{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T01:27:30Z","timestamp":1789694850672,"version":"4.0.1"},"reference-count":18,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder. As the retina is an extension of the central nervous system, retinal imaging may provide insights into the ADHD pathophysiology. The objective of this work was to evaluate structural retinal alterations using optical coherence tomography (OCT) in ADHD patients compared to neurotypical controls. Methods: A case\u2013control study involving 200 eyes (100 from 50 patients with ADHD and 100 from 50 controls) was conducted by comparing the thicknesses of the macular region (total retina, inner and outer retinal layers, ganglion cell layer plus inner plexiform layer [GCIPL], and macular retinal nerve fiber layer [mRNFL]), the peripapillary region (pRNFL), and the optic nerve head (ONH) parameters. Areas under the curve (AUCs) were calculated to evaluate diagnostic performance. Right and left eyes were analyzed separately. Results: Patients with ADHD showed a significant reduction in total and outer retinal thickness across several macular sectors in both eyes. No significant differences were observed in mRNFL, GCIPL, inner retina, pRNFL, or ONH parameters between groups. AUC values derived from ROC analysis indicate moderate diagnostic performance for total and outer retinal thickness in the macular region. Conclusions: ADHD is associated with retinal thinning in the macula (total and outer retinal thickness) in both eyes, suggesting the potential of OCT-based biomarkers for this condition.<\/jats:p>","DOI":"10.3390\/jcm14165723","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T09:43:01Z","timestamp":1755078181000},"page":"5723","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Retinal Thinning in Attention Deficit Hyperactivity Disorder (ADHD): Structural Changes Detected by Spectral-Domain OCT"],"prefix":"10.3390","volume":"14","author":[{"given":"Carmen","family":"Miquel-Lopez","sequence":"first","affiliation":[{"name":"General University Hospital Morales Meseguer, 30008 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6245-7271","authenticated-orcid":false,"given":"Jose Javier","family":"Garcia-Medina","sequence":"additional","affiliation":[{"name":"General University Hospital Morales Meseguer, 30008 Murcia, Spain"},{"name":"Department of Ophthalmology, Optometry, Otolaryngology and Pathology, University of Murcia, 30100 Murcia, Spain"},{"name":"Ophthalmic Research Unit \u201cSantiago Grisolia\u201d, 46010 Valencia, Spain"},{"name":"Spanish Net of Inflammatory Diseases RICORS, Institute of Health Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Eusebio","family":"Lopez-Hernandez","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Optometry, Otolaryngology and Pathology, University of Murcia, 30100 Murcia, Spain"},{"name":"Clinical and Experimental Optometry Research Group, Faculty of Optics and Optometry, University of Murcia, 30003 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7639-5366","authenticated-orcid":false,"given":"Diego","family":"Garcia-Ayuso","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Optometry, Otolaryngology and Pathology, University of Murcia, 30100 Murcia, Spain"},{"name":"Spanish Net of Inflammatory Diseases RICORS, Institute of Health Carlos III, 28029 Madrid, Spain"},{"name":"Clinical and Experimental Optometry Research Group, Faculty of Optics and Optometry, University of Murcia, 30003 Murcia, Spain"},{"name":"Experimental Ophthalmology Research Group, Department of Ophthalmology, Optometry, Otolaryngology and Pathology, Faculty of Medicine, University of Murcia, Instituto Murciano de Investigaci\u00f3n Biosanitaria Pascual Parrilla\u2014IMIB, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maravillas","family":"De-Paco-Matallana","sequence":"additional","affiliation":[{"name":"General University Hospital Morales Meseguer, 30008 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Hernandez-Olivares","sequence":"additional","affiliation":[{"name":"University Hospital Virgen de la Arrixaca, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0118-7837","authenticated-orcid":false,"given":"Maria Dolores","family":"Pinazo-Duran","sequence":"additional","affiliation":[{"name":"Ophthalmic Research Unit \u201cSantiago Grisolia\u201d, 46010 Valencia, Spain"},{"name":"Spanish Net of Inflammatory Diseases RICORS, Institute of Health Carlos III, 28029 Madrid, Spain"},{"name":"Cellular and Molecular Ophthalmobiology Group, Surgery Department, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Del-Rio-Vellosillo","sequence":"additional","affiliation":[{"name":"General University Hospital Morales Meseguer, 30008 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), American Psychiatric Association. [7th ed.].","DOI":"10.1176\/appi.books.9780890425787"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1093\/ije\/dyt261","article-title":"ADHD prevalence estimates across three decades: An updated systematic review and meta-regression analysis","volume":"43","author":"Polanczyk","year":"2014","journal-title":"Int. J. Epidemiol."},{"key":"ref_3","first-page":"2099","article-title":"Predictors of persistence in preschool children with attention-deficit\/hyperactivity disorder","volume":"128","author":"Biederman","year":"2011","journal-title":"Pediatrics"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1055\/s-0040-1701658","article-title":"ADHD: Current concepts and treatments in children and adolescents","volume":"51","author":"Drechsler","year":"2020","journal-title":"Neuropediatrics"},{"key":"ref_5","first-page":"271","article-title":"Assessment of changes in the macula and optic nerve head using optical coherence tomography in patients with attention deficit hyperactivity disorder","volume":"95","author":"Kudsieh","year":"2020","journal-title":"Arch. Soc. Esp. Oftalmol. (Engl. Ed.)"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"370","DOI":"10.5152\/pcp.2021.21183","article-title":"Assessment of optical coherence tomography findings in adults with attention deficit hyperactivity disorder: A case-control study","volume":"31","author":"Erdogan","year":"2021","journal-title":"Psychiatry Clin. Psychopharmacol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3105","DOI":"10.1007\/s10792-020-01497-z","article-title":"Ocular findings in patients with attention deficit and hyperactivity","volume":"40","author":"Ulucan","year":"2020","journal-title":"Int. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"370","DOI":"10.30773\/pi.2019.02.26.1","article-title":"Pilot study: An ocular biomarker for diagnosis of attention deficit hyperactivity disorder","volume":"16","author":"Sujin","year":"2019","journal-title":"Psychiatry Investig."},{"key":"ref_9","first-page":"176","article-title":"Retinal scan with optical coherence tomography in adult attention deficit hyperactivity disorder","volume":"32","author":"Nedime","year":"2021","journal-title":"Turk. Psikiyatri Derg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"128","DOI":"10.3928\/01913913-20230906-03","article-title":"Evaluation of retinal nerve fiber layer, ganglion cell thickness, and macular thickness in children with comorbid specific learning disorder and attention-deficit hyperactivity disorder","volume":"61","author":"Tonkaz","year":"2024","journal-title":"J. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1038\/s41380-022-01699-0","article-title":"Association between ADHD and vision problems: A systematic review and meta-analysis","volume":"28","author":"Bellato","year":"2023","journal-title":"Mol. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.30773\/pi.2021.0167","article-title":"Retinal nerve fiber layer thickness and its relationship with executive functions in adult attention deficit hyperactivity disorder patients","volume":"18","author":"Kaymak","year":"2021","journal-title":"Psychiatry Investig."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), American Psychiatric Association.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1136\/bjophthalmol-2011-301021","article-title":"Glaucoma discrimination of segmented Cirrus spectral domain optical coherence tomography (SD-OCT) macular scans","volume":"96","author":"Kotowski","year":"2012","journal-title":"Br. J. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: A practical and powerful approach in multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J. R. Stat. Soc. Ser. B Stat. Methodol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.preteyeres.2014.06.003","article-title":"Functional architecture of the retina: Development and disease","volume":"42","author":"Hoon","year":"2014","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1177\/1087054713510354","article-title":"Oxidative Stress and ADHD: A Meta-Analysis","volume":"19","author":"Joseph","year":"2015","journal-title":"J. Atten. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"E202147","DOI":"10.21802\/gmj.2021.4.7","article-title":"Reproducibility of Retinal Nerve Fiber Layer and Macular Thickness Measurements Using Spectral Domain Optical Coherence Tomography","volume":"28","author":"Sood","year":"2021","journal-title":"Galician Med. J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5723\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:26:16Z","timestamp":1760034376000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5723"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,13]]},"references-count":18,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14165723"],"URL":"https:\/\/doi.org\/10.3390\/jcm14165723","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,13]]}}}