Accommodative function in individuals with Autism Spectrum Disorder

Purpose: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with a reported prevalence of 1.1-1.5%. Accommodative dysfunction has been noted in other developmental conditions including cerebral palsy and Down’s syndrome. The aim of this study was to investigate how accommodative accuracy and near visual function in ASD compared to typically developing controls. Methods: Accommodative accuracy was assessed using modified Nott dynamic retinoscopy. Individual accommodative demand and response was calculated incorporating residual refractive error (difference between cycloplegic and habitual refractive state). Near visual measures included; near visual acuity (NVA), near point of convergence, fusional reserves and stereoacuity. Cycloplegic autorefraction confirmed refractive error. Results: Accommodative responses were measured from 124 participants with ASD (6-17 years) and 204 age-matched controls. There was no significant difference in the magnitude of residual refractive error between groups (p=0.10). The prevalence of a clinically significant lag of accommodation was greater in the ASD group compared to controls (ASD=17.4%, controls=4.9%, χ2=13.04, p/=+2.00D, >1.00DC), and when these were removed from analysis, there was still an increased prevalence of hypoaccommodation in ASD (14.7%). Conclusion: Children with ASD were significantly more likely to have accommodative deficits (and associated near visual deficits) in their presenting refractive state than typically developing children. Appraisal of refractive error, accommodation and near visual acuity should be considered in visual assessment of children with ASD.