Autism Journal Club

Visual status in children with Autism spectrum disorder: developing an evidence base for clinicians

Despite a significant body of research investigating higher visual processing particularly with regard to facial recognition and biological motion, there is a paucity of basic clinical research on the visual and refractive profile of children with autism spectrum disorder (ASD). Given this lack of data, it is difficult for eyecare professionals to apply an evidence-based approach to their assessment and management of individuals with ASD. This presentation will summarise results from a regional study based in Northern Ireland, which investigated clinical aspects of visual function in 128 children with ASD aged 6-16 years. Design of preparatory participant information using age- and/or cognitively appropriate wording and social stories were employed, and a short video to introduce the team and familiarise participants with what the visual tests would entail was also used. Both these strategies helped to prepare children with ASD for the experience and promoted good compliance for testing. Refractive error, visual acuity, binocular status, stereoacuity, accommodation and eye movements were examined. In comparison to age-matched typically developing (TD) controls (n=206), there was a greater prevalence of astigmatic refractive errors; there was no significant difference in visual acuity between the ASD and TD groups; there was a four-fold increased prevalence of strabismus in the ASD group, and subtle reduction in stereoacuity and accommodative performance was noted. The implications for these findings will be discussed and the visual profile of ASD participants will be described. Finally, this presentation will describe pilot work investigating structural and functional examination of the retina in a sub-group of ASD participants.