In a groundbreaking synthesis poised to reshape our understanding of attention disorders, researchers have embarked on a systematic review illuminating the potential of eye-tracking technology as a transdiagnostic biomarker for inattention across a broad spectrum of psychiatric conditions. This comprehensive examination aggregates findings from seventy-five studies, weaving together intricate oculomotor data with clinical insights to chart a new course for personalized mental health assessment and intervention.
Attention, a fundamental cognitive function, manifests as a continuous and heterogeneous trait flawed by impairment in numerous psychiatric disorders. The quest to elucidate the pathophysiology underlying such deficits has long challenged neuroscientists and clinicians alike. Here, the precision and objectivity of eye movement analysis emerge as a beacon, promising deeper neural insights through measurable behavioral indices. The reviewed literature spans disorders traditionally categorized under discrete diagnostic entities — including ADHD, ASD, Tourette Syndrome, OCD, BPD, Developmental Coordination Disorder, and Schizophrenia Spectrum and other psychotic disorders — yet finds common ground in attention-related dysfunctions evidenced by ocular motor behavior.
Eye movement control, governed by an elaborate neural network integrating cortical and subcortical regions, offers a dynamic window into cognitive processes. By dissecting three principal domains of attention—Selective Attention, Sustained Attention, and Executive Control—this review meticulously maps specific oculomotor paradigms to the underlying attentional mechanisms disrupted across diagnoses. The Selective Attention domain encapsulates the spatial and feature-based focus of perceptual resources, while Sustained Attention addresses vigilance over time, and Executive Control encompasses the higher-order regulation of attentional shifts and inhibition.
Key eye-tracking metrics unearthed by this synthesis reveal striking transdiagnostic impairments. Antisaccade direction errors, indicating failures in inhibitory control when suppressing reflexive glances toward stimuli, emerged as a consistent hallmark of attention dysfunction. Similarly, fixation durations on task-relevant versus irrelevant areas highlighted difficulty in maintaining focus or filtering distractions, while latency to first fixation underscored delayed orienting of attention. Furthermore, anomalous anticipatory and intrusive saccades illuminated deficits in predictive control and suppression of irrelevant eye movements. Collectively, these metrics converge to paint a neural signature of inattention that transcends categorical psychiatric labels.
Importantly, these oculomotor indices showed moderate correlations with classical self-reported and behavioral measures of inattention, lending them robustness and clinical relevance. This convergence suggests that eye-tracking could complement subjective assessments, mitigating biases inherent to self-reporting and producing quantifiable phenotypes of cognitive dysfunction. Such a biomarker-driven approach holds promise not only for diagnostic refinement but also for tracking treatment efficacy and tailoring interventions to individual neurocognitive profiles.
The implications of this review extend beyond academic intrigue, gesturing toward a paradigm shift in clinical psychiatry. Eye-tracking, a non-invasive, relatively cost-effective modality, could evolve from traditional research applications into a standardized component of neuropsychiatric evaluation. This would facilitate earlier detection of attentional impairments, enable monitoring of symptom fluctuations, and support personalized therapeutic strategies aligned to specific biomarkers rather than broad diagnostic categories.
Yet, challenges remain before eye-tracking can be fully integrated into clinical practice. The heterogeneity of current studies, variable paradigms employed, and lack of standardized protocols underscore the necessity for rigorous, large-scale investigations and cross-validation efforts. Moreover, translating oculomotor metrics into actionable clinical insights demands multidisciplinary collaboration bridging neuroscience, psychology, and data analytics.
This systematic review signals a milestone in psychiatric research by advocating for a dimensional, transdiagnostic perspective of attention deficits. It underscores the potential for eye movement data to unveil latent neurobiological mechanisms that traditional diagnostic frameworks might obscure. By capturing the fluid dynamics of attention through precise ocular metrics, clinicians may unlock novel pathways for better diagnosis, monitoring, and treatment across a wide spectrum of mental health disorders.
As science advances, the integration of eye-tracking biomarkers could herald an era in which mental disorders are no longer siloed but understood as overlapping expressions of underlying neural circuit dysfunctions. This approach could facilitate the dismantling of stigma, promote personalized medicine, and ultimately improve outcomes for countless individuals affected by inattention-related psychopathologies.
The journey from laboratory discovery to clinical application will necessitate concerted efforts in method standardization, technological refinement, and validation across diverse populations. Nevertheless, the prospect of harnessing eye-tracking as a window into the mind’s attentional machinery offers an exciting vista for both researchers and clinicians committed to unraveling the complexities of psychiatric disorders.
In conclusion, this systematic review propels eye-tracking from a promising research tool toward a clinically valuable biomarker, with compelling evidence supporting its role in transdiagnostic identification of inattention symptoms. Continued innovation and collaborative inquiry will be pivotal in transforming these insights into tangible benefits for mental health diagnostics and therapeutic interventions worldwide.
Subject of Research: Eye-tracking biomarkers as transdiagnostic indicators of inattention across various psychiatric disorders.
Article Title: Transdiagnostic eye-tracking biomarkers of inattention across psychiatric disorders: a systematic review.
Article References: Toghi, A., Mohammadzadeh, A., Alemi, Z. et al. Transdiagnostic eye-tracking biomarkers of inattention across psychiatric disorders: a systematic review. BMC Psychiatry 25, 1007 (2025). https://doi.org/10.1186/s12888-025-07415-w
Image Credits: AI Generated
