Ophthalmologic diagnoses in youths with autism spectrum disorder: Prevalence and clinical correlates.
Youths with autism carry up to triple the odds of lazy eye, far-sight errors, and crossed eyes—screen them early.
01Research in Context
What this study did
Wu et al. (2023) looked at eye records for youths with autism. They compared rates of lazy eye, far-sight, near-sight, and crossed eyes to kids without autism.
The team used insurance data. They checked if having autism plus intellectual disability made eye problems even more likely.
What they found
Kids with autism had one-and-a-half to three times higher odds of lazy eye, most far-sight errors, and crossed eyes. Near-sight was the only error that did not rise.
The risk jumped higher when the child also had intellectual disability.
How this fits with other research
Wang et al. (2018) saw the same pattern in young Chinese children. They found ten times more crossed eyes in autism, backing up the new odds.
Milne et al. (2009) reported reduced eye convergence in autism. The 2023 study did not find that rise. The gap likely comes from the 2009 sample living in a home for severe ID, while the new study looked at the wider autism population.
Li et al. (2025) widened the lens to all developmental disabilities. They also found doubled astigmatism, showing eye risk is not just an autism issue.
Why it matters
Add a quick eye check to every autism intake. Ask parents if the child squints, tilts his head, or rubs his eyes. Refer for full exam if any sign shows up. Early glasses or patching can cut vision loss and may help learning and social gaze.
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02At a glance
03Original abstract
Autism spectrum disorder (ASD) is associated with a high prevalence of visual dysfunction. This study aimed to investigate the rates of amblyopia, refractive errors, and strabismus, as well as their clinical correlates in ASD. This population-based matched-cohort study used data from the Taiwan National Health Insurance Research Database. A total of 3,551 youths with ASD and 35,510 non-autistic control participants matched by age and sex were included. All the participants were followed-up until they were 18 years old. The prevalence of amblyopia, refractive errors, and strabismus was compared between the ASD and control groups. Effect modifiers, including sex, ASD subgroup, and co-diagnosis of intelligence disability, were examined. Compared to the control group, youths with ASD had a significantly increased risk of amblyopia (adjusted odds ratio [aOR] = 1.75), anisometropia (aOR = 1.66), astigmatism (aOR = 1.51), hypermetropia (aOR = 2.08), exotropia (aOR = 2.86), and esotropia (aOR = 2.63), but a comparable likelihood of myopia according to age. Males with ASD had a significantly lower likelihood of exotropia, but a higher likelihood of myopia than females with ASD. The autism subgroup had a higher OR for hypermetropia, but a lower OR for myopia than the other ASD subgroups. ASD youths with intelligence disabilities demonstrated significantly higher ORs for amblyopia, hypermetropia, and all types of strabismus and lower OR for myopia than those without intelligence disabilities. In conclusion, the rates of amblyopia, refractive errors, and strabismus were higher in youths with ASD. Ocular abnormalities in youths with ASD require a comprehensive assessment and management.
Autism research : official journal of the International Society for Autism Research, 2023 · doi:10.1002/aur.3019