Eye pathology could be related to atypical visual behaviours and impaired social communication through visual cues in children with autism spectrum disorder (ASD). The main purpose of this prospective study was to assess ophthalmological disorders in children with ASD and to investigate the relationships with intellectual disability (ID) and ASD severity.
In this prospective study, comprehensive ophthalmological and oculomotor examinations were performed. ASD severity and verbal and performance intelligence quotients were determined using adapted scales. These clinical data were compared between groups of children based on the presence or absence of ophthalmological disorders and the achievement or not of visual acuity (VA) testing by using non-parametric statistical tests.
Amongst a sample of 51 children, ophthalmological disorders were found in 39% of cases, with 35% having significant refractive errors and 10% presenting with strabismus. Children with ASD and ophthalmological disorders had significantly lower verbal (29.8 ± 14.7 compared with 44.3 ± 21.5; p = 0.010) and performance quotients (57.8 ± 18.3 compared with 67.59 ± 20; p = 0.049) but no significant result was found between the presence of ophthalmological disorders and ASD severity, level of communication and social contact, or modulating behaviour when changes occur. Children who did not achieve monocular VA testing (39%) had significantly lower verbal (25.1 ± 9.7 compared with 46.1 ± 20.9; p < 0.001) and performance quotients (52.7 ± 17 compared with 69.8 ± 18.8; p = 0.001), also presented higher social interaction impairment (p = 0.002), and expressed more important behavioural signs (p = 0.007).
Ophthalmological disorders are frequently found in children with ASD, especially in those with ID. Ophthalmologists and child psychiatrists should pay attention to perform ophthalmological examination in children with ASD since eye disorders might remain undetected. A comprehensive examination by a paediatric ophthalmologist would help to improve the individual clinical description and the global intervention.
Clinical trial registration number: NCT02444117
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Baird G, Simonoff E, Pickles A et al (2006) Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). Lancet Lond Engl 368:210–215
Lai M-C, Lombardo MV, Baron-Cohen S (2014) Autism. Lancet Lond Engl 383:896–910
Bottema-Beutel K, Kim SY, Crowley S (2019) A systematic review and meta-regression analysis of social functioning correlates in autism and typical development. Autism Res Off J Int Soc Autism Res 12:152–175
Zulauf Logoz M (2014) The revision and 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): consequences for the diagnostic work with children and adolescents. Prax Kinderpsychol Kinderpsychiatr 63:562–576
Clifford SM, Hudry K, Elsabbagh M et al (2013) Temperament in the first 2 years of life in infants at high-risk for autism spectrum disorders. J Autism Dev Disord 43:673–686
Glod M, Riby DM, Honey E, Rodgers J (2015) Psychological correlates of sensory processing patterns in individuals with autism spectrum disorder: a systematic review. Rev J Autism Dev Disord 2:199–221
Simmons DR, Robertson AE, McKay LS et al (2009) Vision in autism spectrum disorders. Vis Res 49:2705–2739
Fraiberg S, Fraiberg L (1977) Insights from the blind: comparative studies of blind and sighted infants. Basic Books New York
Klin A, Jones W, Schultz R et al (2002) Defining and quantifying the social phenotype in autism. Am J Psychiatry 159:895–908
Johnson BP, Lum JAG, Rinehart NJ, Fielding J (2016) Ocular motor disturbances in autism spectrum disorders: systematic review and comprehensive meta-analysis. Neurosci Biobehav Rev 69:260–279
Kovarski K, Siwiaszczyk M, Malvy J et al (2019) Faster eye movements in children with autism spectrum disorder. Autism Res Off J Int Soc Autism Res 12:212–224
Webb SJ, Merkle K, Murias M et al (2012) ERP responses differentiate inverted but not upright face processing in adults with ASD. Soc Cogn Affect Neurosci 7:578–587
Kovarski K, Thillay A, Houy-Durand E et al (2016) Brief report: early VEPs to pattern-reversal in adolescents and adults with autism. J Autism Dev Disord 46:3377–3386
Thye MD, Bednarz HM, Herringshaw AJ et al (2018) The impact of atypical sensory processing on social impairments in autism spectrum disorder. Dev Cogn Neurosci 29:151–167
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders 5th edition American Psychiatric Publishing. Arlingt VA USA Doi 10:
Lord C, Risi S, Lambrecht L et al (2000) The autism diagnostic observation schedule-generic: a standard measure of social and communication deficits associated with the spectrum of autism. J Autism Dev Disord 30:205–223
Lord C, Rutter M, Le Couteur A (1994) Autism Diagnostic Interview-Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. J Autism Dev Disord 24:659–685
Pigassou R, Pinçon F (1969) Practical notes: presentation of vision tests. Bull Soc Ophtalmol Fr 69:1015–1025
Donahue SP, Arthur B, Neely DE et al (2013) Guidelines for automated preschool vision screening: a 10-year, evidence-based update. J AAPOS Off Publ Am Assoc Pediatr Ophthalmol Strabismus 17:4–8
Schopler E, Reichler RJ, DeVellis RF, Daly K (1980) Toward objective classification of childhood autism: Childhood Autism Rating Scale (CARS). J Autism Dev Disord 10:91–103
Perron-Borelli M (1996) EDEI-R: Echelles différentielles d’efficiences intellectuelles. Editions et applications psychologiques
Brunet O, Lézine I, Josse D (2001) Brunet-Lézine révisé: échelle de développement psychomoteur de la première enfance : manuel BLR-C. Editions et Applications Psychologiques, Paris
Baron IS (2005) Test review: Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV). Child Neuropsychol J Norm Abnorm Dev Child Adolesc 11:471–475
Barthélémy C, Roux S, Adrien JL et al (1997) Validation of the Revised Behavior Summarized Evaluation Scale. J Autism Dev Disord 27:139–153
Ikeda J, Davitt BV, Ultmann M et al (2013) Brief report: incidence of ophthalmologic disorders in children with autism. J Autism Dev Disord 43:1447–1451
Black K, McCarus C, Collins MLZ, Jensen A (2013) Ocular manifestations of autism in ophthalmology. Strabismus 21:98–102
Kabatas EU, Ozer PA, Ertugrul GT et al (2015) Initial ophthalmic findings in Turkish children with autism spectrum disorder. J Autism Dev Disord 45:2578–2581
Fledelius HC (1981) Changes in refraction and eye size during adolescence. In: Third international conference on myopia Copenhagen, august 24–27, 1980. Springer, Dordrecht, pp 63–69
Scharre JE, Creedon MP (1992) Assessment of visual function in autistic children. Optom Vis Sci Off Publ Am Acad Optom 69:433–439
Denis D, Burillon C, Livet MO, Burguière O (1997) Ophthalmologic signs in children with autism. J Fr Ophtalmol 20:103–110
Ezegwui IR, Lawrence L, Aghaji AE et al (2014) Refractive errors in children with autism in a developing country. Niger J Clin Pract 17:467–470
Singman E, Matta N, Fairward A, Silbert D (2013) Evaluation of plusoptiX photoscreening during examinations of children with autism. Strabismus 21:103–105
Coulter RA, Bade A, Tea Y et al (2015) Eye examination testability in children with autism and in typical peers. Optom Vis Sci Off Publ Am Acad Optom 92:31–43
Anketell PM, Saunders KJ, Gallagher SM et al (2015) Brief report: vision in children with autism spectrum disorder: what should clinicians expect? J Autism Dev Disord 45:3041–3047
Wang J, Ding G, Li Y et al (2018) Refractive status and amblyopia risk factors in Chinese children with autism spectrum disorder. J Autism Dev Disord 48:1530–1536
Ying G, Maguire MG, Cyert LA et al (2014) Prevalence of vision disorders by racial and ethnic group among children participating in head start. Ophthalmology 121:630–636
Butchart M, Long JJ, Brown M et al (2017) Autism and visual impairment: a review of the literature. Rev J Autism Dev Disord 4:118–131
Little J-A, Woodhouse JM, Lauritzen JS, Saunders KJ (2009) Vernier acuity in down syndrome. Invest Ophthalmol Vis Sci 50:567–572
Tsao W-S, Hsieh H-P, Chuang Y-T, Sheu M-M (2017) Ophthalmologic abnormalities among students with cognitive impairment in eastern Taiwan: the special group with undetected visual impairment. J Formos Med Assoc Taiwan Yi Zhi 116:345–350
Haute Autorité de Santé (2012) Recommandation de bonne pratique. Autisme et autres troubles envahissants du développement: interventions éducatives et thérapeutiques coordonnées chez l’enfant et l’adolescent
We thank the children and parents who made this study possible.
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of Tours Hospital, France. Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Khanna, R.K., Kovarski, K., Arsene, S. et al. Ophthalmological findings in children with autism spectrum disorder. Graefes Arch Clin Exp Ophthalmol (2020) doi:10.1007/s00417-019-04594-7
- Autism spectrum disorder
- Eye diseases
- Refractive errors