Association between Autism Spectrum Disorder (ASD) and vision problems. A systematic review and meta-analysis

John Perna; Alessio Bellato; Preethi S Ganapathy; Marco Solmi; Andrea Zampieri; Stephen V Faraone; Samuele Cortese

doi:10.1038/s41380-023-02143-7

Association between Autism Spectrum Disorder (ASD) and vision problems. A systematic review and meta-analysis

Mol Psychiatry. 2023 Dec;28(12):5011-5023. doi: 10.1038/s41380-023-02143-7. Epub 2023 Jul 26.

Authors

John Perna^#^{1

2}, Alessio Bellato^#³, Preethi S Ganapathy⁴, Marco Solmi^{5

6

7

8

9

10}, Andrea Zampieri¹¹, Stephen V Faraone¹², Samuele Cortese^{9

13

14

15

16}

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA.
² Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
³ School of Psychology, University of Nottingham Malaysia, Selangor, Malaysia.
⁴ Department of Ophthalmology & Visual Sciences, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA.
⁵ Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
⁶ On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.
⁷ Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada.
⁸ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁹ Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
¹⁰ Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
¹¹ Vittorio Emanuele III Hospital - Montecchio Maggiore, Vicenza, Italy.
¹² Department of Psychiatry and Behavioral Sciences, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA. SVFaraone@upstate.edu.
¹³ Solent NHS Trust, Southampton, UK.
¹⁴ Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK.
¹⁵ Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA.
¹⁶ Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.

^# Contributed equally.

PMID: 37495888
DOI: 10.1038/s41380-023-02143-7

Abstract

Aim: To conduct a systematic review and meta-analysis assessing whether vision and/or eye disorders are associated with Autism Spectrum Disorder (ASD).

Method: Based on a pre-registered protocol (PROSPERO: CRD42022328485), we searched PubMed, Web of Knowledge/Science, Ovid Medline, Embase and APA PsycINFO up to 5^th February 2022, with no language/type of document restrictions. We included observational studies 1) reporting at least one measure of vision in people of any age with a diagnosis of ASD based on DSM or ICD criteria, or ADOS; or 2) reporting the prevalence of ASD in people with and without vision disorders. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS). Random-effects meta-analyses were used for data synthesis.

Results: We included 49 studies in the narrative synthesis and 46 studies in the meta-analyses (15,629,159 individuals distributed across multiple different measures). We found meta-analytic evidence of increased prevalence of strabismus (OR = 4.72 [95% CI: 4.60, 4.85]) in people with versus those without ASD (non-significant heterogeneity: Q = 1.0545, p = 0.7881). We also found evidence of increased accommodation deficits (Hedge's g = 0.68 [CI: 0.28, 1.08]) (non-significant heterogeneity: Q = 6.9331, p = 0.0741), reduced peripheral vision (-0.82 [CI: -1.32, -0.33]) (non-significant heterogeneity: Q = 4.8075, p = 0.4398), reduced stereoacuity (0.73 [CI: -1.14, -0.31]) (non-significant heterogeneity: Q = 0.8974, p = 0.3435), increased color discrimination difficulties (0.69 [CI: 0.27,1.10]) (non-significant heterogeneity: Q = 9.9928, p = 0.1890), reduced contrast sensitivity (0.45 [CI: -0.60, -0.30]) (non-significant heterogeneity: Q = 9.9928, p = 0.1890) and increased retinal thickness (=0.29 [CI: 0.07, 0.51]) (non-significant heterogeneity: Q = 0.8113, p = 0.9918) in ASD.

Discussion: ASD is associated with some self-reported and objectively measured functional vision problems, and structural alterations of the eye, even though we observed several methodological limitations in the individual studies included in our meta-analyses. Further research should clarify the causal relationship, if any, between ASD and problems of vision during early life.

Prospero registration: CRD42022328485.

Publication types

Systematic Review
Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Autism Spectrum Disorder* / epidemiology
Autism Spectrum Disorder* / physiopathology
Child
Cross-Sectional Studies
Female
Humans
Male
Prevalence
Strabismus
Vision Disorders* / epidemiology