Vision in children with autism spectrum disorder: a critical review

Abstract

Autism spectrum disorder (ASD) is a common neurodevelopmental condition with approximately 1-2 per cent prevalence in the population. The condition has lifelong effects for the individual and family, and early intervention and management helps maximise quality of life and outcomes. Many studies of vision in ASD have attempted to link the behavioural and sensory deficits in ASD with underlying visual processing. From this work, it is clear that individuals with ASD 'see' and process the world differently, but there remain gaps in our understanding. This review will summarise our current knowledge of key aspects of visual functions and the optometric profile of ASD. This includes findings regarding visual acuity and contrast sensitivity, refractive error, eye movements, binocular vision, near visual functions and retinal structure in ASD. From this, a pattern of knowledge emerges for children with ASD: we should expect normal visual acuity; there will likely be atypical eye movements and susceptibility for subtle visuo-motor deficits, there is an increased prevalence of strabismus; an increased likelihood of astigmatism and possibly other refractive errors; attention, crowding and task complexity will likely be problematic; and retinal structure and function may be compromised. Bringing this together, these findings highlight that further work is necessary, not only to understand how higher-level functions link to behaviours, but also to ensure there is a sound understanding of the building-blocks of vision to fully grasp the profile of visual processing as a whole in ASD. This review will give a translational viewpoint for clinicians, and underline the benefits of comprehensive vision care in ASD.

Atypical visual processing in a mouse model of autism

“…The variety of visual phenotypes reported in the literature may be due to the fact that ASD is a spectrum disorder, in which the severity and presentations of the symptoms vary over a very large range. Additionally, there have been many challenges in measuring visual function (including spatial acuity and contrast sensitivity) in this population, especially in children, because of wide variations in testing methods, sample sizes, selection of high-functioning participants, cooperativeness during visual testing, and social and communication difficulties [12][13][14] .…”

Effect size of search superiority in autism spectrum disorder

“…Simmons et al provided a comprehensive review of visual function in ASD with respect to the theories associated with ASD. More recently, Little and Bakroon have critically reviewed visual development and function in children with ASD. Recent systematic reviews have found there was a greater risk for children with ASD if they had a congenital hearing or visual impairment .…”

Retinal alterations in a pre-clinical model of an autism spectrum disorder

“…In this work, we have investigated the retina of the VPA-induced model, since one of the hallmarks of ASD is hypersensitivity to sensory stimuli [15][16][17][18], and the retina is the primary sensory detector for vision. For example, ASD patients apparently perform better than usual in some visual tasks, and worse in others [19]. It has also been shown that certain types of visual stimulus, such as computer screen lights, capture the attention of individuals affected by ASD more than would be expected for neurotypical people [20].…”