Ophthalmologic Peculiarities in Children with Autism Spectrum Disorder

Background:

Impairments in the exploration and perception of social stimuli could at least partially result from undetected eye pathology in ASD. Although highly recommended, eye examination is not done systematically due to a lack of complaints. Moreover, this examination is difficult to realize in children with ASD.

Objectives:

The main purpose of this prospective study was to evaluate the prevalence of ophthalmological disorders in children presenting ASD and understand the influence of these disorders on autistic traits. Another important aim of the study was to developp a suitable clinical protocol to evaluate opthalmological pathologies in children with ASD, including children without langage or with mental retardation.

Methods:

An original procedure was born from the collaboration of ophthalmologic and child psychiatric departments to propose an ophthalmologic examination for each child included in a therapeutic follow-up protocol. Ophthalmologic assessment included a visual acuity test, a sensorimotor exam, a slit lamp examination and a cycloplegic refraction with an automated refractometer. Parents and children were familiarized to the examination thanks to an instruction book. A second examination was conducted when visual acuity could not be evaluated in the child psychiatry department, a place familiar to the child.

Results:

The strategy adopted to measure visual acuity allowed us to measure monocular visual acuity in 52% of the children with ASD after the first examination and was improved to 74% after the second examination. Ophthalmologic pathology was found in 32% of the participants, with 29% having significant refractive errors, 6.5% presenting strabismus and 3.2% demonstrating amblyopia. Children with ophthalmological disorders had significant lower verbal intelligence quotients and higher social impairment.

Conclusions:

The existence of undetected ophthalmologic pathology in ASD and its influence on autistic traits stressed the importance of early, systematic, and comprehensive examination by a pediatric ophthalmologist. It is of main importance to have a reliable diagnosis in order to prescribe spectacles to improve visual development, especially in children with neurodevelopmental issues. This examination procedure of children with ASD contributes to a comprehensive examination, including subjective and objective data, which is mandatory to obtain a reliable diagnosis. Besides, this would help to replicate these results in further prospective studies. Finally, taking into account ophthalmological parameters is a requisite before any research on visual functions in ASD.