Visual Acuity, Refractive Error, and Adaptation to Spectacle Wear in Children with Autism and in Typical Peers

Purpose: To compare visual acuity, refractive error, and spectacle adaptation in children with autism to typically developing (TD) peers; to report visual acuity and spectacle wear in children with Autism Spectrum Disorder (ASD) by parent reported level of verbal communication. Methods: In a prospective pilot study, 61 children and adolescents (34 with ASD and 27 who were TD) aged 9 to 17 years completed an eye examination protocol including tests of visual acuity and refraction. Children who required new refractive correction were given a spectacle prescription. Parents provided information for ASD patients regarding their level of verbal communication. Results: ASD subjects had significantly poorer distance and near, binocular and monocular visual acuity. Though there were no differences in spherical equivalent refractive error between the groups, ASD children were less likely to be wearing appropriate refractive correction. Both TD and ASD children successfully adapted to spectacle wear; Adaptation time was faster for TD subjects (1 week) than ASD subjects (16 weeks). ASD children were more likely to complain about wearing spectacles and require more parental prompting to wear glasses than TD children. ASD children who, were reported to be less verbal wore their glasses fewer hours than ASD children who were reported to be more verbal. Conclusion: When visual acuity is measured during a comprehensive eye examination, ASD children show a small, but significant decrease over multiple measures. Spherical equivalent refractive error does not differ from TD children. ASD children adapt to spectacle wear, but require more time, and experience more symptoms and require more parental support.