Optometric and orthoptic findings in autism: A review and guidelines for working effectively with autistic adult patients during an optometric examination

Autism is a lifelong developmental condition that affects how a person communicates and interacts with people. Altered visual experiences (e.g. hypersensitivity to bright lights and patterns) are common in autistic individuals, and as around 1% of the UK population have autism, optometrists are likely to frequently encounter autistic patients in their practices. In this review, we provide the optometrist with an overview of the state of knowledge regarding optometric and orthoptic findings in autism (e.g. refractive error, visual acuity, binocular vision), together with suggestions for optimising their clinical routine with adult autistic patients. Overall, the reviewed studies indicate a higher incidence of refractive error, strabismus and amblyopia in autistic individuals compared to the incidence within the general population. However, the available studies suffer from methodological flaws including a sampling bias towards children and those autistic individuals with learning difficulties, making it difficult to generalise the findings to autistic adults without learning difficulties. In light of the potentially higher prevalence of optometric findings together with the development of programs designed to increase awareness of visual issues in autism amongst autism support practitioners, it is likely that optometrists may find larger numbers of patients with a diagnosis of autism visiting their practices. Optometrists should be careful to rule out any visual symptoms that may be due to pre-existing optometric and orthoptic conditions when testing autistic patients. They should also be aware of the importance of detecting and treating orthoptic problems as treatment can have a significant impact on the quality of life of autistic individuals. However, to achieve a successful and accurate examination, the optometrist should consider modifying aspects of their clinical routine including their approach to testing, communication and adoption of additional procedures, which can lead to more accurate examinations and optimum outcomes for autistic individuals.