Correcting ophthalmic problems in autism

'Does Correction of Strabismus Improve Quality of Life in Children with Autism Spectrum Disorder?' went the title of the paper by Pinar Ozer and colleagues [1]. Yes, it may very well do was the answer (but with certain caveats and the requirement for a lot more research in this area).

Strabismus, a condition where the eyes don't line up in the same direction, can sometime have some quite noticeable effects on a person's vision and indeed, has been linked to various other non-vision related symptoms and outcomes.

Ozer et al looked to identify "the impact of optical or surgical correction of the strabismus on the child using a questionnaire for parents." The published research of this team has been previously discussed on this blog (see here) with ophthalmic findings in mind, and the requirement for quite a few more resources to be put into eye examinations when autism is diagnosed (see here). This time around they were discussing what happens when such eye issues are resolved.

I'm not completely convinced that the Ozer findings this time around reporting 'significant improvements' in areas of "psychosocial interactions" is as it stands, a methodologically firm finding just pertinent to autism. Although no expert on strabismus, from what I gather, the 'cosmetic' side of the condition can have some far-reaching effects on 'psychosocial' functions. I daresay that such effects would be just as prevalent in autism as they are in the general population and hence, correction would likely have similar outcomes.

I am more open to the idea that if strabismus is affecting vision, as in causing something like blurred or double vision, correction of the issue may in some cases have some important 'effects' in relation to autism. Accepting that structural issues with the eye are not necessarily the same as or causative of visual perceptual issues that seem to crop up quite often in the autism research arena, it is not outside the realms of possibility that something like strabismus could be part and parcel of visual effects for some people.

I suppose to reiterate, screening for structural eye/vision issues when it comes to autism remains a pretty important area.

To close, karate gradings for one of my brood today and this is what they will be attempting...

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[1] Ozer PA. et al. Does Correction of Strabismus Improve Quality of Life in Children with Autism Spectrum Disorder: Results of a Parent Survey by Ophthalmologists. Semin Ophthalmol. 2016 Sep 6:1-6.

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Ozer PA, Kabatas EU, Bicer BK, Bodur S, & Kurtul BE (2016). Does Correction of Strabismus Improve Quality of Life in Children with Autism Spectrum Disorder: Results of a Parent Survey by Ophthalmologists. Seminars in ophthalmology, 1-6 PMID: 27599387

Autism: visual stress and coloured overlays?

The small study from Amanda Ludlow & Arnold Wilkins [1] is introduced for your reading pleasure today and the idea that "atypical sensory behaviours and symptoms of visual stress" were not uncommon features when it came to a diagnosis of autism and/or Tourette's syndrome (TS). As per that opening sentence, this was a small study - 12 children with autism, 12 children with TS and 12 controls - but that doesn't mean that the results might not be important...

So far you might be slightly underwhelmed by the idea that sensory issues (and onwards linked behaviours) might be over-represented when it comes to autism given what has already been talked about for quite a few years. But... following the introduction of a colour overlay (a coloured plastic sheet placed over text) supposedly thought to reduce visual stress, for at least for some children with autism there seemed to be some potential effects noted: "Four of the 12 children with ASD [autism spectrum disorder] and none of the control children read over 15% more quickly with an overlay." The test by the way, used to assess reading performance was the Wilkins Rate of Reading Test designed by one of the authors.

I'm interested in these findings. In one of the earliest posts on this blog, I discussed the idea that visual perceptual issues accompanying a diagnosis of autism might, to some extent, be 'countered' via the use of coloured overlays or tinted glasses (sometimes called Irlen lenses) (see here). Alongside a few quite well-known people on the autism spectrum using such visual aids, there is quite an appetite for this type of approach here in Blighty as for example, per the writings and practice of people such as Ian Jordan. Accepting that the plural of anecdote is not data, I've seen Ian talk about his work, and some of the case studies are really rather interesting including the possibility of a link between vision and coordination.

A quick scan of the other peer-reviewed literature in this area suggests that Ludlow & Arnold are no strangers to this potentially important area of autism research although quite a bit more needs to be done with regards to effectiveness and perhaps identify those potential 'best responders' to this type of approach. I might also suggest that said investigations might also benefit from some good old-fashioned ophthalmic inquiry too given what is starting to be understood about eye pathology and autism (see here).

I appreciate that talk of Irlen lenses and coloured overlays may not be everyone's cup of tea in light of the various 'discussions' these interventions have had when it comes to the diagnosis of dyslexia down the years. Yes, science definitely needs to come before any big claims are made or marketed. But the idea that sensory issues might be a rather common occurrence in relation to autism and that vision in particular might be an important source of those sensory issues reported perhaps means that this research avenue should be more thoroughly explored given that there may be something that can be done to alleviate visual stress as and when it does occur.

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[1] Ludlow AK. & Wilkins AJ. Atypical Sensory behaviours in children with Tourette's Syndrome and in children with Autism Spectrum Disorders. Res Dev Disabil. 2016 Jun 7;56:108-116.

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Ludlow AK, & Wilkins AJ (2016). Atypical Sensory behaviours in children with Tourette's Syndrome and in children with Autism Spectrum Disorders. Research in developmental disabilities, 56, 108-116 PMID: 27286465