripapillary retinal nerve fiber layer Vessel density Capillary perfusion density	Decrease in peripapillary perfusion density (P = 0.029) Increase in FLUX index (P = 0.037)
Grönlund et al.³⁰ (2007, Sweden)	Case–Control	DSM-IV	ADHD + stimulants:42 (M-88%) TD: 50 (M-88%)	ADHD:12 TD: 11.9	Orbit, IOTA Inc Sundsvall eye-tracking technology KM- Bok's chart Monolateral cover test TNO random-dot test RAF ruler, Near point of Accommodation Auto refractometer	Myopia ≥ 0.5D or hyperopia ≥ 2.0 D	Visual acuity, strabismus, and ocular motility Near the point of convergence Refraction under cycloplegia, ocular dimensions	Decrease in visual acuity (P = 0.032) Decrease in heterophoria (P = 0.038) Decrease in subnormal stereovision (P = 0.016) Decrease in abnormal convergence (P = 0.031) Decrease in astigmatism (P = 0.03) Decrease in visuoperceptual problems (P = 0.007) Decrease in optic discs and neuroretinal rim areas (P < 0.0001) Decrease in tortuosity of retinal arteries (P = 0.0002)
Hergüner et al.¹⁵ (2018, Turkey)	Case–Control	DSM-IV	ADHD: 45 (M-84%) TD: 45 (M-84%)	ADHD: 8.6 ± 1.9 TD: 8.9 ± 2.1	Spectralis OCT	ADHD: − 0.17 ± 0.5 TD: − 0.24 ± − 0.6	RNFL thickness Macular thickness Correlation with CPRS-R: S SDQ:P	Decrease in nasal RNFL (P = 0.027) Inattention is correlated with Temporal inferior thickness (P = 0.002)
Işık et al.³¹ (2020, turkey)	Case–Control	K-SADS-PL-T DSM-IV	ADHD: 58 (M-71%) TD:44 (M-73%) ADHD + MPH:45 (M-47%)	ADHD: 9 ± 2.41 ADHD + MPH: 9.02 ± 2.19 TD: 10.85 ± 2.21	Cirrus OCT	NA	Intraocular pressure Macular thickness Retinal nerve fiber layer Ganglion cell layer thicknesses Intraocular pressure	Increase in Left IOP (P = 0.011)
Lynch et al.³² (2018, USA)	Case–Control	DSM-IV	ASD: 10 (M-80%) TD: 12 (M-58%)	ASD: 16.15 TD: 15.20	FaceLAB5VC eye-tracking technology	NA	Baseline pupil diameter latency to maximum constriction Pupil diameter at the maximum constriction, latency of return to baseline pupil diameter	Increase in Pupillary light reflex maximal latency (P = 0.04) Increase in latency of return to baseline pupil diameter (P = 0.02)
Sánchez-Guillén et al.²⁹ (2020, Spain)	Case–Control	DSM	ADHD:9 (M-83%) TD: 23 (M-70%) ADHD + MPH:14 (M-83%)	ADHD: 11.9 ± 3.3 ADHD + MPH:12.4 ± 3 TD: 11.4 ± 3.1	Cirrus 5000 device with Angioplex	NA	Macular thickness Retina Ganglion cell complex, Retinal nerve fiber layer	Decrease in macular central thickness (P = 0.013)
Tarakcioglu et al.³³ (2020, Turkey)	Case–Control	NA	ADHD + MPH: 53 (M-77%) ADHD: 40 (M-80%)	ADHD + MPH: 10.7 ± 1.9 ADHD: 9 ± 1.5	OCT RT XR Avanti with Angio Vue software	ADHD + MPH: ± 3 ADHD: ± 3	Foveal avascular zone Vessel density	Increase in flow area (choriocapillaris) at ADHD + MPH (P = 0.03) Increase in superficial parafoveal thickness ADHD + MPH(P = 0.01) Increase in deep parafoveal thickness ADHD + MPH (P = 0.01)
Ulucan Atas et al.³⁴ (2020, Turkey)	Case–Control	K-SADS-PL-T/DSM-IV	ADHD: 37 (M-84%) TD: 37 (M-62%)	ADHD: 9.5 ± 2.2 TD: 9.4 ± 1.6	Nidek RS-3000 OCT device	ADHD ≤ ± 0.5 TD ≤ ± 0.5	Contrast sensitivity levels RNFL thickness Ganglion cell complex	Decrease in nasal RNFL (P = 0.006) Decrease in contrast sensitivity (P < 0.001)

Author and year

Design

Diagnostic methods

Participants characteristics

Device

Refraction error SE (diopter)

Parameters

Main findings

Sample size, and Gender

Mean age

Aslan et al.²²

(2020, Turkey)

Case–Control

K-SADS-PL-T:

DSM-IV

ADHD: 32 (M-72%)

TD: 43 (M-72%)

ADHD:9.19 ± 1.93

TD: 9.35 ± 1.65

Cirrus OCT: Sirius 3D rotating Scheimpflug camera topography

Pupillary light reflex velocity

RNFL thickness

PLRV and RNFL Correlation

PLRV and RNFL are Correlated

(P = 0.003)

Ayyildiz et al.²³

(2019, Turkey)

Case–Control

K-SADS-PL

ADHD: 30 (M-63%)

TD: 30 (M-50%)

ADHD:142.89 ± 24.31 (Month)

TD:153.13 ± 24.73 (Month)

Spectralis OCT

RNFL thickness

Macula thickness

Anterior segment structure

Increase in axial length (P = 0.04)

Decrease in Corneal curvature Radius (P = 0.03)

Increase in Central corneal thickness (P = 0.005)

Bae et al.²⁴

(2019, South Korea)

Case–Control

K-ARS

ADHD: 12 (M-33%)

TD: 13 (M-15.38%)

ADHD:9.8 ± 2.1

TD: 10.6 ± 1.9

Cirrus OCT: Philips MRI scanner

ADHD: − 1.5 ± 2.1 (right)

− 1.2 ± 2.2 (left)

TD: − 1.9 ± 1.7 (right)

− 2.0 ± 1.6 (left)

Macular thickness

Increase in macular thickness inner ETDRS ring (P = 0.04) and

Outer ETDRS ring

(P = 0.05, right; and P = 0.02, left)

Bodur et al.²⁵

(2018, Turkey)

Case–Control

K-SADS-PL-T:

DSM-IV

ADHD: 16 (M-81%)

TD: 31 (M-15.38%)

ADHD:111.62 ± 27.05 (Month)

TD: 127.19 ± 24.39 (Month)

iVUe 100

RNFL

GCL

ONT

Decrease in ganglion cell layer

(P = 0.0001, right eye; P = 0.002, left)

Decrease in optic nerve thicknesses

(P = 0.015, left)

Daluwatte et al.²⁶

(2013, USA)

Case–Control

ADOS:

DSM-IV

ASD: 152 (M-89%)

NDD: 36 (M-75%)

TD: 107 (M-74%)

ASD: 10.7 ± 3.4

NDD: 9.9 ± 3.0

TD: 10.9 ± 2.9

The binocular Pupillography recording system

Resting pupil diameter, PLR latency, constriction, Constriction time, Redialation time, constriction velocity, Redialation velocity, heart rate

Increase in PLR latency (P < 0.0001)

Decrease in constriction time (P = 0.0007)

Decrease in redialation time (P = 0.01)

Fan et al.²⁷

(2009, USA)

Case–Control

PDD-NOS

ASD: 24 (M-92%)

TD: 44 (M-48%)

ASD: 12.9 ± 4.3

TD: 10.4 ± 2.7

A binocular pupillogram recording system

Pupillary light reflex latency

PLR constriction

Anisocoria

Contraction anisocoria

Decrease in pupillary light reflex latency

(P = 0.013)

Garcia-Medina et al.²⁸

(2017, Spain)

Case–Control

DSM-V

ASD: 27, TD:31

ASD: 27, TD:62

ASD: 13.70 ± 3.03

TD: 13.70 ± 3.03

Spectralis OCT

TruTrack Active Eye Tracking

< 6 spherical diopters and < 2.5 cylinder diopters

Total retina

In pRNFL measurement increase in temporal inferior (P = 0.03), nasal inferior (P = 0.01), inferior (P = 0.01). In macular measurement increase in total retina

(P = 0.04), total inner retina (P = 0.04)

Garcia-Medina et al.²⁹

(2020, Spain )

Case–Control

DSM-IV

ASD: 13 (M-77%)

TD:14 (M-71%)

ASD: 16.615 ± 2.987

TD: 16.857 ± 4.055

Cirrus 5000 device with Angioplex

Full retina thickness

Peripapillary retinal nerve fiber layer

Vessel density

Capillary perfusion density

Decrease in peripapillary perfusion density (P = 0.029)

Increase in FLUX index

(P = 0.037)

Grönlund et al.³⁰

(2007, Sweden)

Case–Control

DSM-IV

ADHD + stimulants:42 (M-88%)

TD: 50 (M-88%)

ADHD:12

TD: 11.9

Orbit, IOTA Inc

Sundsvall eye-tracking technology

KM- Bok's chart Monolateral cover test

TNO random-dot test RAF ruler, Near point of Accommodation

Auto refractometer

Myopia ≥ 0.5D

or hyperopia ≥ 2.0 D

Visual acuity, strabismus, and ocular motility

Near the point of convergence

Refraction under cycloplegia, ocular dimensions

Decrease in visual acuity (P = 0.032)

Decrease in heterophoria (P = 0.038)

Decrease in subnormal stereovision (P = 0.016)

Decrease in abnormal convergence (P = 0.031)

Decrease in astigmatism (P = 0.03)

Decrease in visuoperceptual problems (P = 0.007)

Decrease in optic discs and neuroretinal rim areas (P < 0.0001)

Decrease in tortuosity of retinal arteries (P = 0.0002)

Hergüner et al.¹⁵

(2018, Turkey)

Case–Control

DSM-IV

ADHD: 45 (M-84%)

TD: 45 (M-84%)

ADHD: 8.6 ± 1.9

TD: 8.9 ± 2.1

Spectralis OCT

ADHD: − 0.17 ± 0.5

TD: − 0.24 ± − 0.6

RNFL thickness

Macular thickness

Correlation with CPRS-R: S

SDQ:P

Decrease in nasal RNFL

(P = 0.027)

Inattention is correlated with Temporal inferior thickness (P = 0.002)

Işık et al.³¹

(2020, turkey)

Case–Control

K-SADS-PL-T

DSM-IV

ADHD: 58 (M-71%)

TD:44 (M-73%)

ADHD + MPH:45 (M-47%)

ADHD: 9 ± 2.41

ADHD + MPH: 9.02 ± 2.19

TD: 10.85 ± 2.21

Cirrus OCT

Intraocular pressure

Macular thickness

Retinal nerve fiber layer

Ganglion cell layer thicknesses

Intraocular pressure

Increase in Left IOP

(P = 0.011)

Lynch et al.³²

(2018, USA)

Case–Control

DSM-IV

ASD: 10 (M-80%)

TD: 12 (M-58%)

ASD: 16.15

TD: 15.20

FaceLAB5VC eye-tracking technology

Baseline pupil diameter latency to maximum constriction

Pupil diameter at the maximum constriction, latency of return to baseline pupil diameter

Increase in Pupillary light reflex maximal latency

(P = 0.04)

Increase in latency of return to baseline pupil diameter

(P = 0.02)

Sánchez-Guillén et al.²⁹

(2020, Spain)

Case–Control

DSM

ADHD:9 (M-83%)

TD: 23 (M-70%)

ADHD + MPH:14 (M-83%)

ADHD: 11.9 ± 3.3

ADHD + MPH:12.4 ± 3

TD: 11.4 ± 3.1

Cirrus 5000 device with Angioplex

Macular thickness

Retina

Ganglion cell complex,

Retinal nerve fiber layer

Decrease in macular central thickness

(P = 0.013)

Tarakcioglu et al.³³

(2020, Turkey)

Case–Control

ADHD + MPH: 53 (M-77%)

ADHD: 40 (M-80%)

ADHD + MPH: 10.7 ± 1.9

ADHD: 9 ± 1.5

OCT RT XR Avanti with Angio Vue software

ADHD + MPH: ± 3

ADHD: ± 3

Foveal avascular zone

Vessel density

Increase in flow area (choriocapillaris) at

ADHD + MPH (P = 0.03)

Increase in superficial parafoveal thickness

ADHD + MPH(P = 0.01)

Increase in deep parafoveal thickness ADHD + MPH (P = 0.01)

Ulucan Atas et al.³⁴

(2020, Turkey)

Case–Control

K-SADS-PL-T/DSM-IV

ADHD: 37 (M-84%)

TD: 37 (M-62%)

ADHD: 9.5 ± 2.2

TD: 9.4 ± 1.6

Nidek RS-3000 OCT device

ADHD ≤ ± 0.5

TD ≤ ± 0.5

Contrast sensitivity levels

RNFL thickness

Ganglion cell complex

Decrease in nasal RNFL (P = 0.006)

Decrease in contrast sensitivity (P < 0.001)

RNFL Retinal nerve fiber layer thickness, PLRV Pupillary light reflex velocity, GCL Ganglion cell layer, ONT optic nerve thicknesses, CCT Central corneal thickness, AL Axial length, CR Corneal curvature radius, CPRS-R:S Conners’ Parent Rating Scale-Revised: Short, SDQ:P Strengths and Difficulties Questionnaire: Parent Form.