This retrospective cross-sectional study used the NIH All of Us Research Program to examine whether ADHD is associated with keratoconus (KC) in adults, comparing 10,090 ADHD patients to 30,270 propensity-score-matched controls (mean age 42.3 years; 63.1% female).
KC prevalence was 0.33% in the ADHD group vs. 0.14% in controls; ADHD was associated with more than twice the odds of KC after full multivariable adjustment (OR 2.43, 95% CI 1.28–4.61, P = 0.01). Tear-film-related disorders were also an independent predictor of KC (OR 5.37, 95% CI 2.62–11.01, P < 0.01).
- Cross-sectional design prevents causal inference. - KC diagnosis relied on administrative/EHR coding, which may underdetect subclinical cases. - Tear-film disorders as a proxy for eye rubbing is speculative and not directly measured.
Clinicians managing adults with ADHD should maintain a low threshold for corneal screening, given a more than 2-fold increased odds of keratoconus. Counseling patients with ADHD about avoiding eye rubbing may be prudent, particularly those with concurrent tear-film disorders.
