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

Molecular Psychiatry volume 28, pages 5011–5023 (2023)Cite this article

Subjects

A Correction to this article was published on 09 August 2023

This article has been updated

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 5th 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.

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Fig. 1: PRISMA flowchart.

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Data availability

Raw data and R codes for the meta-analysis are available upon request to the corresponding author.

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Acknowledgements

No funding has been received for the present study. We thank Matthew A. Albrecht, Paul A. Constable, Luc Kéïta, Julie-Anne Little and their colleagues, for providing additional details about their studies and helping us to determine the eligibility for the systematic review and meta-analyses, and for providing additional data when these were not present in the original papers.

Author information

Author notes

  1. These authors contributed equally: John Perna, Alessio Bellato.

  2. These authors jointly supervised this work: Stephen V. Faraone, Samuele Cortese.

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA

    John Perna & Stephen V. Faraone

  2. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA

    John Perna

  3. School of Psychology, University of Nottingham Malaysia, Selangor, Malaysia

    Alessio Bellato

  4. Department of Ophthalmology & Visual Sciences, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA

    Preethi S. Ganapathy

  5. Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada

    Marco Solmi

  6. On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada

    Marco Solmi

  7. Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada

    Marco Solmi

  8. School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Marco Solmi

  9. Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK

    Marco Solmi & Samuele Cortese

  10. Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany

    Marco Solmi

  11. Vittorio Emanuele III Hospital - Montecchio Maggiore, Vicenza, Italy

    Andrea Zampieri

  12. Solent NHS Trust, Southampton, UK

    Samuele Cortese

  13. Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK

    Samuele Cortese

  14. Hassenfeld Children’s Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA

    Samuele Cortese

  15. Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK

    Samuele Cortese

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  1. John Perna
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  4. Marco Solmi
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  6. Stephen V. Faraone
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  7. Samuele Cortese
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Contributions

JP: Investigation, Data Curation, Visualization, Writing - Original Draft, Writing - Review & Editing. AB: Formal analysis, Investigation, Data Curation, Visualization, Writing - Original Draft, Writing - Review & Editing. PSG: Validation, Writing - Review & Editing. MS: Validation, Writing - Review & Editing. AZ: Validation, Writing - Review & Editing. SVF: Conceptualization, Methodology, Writing - Original Draft, Writing - Review & Editing, Supervision, Project administration. SC: Conceptualization, Methodology, Writing - Original Draft, Writing - Review & Editing, Supervision, Project administration.

Corresponding author

Correspondence to Stephen V. Faraone.

Ethics declarations

Competing interests

In the past year, SVF received income, potential income, travel expenses continuing education support and/or research support from Aardvark, Aardwolf, Akili, Atentiv, Corium, Genomind, Ironshore, Medice, Noven, Otsuka, Sandoz, Sky Therapeutics, Supernus, Tris, and Vallon. With his institution, he has US patent US20130217707 A1 for the use of sodium-hydrogen exchange inhibitors in the treatment of ADHD. In previous years, he received support from: Alcobra, Arbor, Aveksham, Axsome, CogCubed, Eli Lilly, Enzymotec, Impact, Janssen, KemPharm, Lundbeck/Takeda, Shire/Takeda, McNeil, NeuroLifeSciences, Neurovance, Novartis, Pfizer, Rhodes, Shire, and Sunovion. He also receives royalties from books published by Guilford Press: Straight Talk about Your Child’s Mental Health; Oxford University Press: Schizophrenia: The Facts; and Elsevier: ADHD: Non-Pharmacologic Interventions. In addition, he is the program director of www.adhdinadults.com. SVF is supported by the European Union’s Horizon 2020 research and innovation programme under grant agreement No 965381; NIMH grants U01AR076092-01A1, 1R21MH1264940, R01MH116037; 1R01NS128535 – 01; Oregon Health and Science University, Otsuka Pharmaceuticals, Noven Pharmaceuticals Incorporated, and Supernus Pharmaceutical Company. SC declares honoraria and reimbursement for travel and accommodation expenses for lectures from the following non-profit associations: Association for Child and Adolescent Central Health (ACAMH), Canadian ADHD Alliance Resource (CADDRA), and British Association of Pharmacology (BAP), for educational activity on ADHD. All other authors declare no competing interests.

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The original online version of this article was revised: In the Discussion paragraph of the abstract, the sentence ‘Further research should clarify the causal relationship, if any, between ASD and problems of vision and if problems of vision during early life’. should have read ‘Further research should clarify the causal relationship, if any, between ASD and problems of vision during early life’.

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Perna, J., Bellato, A., Ganapathy, P.S. et al. Association between Autism Spectrum Disorder (ASD) and vision problems. A systematic review and meta-analysis. Mol Psychiatry 28, 5011–5023 (2023). https://doi.org/10.1038/s41380-023-02143-7

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