Analysis: Children with Autism Spectrum Disorder Insufficiently Referred to Eye Care

Little girl having her eyes checked at ophthalmologist while her parents are supporting her. Focus is on girl.
Pediatrician and caregiver education may be essential to increase referrals of children with autism spectrum disorder to eye care practitioners.

Ophthalmologists and optometrists may receive infrequent referrals of children with autism spectrum disorder (ASD) from pediatricians, potentially due to the challenge of screening young children with ASD and to guardians or caregivers not recognizing the need for comprehensive assessment, according to researchers. 

Data from the National Survey of Children’s Health indicate that, in the United States, no child younger than 5 years diagnosed with ASD and screened by a pediatrician, also underwent a comprehensive examination by an eye care professional, according to the study. The National Center for Children’s Vision and Eye Health, National Expert Panel advises at least 1 vision screening for all children between 3 and 6 years of age, and referral to an ophthalmologist or optometrist for those with neurodevelopmental disorders.

Although younger children with ASD were referred to eye care providers from schools and other locations such as community centers, less than 50% of children with ASD received referrals. Vision screenings often check for amblyopia, while comprehensive examinations typically test acuity, tracking, retina condition, and general eye health.

For younger children with ASD who were screened at school, 55.31% were also evaluated by an eye care provider, and 21.98% of older children with ASD screened by a pediatrician were subsequently seen in an eye care clinic, the investigators added.

Of the study participants, children with ASD were more often male at a ratio greater than 4:1, White (P =.003), and living in middle-income homes (P =.05). While 82.21% of children of any age with ASD obtained a vision screening — at a pediatrician’s office, eye care clinic, school, or other location — they were more likely to have a comprehensive vision exam if their autism was mild, according to the analysis. Conversely, if their family spoke a language other than English, they were 90% (odds ratio, 0.10; 95% confidence interval, 0.03 to 0.37) less likely to be tested at an eye care facility.

The study cohort comprised 85,482 respondents for children 18 months to 17 years of age from the 2011–2012 National Survey of Children’s Health. Investigators noted that although more recent versions of the survey exist, these have a “much smaller absolute sampling frame and lower response rates and may be less useful” for subgroup evaluation — moreover, other surveys reported larger prevalence rates of ASD than the generally accepted standard.

Researchers conclude that pediatrician and caregiver education encouraging comprehensive eye assessment for children with ASD may increase the rate at which this more at-risk population receives rigorous and ongoing eye care.


Swanson MW, Lee SD, Frazier MG, Bade A, Coulter RA. Vision screening among children with autism spectrum disorder, Optom Vis Sci. 2020;97:917–928. DOI: 10.1097/OPX.0000000000001593.