Autism spectrum disorder (ASD) affects an estimated 1.85% of children in the United States, but despite its increased prevalence, the relationship between ocular disorders and ASD isn’t clearly understood. Now, a new study in the American Journal of Ophthalmology suggests autistic children are at an increased risk of adverse ocular problems.                

The population-based retrospective cohort study included claims from more than 10 million children from 2007 to 2013. Participants were 18 or younger at the time of the first claim. The researchers looked for a diagnosis of pervasive developmental disorder (PDD) or autistic disorder and assessed the prevalence of ocular diagnoses including amblyopia, strabismus, optic neuropathy, nystagmus or retinopathy of prematurity in a normally developing control group and children with PDD or autistic disorder.

The prevalence of any ophthalmologic diagnosis was 3.5% in the controls, but much higher at 12.5% in children with PDD and at 13.5% in children with autistic disorder.

More research is necessary to further clarify the relation between ocular disorders and autistic symptoms and severity, the researchers noted in their paper.

“Our study provides epidemiologic support for an association between autism and ophthalmologic disorders, including amblyopia, strabismus, nystagmus and optic atrophy,” says researcher Melinda Chang, MD. “This is the first step toward understanding the relationship between autism and visual disorders.”

She hopes future research can help illuminate whether an abnormal early visual experience is a contributing factor to patients’ disrupted social and language development. If that’s true, treating the ocular disorders could be an important part of autism therapy, she says.

“In the meantime, eye care practitioners must be aware of the potential increased risk of visual disorders in children with autism and screen appropriately,” she concludes. “Since these patients have difficulty cooperating with typical vision screening, they may benefit from referral to pediatric ophthalmology specialists.”

Chang MY, Doppee D, Yu F, et al. Prevalence of ophthalmologic diagnoses in children with autism spectrum disorder using the Optum dataset: a population-based study. American Journal of Ophthalmology. September 5, 2020. [Epub ahead of print].