Skip to main content

Advertisement

SpringerLink
Log in

Ophthalmological findings in children with autism spectrum disorder

  • Pediatrics
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

Trial registration

Clinical trial registration number: NCT02444117

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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

    Article  Google Scholar 

  2. Lai M-C, Lombardo MV, Baron-Cohen S (2014) Autism. Lancet Lond Engl 383:896–910

    Article  Google Scholar 

  3. 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

    Article  Google Scholar 

  4. 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

    Article  Google Scholar 

  5. 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

    Article  Google Scholar 

  6. 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

    Article  Google Scholar 

  7. Simmons DR, Robertson AE, McKay LS et al (2009) Vision in autism spectrum disorders. Vis Res 49:2705–2739

    Article  Google Scholar 

  8. Fraiberg S, Fraiberg L (1977) Insights from the blind: comparative studies of blind and sighted infants. Basic Books New York

  9. Klin A, Jones W, Schultz R et al (2002) Defining and quantifying the social phenotype in autism. Am J Psychiatry 159:895–908

    Article  Google Scholar 

  10. 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

    Article  Google Scholar 

  11. 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

    Article  Google Scholar 

  12. 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

    Article  Google Scholar 

  13. 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

    Article  CAS  Google Scholar 

  14. 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

    Article  Google Scholar 

  15. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders 5th edition American Psychiatric Publishing. Arlingt VA USA Doi 10:

  16. 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

    Article  CAS  Google Scholar 

  17. 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

    Article  CAS  Google Scholar 

  18. Pigassou R, Pinçon F (1969) Practical notes: presentation of vision tests. Bull Soc Ophtalmol Fr 69:1015–1025

    CAS  PubMed  Google Scholar 

  19. 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

    Article  Google Scholar 

  20. 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

    Article  CAS  Google Scholar 

  21. Perron-Borelli M (1996) EDEI-R: Echelles différentielles d’efficiences intellectuelles. Editions et applications psychologiques

  22. 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

    Google Scholar 

  23. 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

    Google Scholar 

  24. Barthélémy C, Roux S, Adrien JL et al (1997) Validation of the Revised Behavior Summarized Evaluation Scale. J Autism Dev Disord 27:139–153

    Article  Google Scholar 

  25. 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

    Article  Google Scholar 

  26. Black K, McCarus C, Collins MLZ, Jensen A (2013) Ocular manifestations of autism in ophthalmology. Strabismus 21:98–102

    Article  Google Scholar 

  27. 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

    Article  Google Scholar 

  28. 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

    Chapter  Google Scholar 

  29. Scharre JE, Creedon MP (1992) Assessment of visual function in autistic children. Optom Vis Sci Off Publ Am Acad Optom 69:433–439

    Article  CAS  Google Scholar 

  30. Denis D, Burillon C, Livet MO, Burguière O (1997) Ophthalmologic signs in children with autism. J Fr Ophtalmol 20:103–110

    CAS  PubMed  Google Scholar 

  31. 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

    Article  CAS  Google Scholar 

  32. Singman E, Matta N, Fairward A, Silbert D (2013) Evaluation of plusoptiX photoscreening during examinations of children with autism. Strabismus 21:103–105

    Article  Google Scholar 

  33. 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

    Article  Google Scholar 

  34. 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

    Article  Google Scholar 

  35. 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

    Article  Google Scholar 

  36. 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

    Article  Google Scholar 

  37. 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

    Article  Google Scholar 

  38. Little J-A, Woodhouse JM, Lauritzen JS, Saunders KJ (2009) Vernier acuity in down syndrome. Invest Ophthalmol Vis Sci 50:567–572

    Article  Google Scholar 

  39. 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

    Article  Google Scholar 

  40. 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

Download references

Acknowledgments

We thank the children and parents who made this study possible.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, CHRU de Tours, Tours, France

    Raoul Kanav Khanna, Sophie Arsene & Pierre-Jean Pisella

  2. UMR 1253, iBrain, Université de Tours, Inserm, CHRU de Tours, Centre Universitaire de Pédopsychiatrie, Tours, France

    Raoul Kanav Khanna, Klara Kovarski, Marine Siwiaszczyk, Frédérique Bonnet-Brilhault, Magali Batty & Joëlle Malvy

  3. Institut de Neuropsychologie, Neurovision et NeuroCognition, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France

    Klara Kovarski

  4. CNRS (Integrative Neuroscience and Cognition Center, UMR 8002), Paris, France

    Klara Kovarski

  5. Université Paris Descartes, Sorbonne Paris Cité, Paris, France

    Klara Kovarski

  6. Université de Toulouse, CERPPS, Toulouse, France

    Magali Batty

Authors
  1. Raoul Kanav Khanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Klara Kovarski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sophie Arsene
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marine Siwiaszczyk
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pierre-Jean Pisella
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frédérique Bonnet-Brilhault
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Magali Batty
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Joëlle Malvy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raoul Kanav Khanna.

Ethics declarations

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.

Ethical approval

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.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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 258, 909–916 (2020). https://doi.org/10.1007/s00417-019-04594-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-019-04594-7

Keywords

Search

Navigation