Visual Health in Autism Spectrum Disorder: Screening Outcomes, Clinical Associations, and Service Gaps.

This study looked at eye health in 210 autistic children and found that vision problems are common but often missed. About 1 in 4 children had refractive errors (needing glasses), and 1 in 8 had eye muscle problems. Children with more severe autism had more difficulty with eye tests and slightly worse vision problems. Worryingly, nearly 1 in 4 children had never had an eye exam before this study.

This cross-sectional study examined visual health in 210 children with autism spectrum disorder (mean age 8.18 years, 83.3% male) using non-contact screening methods. Refractive errors were found in 22.3% of participants, with astigmatism being most common (15.2%), followed by myopia (5.2%) and hyperopia (1.9%). Strabismus was present in 11.9% of children, primarily intermittent exotropia. Nearly half (49.5%) could not complete stereopsis testing, and greater autism severity correlated with reduced test cooperation and modestly worse refractive errors.

Notably, 23.8% of children had never received an eye examination prior to this study, highlighting significant service gaps in visual healthcare for autistic children.

Results support implementing systematic vision screening for autistic children using autism-friendly, non-contact methods. Healthcare providers should prioritize accessible eye care approaches and consider autism severity when planning examinations. Early identification of visual problems may improve overall developmental outcomes and quality of life for autistic children.

Single cross-sectional study design limits causal inferences. Non-contact screening methods may be less precise than comprehensive eye examinations. Study conducted in one autism education center may limit generalizability. Sample predominantly male (83.3%), potentially affecting representativeness of findings across genders.

: Children with autism spectrum disorder (ASD) often experience visual problems, yet their ophthalmic health remains underexplored due to testability challenges and limited-service access. This study evaluated ophthalmic screening outcomes in children with ASD and examined whether autism severity influenced ocular findings or cooperation during examinations.: This cross-sectional study included 210 children with ASD (mean age 8.18 ± 4.99 years; 83.3% male). Examinations were conducted in an autism education center using non-contact methods: stereopsis (LANG I stereotest; LANG-STEREOTEST AG, Küsnacht, Switzerland), cover-uncover, and Hirschberg tests for strabismus, Spot Vision Screener (Welch Allyn Inc., Skaneateles Falls, NY, USA) for refractive errors, and Brückner test for red reflex. Autism severity was assessed with the Turkish version of the Adapted Autism Behavior Checklist (AABC).: Refractive errors were identified in 22.3% of participants: astigmatism in 15.2%, myopia in 5.2% (including 3 high myopia), and hyperopia in 1.9%.

Strabismus was present in 11.9%, most commonly intermittent exotropia. Nearly half (49.5%) could not complete stereopsis testing, and a weak positive correlation was observed between AABC scores and the higher absolute spherical equivalent (SE) value between the two eyes (r = 0.173,= 0.044). Children unable to complete stereopsis testing had significantly higher AABC scores (22.66 ± 9.69 vs. 13.39 ± 9.41,< 0.001). Notably, 50 children (23.8%) had never undergone an eye examination prior to this study.: Ophthalmic findings, particularly astigmatism and strabismus, are common in children with ASD.

Greater autism severity was associated with reduced testability and modestly worse refractive error status. These findings suggest that tailored, accessible eye-care approaches and systematic vision screening may help to reduce overlooked visual problems and support more equitable care for children with ASD.