Journal of pediatric ophthalmology and strabismus · 2026
A Systematic Analysis of Amblyopia and Strabismus in Children With Autism Spectrum Disorder Across Tertiary Referral Centers in the United States.
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Goetz Julia, Onwuka Oluchukwu, Moon Jee-Young, Shrivastava Anurag, Park Sunju, SOURCE Consortium
Аннотация
PURPOSE: To evaluate the prevalence of amblyopia and/or strabismus in children with autism spectrum disorder (ASD) in tertiary referral centers across the United States and rates of surgical management of strabismus.
METHODS: A systematic analysis of pediatric patients diagnosed as having ASD was performed using the Sight Outcomes Research Collaborative (SOURCE) database. Prevalence, odds ratios, and the rate of surgical management for strabismus were determined compared to age-matched controls.
RESULTS: Strabismus and/or amblyopia was present in 35% of patients with ASD and 29% of age-matched controls (odds ratio = 1.33, 95% CI = 1.254 to 1.415, P < .001). Exotropia was more common than esotropia in both the ASD and control groups. The mean age at first ophthalmologic evaluation was 5.2 years for both controls and patients with ASD and strabismus/amblyopia. However, among those without strabismus/amblyopia, patients with ASD were evaluated earlier (mean ± standard deviation [SD] = 6.7 ± 4.8 years) compared to controls (mean ± SD = 7.4 ± 5.8 years). Although the ASD population had a male predominance, females had higher rates of amblyopia and/or strabismus at 39% compared to males with ASD at 34%. In all age groups, children with ASD had significantly (P < .001) higher rates of amblyopia and/or strabismus when compared to controls. The analysis found children with ASD have a higher prevalence of strabismus and/or amblyopia, with an increasing rate of diagnosis over the past two decades.
CONCLUSIONS: Findings support further research into both the underlying mechanisms of strabismus in neurodivergent children and overall trends in the diagnosis of ASD and concomitant ophthalmic disease.
METHODS: A systematic analysis of pediatric patients diagnosed as having ASD was performed using the Sight Outcomes Research Collaborative (SOURCE) database. Prevalence, odds ratios, and the rate of surgical management for strabismus were determined compared to age-matched controls.
RESULTS: Strabismus and/or amblyopia was present in 35% of patients with ASD and 29% of age-matched controls (odds ratio = 1.33, 95% CI = 1.254 to 1.415, P < .001). Exotropia was more common than esotropia in both the ASD and control groups. The mean age at first ophthalmologic evaluation was 5.2 years for both controls and patients with ASD and strabismus/amblyopia. However, among those without strabismus/amblyopia, patients with ASD were evaluated earlier (mean ± standard deviation [SD] = 6.7 ± 4.8 years) compared to controls (mean ± SD = 7.4 ± 5.8 years). Although the ASD population had a male predominance, females had higher rates of amblyopia and/or strabismus at 39% compared to males with ASD at 34%. In all age groups, children with ASD had significantly (P < .001) higher rates of amblyopia and/or strabismus when compared to controls. The analysis found children with ASD have a higher prevalence of strabismus and/or amblyopia, with an increasing rate of diagnosis over the past two decades.
CONCLUSIONS: Findings support further research into both the underlying mechanisms of strabismus in neurodivergent children and overall trends in the diagnosis of ASD and concomitant ophthalmic disease.