Xerophthalmia — a condition characterized by night blindness and ocular surface changes — can develop as the result of a vitamin A deficiency (VAD). Although VAD is uncommon in developed countries, children in the United States who have been diagnosed with autism spectrum disorders (ASD) are at particularly high risk of developing xerophthalmia secondary to a vitamin A deficiency due to potentially restrictive eating habits, according to findings from a case series published in the Journal of American Association for Pediatric Ophthalmology and Strabismus.
A team of researchers affiliated with the Children’s Hospital of Philadelphia reviewed a series of 6 pediatric patients who had an ASD diagnosis and who developed varying degrees of xerophthalmia due to restrictive eating habits. The researchers aimed to highlight the serious risk of blindness present for this population. All the patients in the series presented between 2018 and 2022.
All 6 patients had a history of eye irritation that did not resolve with antibiotic or allergy eye drops. All 6 patients were noted to have a restrictive diet of predominantly white and tan foods and were confirmed with serum testing to have severe VAD.
Normal serum vitamin A levels are between 0.20 ml/L and 0.50 ml/L. All 6 patients in this case series were found to have serum vitamin A levels lower than 0.06 mg/L, less than half the normal range.
Xerophthalmia was reversed in 4 patients with vitamin A supplementation. However, 2 patients experienced irreversible blindness and ocular damage due to advanced xerophthalmia.
Children with autism spectrum disorders commonly develop restrictive diets due to sensory issues which can cause them to reject foods that don’t have particular colors or textures. Foods high in vitamin A include sweet potato, kale, and salmon. Most of the patients with ASD in this study preferred foods such as chicken nuggets, cheese quesadillas, rice, and French fries.
The researchers suspect that xerophthalmia may be underdiagnosed, partly because of lack of familiarity with the condition.
“We hope to effect change by increasing awareness about this public health issue by urging pediatricians and ophthalmologists to routinely take a diet history and consider vitamin A supplementation (VAS) when there is an abnormal ocular surface in the setting of poor diet” the study authors explain. “Pediatricians and ophthalmologists should consider VAD in at risk groups with photophobia, dry eye, or unexplained vision loss. Early identification and [vitamin A supplementation] can prevent irreversible ocular damage and vision loss.”
They also suggest that a review of the patient’s diet should be a standard part of the medical history in this population because early identification of patients with VAD could start the process to reverse xerophthalmia and prevent permanent vision loss.
Marek S, Forbes G, Avery RA, et al. Potential blindness from nutritional xerophthalmia in autistic patients. J AAPOS. 2023;S1091-8531(23)00138-6. doi:10.1016/j.jaapos.2023.05.009