As optometrists, the topic of autism is rarely presented at our CE lectures and meetings. I heard a lecture at Academy in 2012 and it was the first time I considered the link between visual development and autism and the role of primary eye care. Autism Speaks reports 1 in 88 children are diagnosed on the autism spectrum; most of us see hundreds of children annually in our practices, so it stands to reason we will soon or may have already treated an autistic child. How will/would you know? Autism spectrum disorder (ASD) is generally recognized as a group of neurobehavioral disorders characterized by atypical social interaction, including gaze avoidance. Spectrum of course refers to the wide variability of patient presentations, from high functioning to severe neurological impairment including seizures. Repetitive behavior is also very common with ASD children. No race predilection has been documented, but ASD is four times more common in boys than girls.
Interestingly, even if your practice is not primarily pediatric based, you have probably done testing on very young patients that can help screen for autism. I’m sure everyone knows the frustration of trying to do retinoscopy on a child that will not look at your distance target, but only at you. While exasperating to the clinican, it is a sign of normal neurodevelopment. ASD children will likely be looking anywhere but at you. “Fix, follow, maintain” is a staple for infant examinations and will be difficult for those with ASD. Preferential looking testing, especially with facial targets, is also a very good early detection device for ASD. Uncorrected refractive error can give false positive results, however. And while some argue case history with adults is the most important aspect of an eye exam, so too is observation with infants/toddlers. Visual signs that are highly correlated with ASD include: gaze avoidance, turning head to look out of corner of eye, hyper fixating on only one object, extreme light sensitivity, and color preference/avoidance.
There is still much that is unknown about ASD and therapy research is constantly ongoing to develop more effective treatment for patient symptoms, both social and neurological. Diet has been shown to play a large role in improving symptoms, as a subset of those with ASD are sensitive to gluten. Vitamin therapy has also been shown to be helpful, especially vitamin D. Many therapy regimens are centered on improving social interaction, recognizing facial cues and helping patients cope with visual or tactile overstimulation. Vision therapy, including the use of yoked prism, has been anecdotally reported to show improvement in posture, body orientation and spatial awareness. While many optometrists may not feel comfortable implementing a vision therapy plan to treat a child with ASD, recognizing early symptoms and making appropriate referrals is very valuable to their overall development.