This document is provided by the College of Optometrists in vision development.

Autism is a neurobiological disorder that is described as a behavioral syndrome. Individuals with autistic behaviors have difficulty with processing and responding to information from their senses and with communication and social interaction. Vision problems are very common in individuals with autism. Autistic behaviors may include visual components such as lack of eye contact, starring at light or spinning objects, fleeting peripheral glances, side viewing and difficulty attending visually. Other symptoms of autism include lack of reciprocal social interaction, delays in development and a hypo- or hyper-response to sensory information. Symptoms appear over time as the child shows a pattern of developmental problems.

Some persons with autism use visual information inefficiently. They have problems coordinating their central and peripheral vision. When asked to follow an object with their eyes, they usually do not look at it directly. They scan or look off to the side at the object. These individuals may have difficulty maintaining visual attention. Eye movement disorders and strabismus are also common.

Many persons with autism are tactually or visually defensive. Tactually defensive persons are over stimulated by input through touch. They are always moving and wiggling. They avoid contact with certain textures. Visually defensive persons avoid contact with specific visual input and may have hypersensitive vision. They have difficulty with visually “holding still” and frequently rely on a constant scanning of visual information in an attempt to gain meaning.

As a result of poor integration of central and peripheral visual input, individuals with autism may have difficulty processing information. Once central focus is gained, they ignore peripheral vision and remain fixated on a task for excessive periods. Since the visual system relates to motor, cognitive, speech and perceptual abilities, these areas may also be affected when the visual processing is interrupted.

The vision evaluation of persons with autism varies depending on their developmental, emotional and physical level. After a thorough patient history, a comprehensive vision examination is initiated. The examination includes, but is not limited to, an evaluation of: visual acuity, eye tracking and fixations, depth perception, color vision, eye teaming and focusing, the presence of nearsightedness, farsightedness and/or astigmatism, eye health and visual fields. Observation of postural adaptations and compensations while the patient is sitting, walking and standing with and without the lenses and prisms are often conducted.

Depending on the results of testing, lenses to compensate for nearsightedness, farsightedness and astigmatism, with or without yoked prism may be prescribed. A progress examination may be scheduled in three to five weeks to evaluate subjective changes and to repeat portions of the vision examination as needed. Vision therapy activities are used to stimulate general visual arousal, eye movement and the central visual system. The goals of the treatment program using lenses, prisms and vision therapy are to help the individual organize visual space and gain peripheral stability so that he or she can better attend to and appreciate central vision. In addition, treatment is directed at gaining efficient eye teaming and visual information processing.

Treatment programs are coordinated with the patient’s primary care physician and others who may be participating in the multi-disciplinary management of the patient.