Anketell Pamela M, Saunders Kathryn J, Gallagher Stephen M, Bailey Clare, Little Julie-Anne
Orthoptic Department, Belfast Health & Social Care Trust, Royal Victoria Hospital Belfast, United Kingdom.
Optometry & Vision Science Research Group, Biomedical Sciences Research Institute, Ulster University, Coleraine United Kingdom.
Optom Vis Sci. 2018 Mar;95(3):193-201. doi: 10.1097/OPX.0000000000001190.
Accommodative responses were significantly poorer in individuals with autism spectrum disorder (ASD) compared with age-matched typically developing control subjects, and hypoaccommodation was associated with reduced near visual acuity (NVA) and convergence.
Autism spectrum disorder is a neurodevelopmental disorder with a reported prevalence of 1.1 to 1.5%. Accommodative dysfunction has been noted in other developmental conditions including cerebral palsy and Down syndrome. The aim of this study was to investigate how accommodative accuracy and near visual function in ASD compared with typically developing control subjects.
This study investigated accommodative function in children with ASD, in conjunction with other vision measures with habitual refractive corrections. Accommodative accuracy was assessed using modified Nott dynamic retinoscopy. Individual accommodative demand and response were calculated incorporating residual refractive error (difference between cycloplegic and habitual refractive state). Near visual measures included NVA, near point of convergence, fusional reserves, and stereoacuity. Cycloplegic autorefraction confirmed refractive error.
Accommodative responses were measured from 124 participants with ASD (6 to 17 years old) and 204 age-matched control subjects. There was no significant difference in the magnitude of residual refractive error between groups (P = .10). The prevalence of a clinically significant lag of accommodation was greater in the ASD group compared with control subjects (ASD = 17.4%, control subjects = 4.9%, χ = 13.04, P < .0001). Near visual acuity was significantly reduced in the ASD group with a clinically significant lag of accommodation (P < .01). A few participants (n = 24 control subjects, n = 14 ASD) had uncorrected or undercorrected refractive errors (spherical equivalent refractive error ≥+2.00 D, >1.00 DC), and when these were removed from analysis, there was still an increased prevalence of hypoaccommodation in ASD (14.7%).
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 NVA should be considered in visual assessment of children with ASD.
与年龄匹配的正常发育对照受试者相比，自闭症谱系障碍（ASD）患者的调节反应明显较差，且调节不足与近视力（NVA）下降和集合功能降低有关。
自闭症谱系障碍是一种神经发育障碍，报告患病率为1.1%至1.5%。在包括脑瘫和唐氏综合征在内的其他发育状况中已注意到调节功能障碍。本研究的目的是调查与正常发育的对照受试者相比，ASD患者的调节准确性和近视力功能如何。
本研究结合其他视力测量方法和习惯性屈光矫正，对ASD儿童的调节功能进行了调查。使用改良的诺特动态检影法评估调节准确性。结合残余屈光不正（睫状肌麻痹和习惯性屈光状态之间的差异）计算个体调节需求和反应。近视力测量包括NVA、集合近点、融合储备和立体视锐度。睫状肌麻痹验光确定屈光不正。
对124名ASD患者（6至17岁）和204名年龄匹配的对照受试者测量了调节反应。两组之间残余屈光不正的程度无显著差异（P = 0.10）。与对照受试者相比，ASD组中临床上显著的调节滞后患病率更高（ASD = 17.4%，对照受试者 = 4.9%，χ = 13.04，P < 0.0001）。ASD组中存在临床上显著调节滞后的患者近视力显著降低（P < 0.01）。少数参与者（24名对照受试者，14名ASD患者）有未矫正或矫正不足的屈光不正（球镜等效屈光不正≥+2.00 D，>1.00 DC），当将这些患者排除在分析之外时，ASD中调节不足的患病率仍然增加（14.7%）。
与正常发育的儿童相比，ASD儿童在其当前屈光状态下更有可能出现调节缺陷（以及相关的近视力缺陷）。在对ASD儿童进行视力评估时，应考虑对屈光不正、调节和NVA进行评估。
