lazy eye, other eye related disturbances, theories.

that's a great list and clears things up a bit. i wonder if the Lancet has been covering this at all. thanks for the list.

TL;DR There is clearly a link between autism and eye conditions such as amblyopia (lazy eye) and strabismus (eye turn). The prevalence rates vary between studies but are significantly higher than in the general population.

My condition is a lazy right eye (amblyopia) which has an outward turn (constant strabismus - exotropia). The vision in that eye is much weaker and therefore my brain doesn't use it, unless my good left eye is covered or closed. I had surgery and patch treatment at a very early age but they failed to work and my eye problems have been lifelong.

I have been investigating this connection between autism and eye conditions further (since it was mentioned here). The actual scientific studies these claims are based upon seem few and some are quite dated. In one study the sample of autistic patients was taken from those attending an eye clinic, so the prevalence of eye conditions among them is obviously going to be high. Also some of the sites I have come across are in the business of selling vision therapy services and their claims should therefore be treated with some caution. Despite this it appears that there is very clearly a higher incidence of these conditions in the autistic population compared to the general population.

I will info dump some of the terminology first, for anyone who may be interested and is not familiar.

Amblyopia / Lazy Eye

One eye lacks a strong visual pathway to the brain, and as a result, its vision is weaker than it should be. The brain chooses to ignore the visual information coming from that eye in favour of relying solely on the stronger eye.

The main causes of amblyopia are:

Constant Strabismus / Eye Turn (sometimes known as a squint)

This is where the eyes point in different directions, due to the brain’s inability to coordinate both eyes at the same time. The main variants of this condition are:

1. Esotropia / Convergent where one eye turns inwards (commonly known as cross eyed) is the most common

2. Exotropia / Divergent where one eye turns outwards

3. Hypertropia where one eye points upwards

4. Hypotropia where one eye points downwards

Refractive is the most common form of amblyopia. It can be divided into two types:

1. 1. Isometropia is a significantly high, but equal optical prescription in both eyes.

   2. Anisometropia is a significant difference in optical prescription between the two eyes.

Ocular Obstruction such as a cataract, lid droop or blocked tear duct.

Some links to relevant articles and studies:

https://www.optometrists.org/childrens-vision/vision-therapy-for-special-needs/autism-vision/

"According to research, children with ASD present with a higher incidence of strabismus (eye turn) ranging from 21-50 percent prevalence, as compared to children without ASD."

https://myvision.org/guides/vision-problems-in-persons-with-autism/

"Amblyopia often occurs in children with autism spectrum disorder. A recent study revealed that more than half of children with autism had some form of amblyopia compared to children without autism."

https://www.spectrumnews.org/features/deep-dive/eyeing-the-connection-between-autism-and-vision/

"In a study published this month, Chang’s team reviewed the medical records of more than 10 million children and found that 13.5 percent of the autistic children have vision disorders, compared with 3.5 percent of the typical children. Children with autism are about 5 times as likely as typical children to have nystagmus, in which the eyes move rhythmically back and forth, they found, and they are 3.5 times as likely to have strabismus and 2.5 times as likely to have amblyopia."

https://autism.org/vision-problems-common-in-children-with-autism

"The researchers found that 48.4 percent of the children had refractive problems, most commonly hyperopia (farsightedness) and astigmatism (distorted vision due to alterations in the shape of the cornea or lens). Myopia (nearsightedness) was more common in children with Asperger syndrome, with nearly 18 percent of them exhibiting this problem. More than 15 percent of patients with autism or autism-related disorders exhibited strabismus, a type of eye movement disorder in which the eyes do not align properly; exotropia, or an outward turning of one or both eyes, was the most common form of strabismus seen. Optic nerve abnormalities were detected in four percent of the children, while nystagmus (rapid and uncontrolled eye movement) was seen in fewer than one percent of them."

https://modernod.com/articles/2022-may-june/what-you-need-to-know-about-autism

"Some ophthalmic disorders have been noted in higher incidence in patients with ASD. One retrospective study of charts between 1998 and 2006 looked at 154 children diagnosed with ASD who had a comprehensive eye examination found that 40% of the children had ocular pathology; 29% had significant refractive error, 21% had strabismus, and 10% had amblyopia."

"Another retrospective study reviewed 380 charts of children with ASD who had been seen for an eye examination between 2007 and 2017.2 This study found that 71% of the children had an ophthalmic diagnosis; 42% had significant refractive error, 32% had strabismus, 22% had amblyopia."

https://journals.sagepub.com/doi/10.1177/108835769901400205

"A clinical optometric examination of 34 individuals with autism, ages 7 to 19 years, found a strabismus rate of 50% (65% with exotropia and 35% with esotropia). A parent survey of 7,640 families found a reported incidence of 20% (18% in boys, 29% in girls). As strabismus occurs in only 2% to 4% of the general population, both studies reported here confirm the high rate of strabismus in autism."

https://www.medrxiv.org/content/10.1101/2021.07.13.21260452v1.full.pdf

"Strabismus, a misalignment of the eyes, is an important risk factor for amblyopia and visual impairment in the pediatric population. Several studies have reported an increased likelihood of strabismus in persons on the autism spectrum, but prevalence estimates in this group vary greatly."

"This meta-analysis found a high prevalence of strabismus in autistic individuals, with rates 3–10 times that of the general population."

"In conclusion, our meta-analysis suggests that strabismus is substantially more common in individuals on the autism spectrum than the general population, putting autistic persons at increased risk for amblyopia and other serious sequelae of this condition. The findings of this study highlight the need to screen individuals diagnosed with autism for ocular problems early in life, as early correction of strabismus may significantly decrease the incidence of amblyopia in these individuals and improve overall quality of life."

Yes, in social settings too! For example family reunion. Now I just skip it, but earlier I had no choice. And I always heard “just stop doing your weird things, behave normal “

I have something similar in public where I try to tear off my clothes and stop myself. I pull and shrug. I also have a dancing thing but that is an expression of joy at the music.

Thank you for reviving this thread. I’m also curious about co-occurring ticks. I red that children with autism often have ticks and also saw a video of an autistic boy with ticks. I had ticks since I turned 15, no vocal only physical. I was diagnosed with Tourette but later it turned out it was a wrong diagnosis. Currently ticks happen to me only if I’m highly stressed or annoyed. Then I shake my head and for this reason I also hear that I look like a freak. As I know ticks in Tourette have nothing to do with stress. In my case even a tiny chain on my neck drove me crazy. I was ticking whole day so strong that I had pain in my neck and headache and only when I took the jewellery off I realized it was the chain. No more jewellery anymore! 

Interesting, is alexythemia inability to identify my own emotions or someone else’s? In my case it took my years to identify emotions that I had as a kid and young adult. And I still struggle to identify my current emotions even if they are too strong or too many and I get somehow overwhelmed and cry, I still can’t say, why. But When someone tells me directly what they feel and their situation, I have no problem to understand and literally feel their emotions like my own. What a strange phenomenon… I also had lazy eye. And my speach development was weird. I was fully non verbal till I turned 3. One day suddenly a miracle happened- I started talking with full sentences and then I was often told that I was more mature and articulate for my age. Currently when I focus my eyes, I see super sharp and plunged, but when I’m tired I lose focus and then everything is blurry. I’m not sure if these things are related to autism or it’s just me. Maybe someone else can relate. 

it is the same for me. I had trouble with the reading as the letters forming words was puzzling. They also scramble -to this day - but just as I write. Sometimes, by hard, I still write some of them backward at first and catch it once I see the word.

Lazy eye is properly called amblyopia and is caused when each eye focusses differently, leading to the brain receiving two different images. After a while the brain shuts off one image, causing a decrease of sight in that eye.

For me it's my right eye. I didn't have a "squint" as a baby/toddler, so it wasn't picked up until I was about 5. It was too late to fully correct, so I still have poor, blurry vision from that eye. The eye is healthy, it's just the brain doesn't receive a clear picture from it.

I understand this condition is common in people on the spectrum. I've just found out about this, plus that I have two other conditions common in autistic people:

Hyperlexia - reading early and above the expected level

Alexythemia - difficulty identifying & understanding emotions

It's interesting learning these terms and what they mean.