Understanding Vision Problems in Persons With Autism Spectrum Disorders (ASD)

Autism spectrum disorder (ASD) is a developmental condition affecting language, social skills, and communication ability. In some cases, people with ASD also experience vision problems, and around 71 percent of children with autism have visual problems. 

Eye & Vision Problems Linked to Autism

Eye and vision problems are common in people with autism because they are caused by decreased brain function in areas like the frontal or occipital lobe. The frontal lobe controls visual attention, while the occipital lobe allows us to see the detail of objects around us clearly without blurriness or distortion of coloration between objects that appear close together visually (acuity). 

These are some of the most common issues related to vision in people with autism:

Strabismus (Misaligned Eyes or Wall Eyes)

Strabismus is a disorder in which the eyes are not aligned. Misaligned eyes cause double vision and other vision problems. Strabismus is a common condition affecting approximately 4 percent of children under 6 years old globally.

People with ASD are more likely to develop acquired strabismus. This is thought to be partly because they tend to have weaker muscles than those without autism.

Other causes of strabismus include genetic conditions such as Down syndrome and cerebral palsy, developmental delays, congenital cataracts (clouding of the lens,) and trauma to the head or eye (such as from an accident).

 People with strabismus typically experience the following symptoms:

• Squinting with both eyes open
• Crossed eyes when looking at something up close
• Inability to focus for long periods, such as when reading
• Dystrophy, which occurs when the child sees double because they are using both eyes
• Headaches caused by squinting
• Blurry vision caused by unequal eye muscle control, which can lead to amblyopia (lazy eye)
• Eye fatigue and tiredness due to frequent eye movements, which are needed to keep images clear
• Loss of depth perception and poor balance because one or both eyes are misaligned and not working together properly for depth perception

Strabismus may mimic other illnesses, so it is vital to see a doctor for a diagnosis.

Amblyopia (Lazy Eye)

Amblyopia is a disorder where your brain doesn’t give the same level of attention to both eyes. Lazy eye is the prevalent cause of visual impairment in children, and 3 out of every 100 children are estimated to have it.

A lazy eye tends to occur when the brain does not receive clear signals from both eyes, so it chooses to ignore one eye’s image. This happens because the two eyes are out of alignment with each other rather than working together properly.

Amblyopia often occurs in children with autism spectrum disorder. A recent study revealed that more than half of children with autism had some form of amblyopia compared to children without autism.

The cause of amblyopia is unclear. It may result from an injury to the eye or brain, or it may be inherited.

The most common symptom is blurred vision in one eye, unaffected by the other eye. 

Other symptoms may include the following:

• Headaches or eye strain
• Difficulty seeing in low-light situations or at night, requiring glasses with a stronger prescription in these situations
• Double vision when looking at an object that is very close (without glasses), which can potentially be corrected by using an eye patch over the affected eye for a while each day

If amblyopia is diagnosed early enough, treatment may help to improve vision in both eyes and prevent permanent loss of sight from occurring later in life.

Glare Sensitivity

Glare sensitivity is a common symptom associated with autism, making it difficult to see clearly in bright light. While it’s unclear exactly why this link exists, it may be due to the fact that people with autism are more sensitive to light than others.

Glare sensitivity is thought to be caused by an imbalance between the cones and rods in your eyes. Rods are used for night vision and help us see clearly when there’s not much light around us, while cones are used for color vision and help us see clearly during the day.

People with autism have fewer cones than rods in their eyes, which can make them more sensitive to bright lights.

Other experts believe that the cause of glare sensitivity comes from an inability to distinguish between ambient light levels and direct light sources, such as sunlight. As a result, bright lights may seem overwhelming for autistic individuals and cause them to avoid certain areas or situations altogether.

Visual Processing Disorder

Visual processing disorders, also known as visual perceptual disorders, are commonly associated with autism spectrum disorder. These visual disorders involve problems with processing visual information from your eyes and translating them into thoughts or actions. 

They may manifest as poor depth perception or poor motion detection, such as being unable to catch a ball while playing baseball. 

Either oversensitivity or under-sensitivity can cause these impairments to light, brightness perception problems, color blindness, or visual acuity issues.

The most common signs of visual processing disorders include the following:

• Difficulty with depth perception
• Poor ability to focus on objects
• Excessive blinking or eye strain
• Difficulty with eye contact, reading, and writing
• Poor coordination between the eyes and hands

People with ASD and vision problems may also experience difficulties in social situations, such as in making friends or communicating effectively with others, due to their inability to read facial expressions and body language accurately. 

Many people with ASD also find it difficult to follow directions because they cannot understand pictures or diagrams that explain how tasks should be performed.

Eye Tracking Disorder

These disorders involve difficulty moving your eyes to point at what you want them to look at. This can lead to trouble following directions.

Signs of an eye-tracking disorder include the following:

• A tendency to fixate on objects at close range rather than at a distance
• Inability to track objects accurately in a smooth, coordinated manner
• Lack of eye contact with other people
• Difficulty following what others say and do
• Circling back to previously viewed objects or areas when walking or moving around

Eye tracking disorders can occur at any age, but they are more prevalent in children than adults.

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Vision Exams for Autistic Patients

Vision exams for autistic patients should be performed by ophthalmologists trained in this type of care. It’s important to make sure your autistic child has regular vision exams, so you can monitor any changes in their sight. 

Even if your child does not have any vision problems at this time, the doctor will be able to perform eye tests regularly as part of routine checkups. If any vision issues pop up, your child will benefit from early diagnosis and treatment.

Vision exams for autistic patients are different from those given to other patients. They are more comprehensive and include more aspects of the eye as well as a general checkup on the patient’s overall health. 

Vision exams can be a bit scary for neurodivergent kids, but it’s important to ensure your child gets the best care possible. This means checking their eyesight at every appointment. To ease the experience for your child, choose a vision provider with experience in treating kids with autism.

What to Expect During a Visual Exam for Your Child

While each office works a little differently, you can expect the following at most vision checkups:

1. The doctor will inquire about your child’s vision history and habits and any other medical conditions they may have. They do so to understand your child’s visual needs and develop an exam plan that works for them.
2. Ask if there is any way that your child can be made more comfortable during their exam. If they have a favorite toy or animal, bring it along. It will help them feel at ease and communicate with the doctor better.
3. Feel free to ask questions about the procedure or what tests might be performed.
4. Ask your doctor what the results of an eye exam could mean and how any issues might affect your child’s vision over time if left untreated.

Tips for Preparing Your Child for Their Next Vision Exam

1. Prepare them in advance. Explain what will happen during the exam and what they must do. Tell them it’ll only take a few minutes, and you’ll stay with them the whole time. Remember, if your child has trouble understanding language, you should try using visual cues like pictures instead of words.
2. Bring comfort items. If your child has a special blanket or stuffed animal, bring it along for the appointment. Having something familiar with them can help to calm them down during the exam.
3. Be patient. Don’t rush the process. Your child might need extra time and attention at each step until they feel comfortable enough to proceed without being overwhelmed by all the stimuli around them. Take some deep breaths and expect the process to take longer than your exams take.

Vision Therapy for Children With Autism

Vision therapy is a non-invasive treatment that helps children with autism to improve their ability to see, learn, and interact with the world around them.

Children with autism often have difficulty processing information from their eyes and ears. Therapy is a good way to aid autistic children in improving their visual processing skills, helping them better understand the meaning of what they see or hear.

In addition, vision therapy can reduce or even eliminate some of the common symptoms associated with autism, such as these:

• Difficulty making eye contact
• Difficulty following instructions or staying on task
• Difficulty understanding social cues (like knowing when someone is upset or angry)

Some vision therapy exercises include the following:

• Eye exercises: These exercises help to strengthen eye muscles so they can focus more easily on objects close up or far away. They teach your child how to track objects with their eyes as they move across the room or pass by quickly, like when you wave goodbye at them while walking out the door or when someone else walks by in the hallway outside a classroom window.
• Computer programs: These programs help your child learn how to use computers more effectively by using software designed specifically for people who have trouble reading letters or numbers on the screen.

Ongoing Research

Much remains to be learned about the connection between vision problems and autism. Still, studies indicate that vision exams can identify eye-related issues in autistic children. 

Early knowledge of any vision issues can help parents and clinicians devise appropriate interventions, which may reduce physical and behavioral symptoms. The sooner you can begin managing any issues, the better it is for your child’s long-term health.

References

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2. Strabismus (Crossed Eyes). American Optometric Association.

3. Eyeing the Connection Between Autism and Vision. (September 2020). Spectrum News.

4. Amblyopia: What Is Lazy Eye? (September 2022). American Academy of Ophthalmology.

5. Light Sensitivity (Photophobia). (September 2022). Royal National Institute of Blind People.

6. Prevalence of Strabismus and Its Associated Factors Among School-Age Children Living in Bahir Dar City: A Community-Based Cross-Sectional Study. (April 2021). Clinical Optometry.

7. Visual Processing Disorder. St. Louis Learning Disabilities Association.

8. Amblyopia (Lazy Eye). (September 2022). National Eye Institute.

9. How Can We Tell if Our Nonverbal Teen Needs Glasses? (April 2015). Autism Speaks.

10. Ophthalmologic Manifestations in Autism Spectrum Disorder. (August 2022). Turkish Journal of Ophthalmology.

11. Visual Perception in Autism Spectrum Disorder: A Review of Neuroimaging Studies. (July 2020). Journal of the Korean Academy of Child and Adolescent Psychiatry.

12. Ophthalmologic Manifestations in Autism Spectrum Disorder. (August 2022). Turkish Journal of Ophthalmology.

13. Vision in Autism Spectrum Disorders. (November 2009). Vision Research Special Issue: Vision Research Reviews.

14. Vision in Children With Autism Spectrum Disorder: A Critical Review. (June 2017). Clinical and Experimental Optometry.

15. Eye Tracking in Early Autism Research. (September 2013). Journal of Neurodevelopmental Disorders.

16. Vision Screening Among Children With Autism Spectrum Disorder. (November 2020). Optometry and Vision Science.

17. Atypical and Inflexible Visual Encoding in Autism Spectrum Disorder. (June 2021). PLOS Biology.