Functional and cognitive vision assessment in children with autism spectrum disorder

Purpose To assess functional vision in children with autism spectrum disorder (ASD) with a cognitive visual function battery in addition to standard ophthalmic examinations. Methods Subjects were recruited from a school for children with ASD. In addition to a comprehensive ophthalmic examination, all children underwent cognitive vision assessment at a tertiary ophthalmological care center in India. Results A total of 30 children were included. The distribution of the number of children with mild to moderate versus severe ASD was nearly equal based on CARS autism scores. The majority of subjects had normal color vision (16/18), contrast (24), shape discrimination (26), and perception of directionality (28). Most were not able to identify optical illusions or differentiate tests of emotions. Ocular pursuits, saccades, and recognition of size differences were often abnormal. Poor visual closure was noted in (11) subjects. The duration of fixation to Heidi face target was inversely proportional to the severity of ASD. The study further established that cognitive visual impairment was present in children with ASD irrespective of their severity of ASD. Conclusions All subjects had some form of cognitive visual impairment independent of ASD severity.