Congenital disorders
Association between Autism Spectrum Disorder (ASD) and vision problems. A systematic review and meta-analysis
Jul
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 and if problems of vision during early life.
PROSPERO registration
CRD42022328485.
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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.
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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.
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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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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 (2023). https://doi.org/10.1038/s41380-023-02143-7
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Received: 03 February 2023
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Revised: 15 May 2023
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Accepted: 16 June 2023
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Published: 26 July 2023
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DOI: https://doi.org/10.1038/s41380-023-02143-7
