The Influence of Refractive Errors on Facial Expression Processing in Children With Autism Spectrum Disorder: An Eye-Tracking Study.

This study looked at how vision problems affect how children with autism look at and understand faces. Children with autism who had vision problems (mainly astigmatism) were slower to look at faces and had more trouble focusing on important facial features like eyes and mouth. However, children with autism who had normal vision looked at faces similarly to other children, suggesting that fixing vision problems might help with social skills.

This eye-tracking study examined how refractive errors (primarily astigmatism) affect facial expression processing in 76 children with ASD compared to 73 typically developing children. Children with ASD and refractive errors showed significantly slower responses to visual stimuli and had particular difficulty processing facial features, especially the mouth area. They struggled to distinguish between nose and eyes regions and could not differentiate visual patterns between nose and mouth during fixation tasks. In contrast, children with ASD who had normal vision showed visual processing patterns similar to typically developing children, suggesting refractive errors may compound social visual processing challenges in autism.

Regular comprehensive eye examinations should be prioritized for children with ASD. Vision correction may improve facial expression processing and social visual attention. Refractive errors, particularly astigmatism, may compound existing social communication challenges in autism and should be addressed as part of comprehensive intervention planning.

Study design type not specified. Sample characteristics beyond ASD diagnosis and age-matching not detailed. Unclear if findings generalize beyond astigmatism to other refractive errors. No information provided about intervention outcomes or long-term effects of vision correction.

Facial expression processing is important for social understanding; among children with autism spectrum disorder (ASD), refractive errors may reduce visual input, further hindering their ability to recognize and interpret faces. This study aimed to investigate the gaze patterns of children with ASD when viewing facial emotion expression pictures under refractive errors and compare these patterns with those of typically developing (TD) children. A total of 76 participants diagnosed with ASD and 73 TD children matched by age were included. All children underwent a comprehensive ophthalmic examination and successfully completed the eye-tracking tasks.

Astigmatism accounted for > 90% of refractive errors, though all types were included to reflect real-world visual challenges. The results showed that children with refractive errors showed slower responses to the visual stimuli than children with typical refractive status. Children with ASD and refractive errors exhibited slower responses to the mouth area compared to the nose and eyes and experienced difficulty in rapidly distinguishing between the nose and eyes. Additionally, they were unable to differentiate visual patterns between the nose and mouth regions during fixation tasks.

In contrast, children with ASD with typical refractive status showed visual sensitivity and tendencies for areas of interest (AOIs) comparable to those of TD children, with response times fastest for the nose, followed by the eyes, and slowest for the mouth. In conclusion, refractive errors, particularly astigmatism, may substantially contribute to difficulties in accurately responding to facial social cues and directing visual attention to socially relevant areas in children with ASD.