Reynolds Margaret, Faron Nicholas, Hoekel James, Tychsen Lawrence
Washington University in St. Louis John F Hardesty MD Department of Ophthalmology and Visual Sciences, Missouri, USA.
Washington University in St. Louis Department of Pediatrics, Missouri, USA.
Med Hypothesis Discov Innov Ophthalmol. 2024 Aug 14;13(2):88-95. doi: 10.51329/mehdiophthal1499. eCollection 2024 Summer.
Children with autism spectrum disorder (ASD) may have impaired vision owing to high refractive errors and aversion to spectacles or contact lenses. Visual blurring is caused by near-sighted myopia, far-sighted hyperopia, or astigmatism in one or both eyes. Refractive surgery can restore sharp vision and eliminate the need for spectacles and contact lenses. Restoration of sharp vision may improve ASD behavior. We aimed to determine the refractive outcomes in this cohort using ophthalmic measures and behavioral and school performance alterations after refractive surgery by employing parent-proxy reports.
This interventional, retrospective case series included data from 267 children with refractive errors and neurodevelopmental disorders (NDDs) diagnosed as ASD alone or NDD with ASD-like behaviors over a 15-year period. One of three refractive surgery methods was employed, with the choice of method uniquely tailored to the child's eye anatomy. Laser photorefractive keratectomy (PRK) was performed in 131 children, implantation of a phakic intraocular lens (pIOL) in 115 children, and removal of the crystalline lens and implantation of an intraocular lens (refractive lens exchange, RLE) in 21 children. All procedures were performed under brief general anesthesia, with the child returning home on the same day.
The median age at surgery was 10.9 years and the median follow-up period was 3.1 years. Pre-operative refractive errors ranged from a mean (standard deviation) +7.5 (0.09) D to -14.3 (4.8) D. Surgery corrected 87% of the children to normal focal length (± 1 D). Visual acuity improved an average of 0.6 logarithm of the minimum angle of resolution, the equivalent of 6 lines on a standard eye chart. Change in visual acuity was significant (all < 0.01) between baseline and the most recent follow-up examination in each of subgroups. Change in spherical equivalent refractive error at 3, 12, 24, 36, 60, and > 60 months post-operatively were significant (all < 0.01) between baseline and each follow-up visit in each of subgroups. Social interactions and ASD behaviors improved in 72% (192) of the treated children ( < 0.01). The incidence of sight-threatening complications was low.
Refractive surgery improves both visual function and behavior in most children with ASD and major myopia, hyperopia, or astigmatism. The PRK, pIOL, and RLE procedures appear to be effective and reasonably safe methods for improving refractive error, visual acuity, and behavior in many ametropic children with ASD and ASD-like NDDs.
自闭症谱系障碍（ASD）患儿可能因高度屈光不正以及对眼镜或隐形眼镜的厌恶而视力受损。视力模糊是由一只或两只眼睛的近视、远视或散光引起的。屈光手术可以恢复清晰视力，消除对眼镜和隐形眼镜的需求。恢复清晰视力可能会改善ASD行为。我们旨在通过家长代理报告，利用眼科测量以及屈光手术后的行为和学习成绩变化，确定该队列中的屈光结果。
这个干预性回顾性病例系列纳入了267名患有屈光不正和神经发育障碍（NDDs）的儿童的数据，这些儿童在15年期间被诊断为单纯ASD或伴有ASD样行为的NDD。采用了三种屈光手术方法之一，手术方法的选择是根据每个孩子的眼部解剖结构量身定制的。131名儿童接受了激光屈光性角膜切削术（PRK），115名儿童植入了有晶状体眼人工晶状体（pIOL），21名儿童进行了晶状体摘除并植入了人工晶状体（屈光性晶状体置换术，RLE）。所有手术均在短暂全身麻醉下进行，患儿于同日出院回家。
手术时的中位年龄为10.9岁，中位随访期为3.1年。术前屈光不正范围为平均（标准差）+7.5（0.09）D至 -14.3（4.8）D。手术使87%的儿童屈光矫正至正常焦距（±1 D）。视力平均提高了0.6最小分辨角对数，相当于标准视力表上的6行。在每个亚组中，基线与最近一次随访检查之间的视力变化均具有显著性（均<0.01）。术后3、12、24、36、60和>60个月时，每个亚组中基线与每次随访之间的等效球镜屈光不正变化均具有显著性（均<0.01）。72%（192名）接受治疗的儿童的社交互动和ASD行为得到改善（<0.01）。威胁视力并发症的发生率较低。
屈光手术可改善大多数患有ASD且伴有高度近视、远视或散光的儿童的视觉功能和行为。PRK、pIOL和RLE手术似乎是改善许多患有ASD和ASD样NDD的屈光不正儿童的屈光不正、视力和行为的有效且相对安全的方法。
