Autism, Vision and Visual Problems

As we all know, emotions, feelings, and senses are very important to understand, receive, and respond to individuals with autism. They have difficulties in processing and responding. More than that, when it comes to senses, visual problems are very common among those individuals.

Even though autism seems only social functioning disorder, there may some physical abnormalities exist. All diagnostic criterion of autism looks far removed from vision. On the other hand, it is possible to exhibit some visual abnormalities. But, in the field, researchers don’t give enough importance to this visual related problems. There is a need for studying visual functions in autism. Because of the fact that, even if it doesn’t affect autism directly, those problems could be the reason or result of underlying neural abnormalities.

Children with autism or on the autism spectrum may experience refractive errors, accommodation disorders, binocular vision disorders, and eye movement disorders. In addition to these, the perception of the visual behaviors resulting from the translation of visual perception and visual information coming to the primary vision center led to the need to evaluate these children together with pediatric psychologists and ophthalmologists specialized in the subject.

According to published studies, many individuals on the spectrum could have specific eye and vision problems. These problems include crossed eyes, lazy eye, etc. As we mentioned above, it is a very controversial topic in the field of autism. While some researchers claim that they have superior vision, others claim the opposite. And, researches have been conducted until now mostly focused on visual sharpness. It has to be known and investigated what kind of visual problems they have, what the frequency is, and whether there is a relation between those problems and autism or not.

There is a new study related to this topic which is a vision of individuals with autism. It is a relatively new study. Researchers took into consideration the medical charts of children on the spectrum who go to see ophthalmologists on a regular basis. They had 44 children which consist of 18 have strabismus (crossed eyes) with 4 requiring surgery, 5 children have amblyopia (lazy eye), and 3 have anisometropia (two eyes have different acuities).

The study is limited. The sample is not representative which means we cannot generalize to the whole population. Still, the prevalence of these eye problems in autism appears to be several times higher than that of the general population, they note. In addition to that information, the findings support those from a study published before. In that study, a team from Saint Louis University reported that 40 percent of children with autism spectrum disorder and related disorders have some kind of eye problem. The researchers recommended comprehensive eye exams for all children with the disorder.

Visual impairments might provide a causal account of some salient aspects of the autism phenotype is not entirely compelling. However, it is believed that it is potentially even more interesting and far-reaching topic to investigate. Abnormalities of vision associated with autism may not be the causes of the hallmark characteristics of the condition, but rather may be manifestations of more general underlying neural abnormalities.

From this perspective, it is possible to say that visual disorders are not one of the main features of autism. However, it creates a gateway to approach key features. For example, an individual with autism may have trouble seeing distant distance. This may be the result of mutations that cause autism in their brains. These mutations may also have affected the visual nervous system. Vision is simply a domain in which general underlying impairments become manifest.

On the other hand, as a result of researches related to visual fields, researchers used many different ways. These are classified as low-level, mid-level, and high-level. Low level, sharpness, and contrast; mid-level, visual search; and high levels include face and object recognition with higher social skills.

Symptoms of vision problems that individuals with autism often have can be masked. Because the behaviors they use to deal with the overload of the world around them can cause this. There are some features that belong to both autism and visual impairments. For example, lack of eye contact, looking at rotating objects, fixation to light, lateral view, etc. can be counted from these features.

People with autism may also have trouble coordinating their central and peripheral views. For example, when asked to follow an object with their eyes, they usually do not look directly at the object. Instead, they will scan or look over the side of the object. In addition, many people with autism are visually defensive, meaning they avoid contact with visual inputs and may have an overly sensitive vision. They have difficulty visually standing still, they constantly scan around with their eyes, and they often want their visual information to be renewed so that the world around them becomes meaningful.

In one study, it was stated that the ophthalmologist and psychiatrist are very important in terms of analyzing the visual behaviors in autism spectrum disorder and making the diagnosis better. Autism spectrum disorder and visional disorders are both clinical manifestations of brain disorders. Often, these children also have two clinical entities. Therefore, educational and social studies, rehabilitation will be shaped accordingly and much more beneficial results will be obtained.

After ignoring these new developments, unfortunately, many young children between 1-3 years of age who come to the hospital with premature or brain pathology may have eye disorders with or without an autism diagnosis. In many children who do not make eye contact and who are not interested in their physical environment, we can see that eye contact occurs immediately when they are given close eyeglasses appropriate to their visual sphere and age.

The possibility of an eye disorder in children with autism should also be considered. For this purpose, the routine clinical eye examination performed by each ophthalmologist does not give an idea about what the child sees and how. What needs to be done is functional vision examination and interdisciplinary study and evaluation of the child.

For example, in the case of a bilateral striated cortex, children look at people and drawings first, then turn their heads. This is a behavior both in children with autism and in children only with eye disorders. Children with eye disorders cannot use vision in crowded environments. Therefore, as with autism spectrum disorder, there is no pointing with fingers.

In children with ASD and visual impairment, there are difficulties in recognizing facial recognition, remembering people, and detecting facial expressions. A child’s functional vision assessment should be performed before diagnosing that this is due to autism. Visual functions should be evaluated in terms of face recognition. Without doing these, we cannot decide on visual acuity and visual recognition of the child’s faces by routine clinical examination.

  • Visual acuity, shortsighted and longsighted
  • Contrast vision evaluation
  • Follow-up movements of the eye
  • Motion perception
  • Answer the question as to whether it can detect and mimic
  • Visual field
  • Fixation skills
  • Face recognition and pairing
  • Front and back current functions

Super Vision (Eagle-Eyed Vision)

Temple Grandin is a very important person in the field of autism. She, herself was on the spectrum as well as a researcher. She also contributed visual problems in autism. It all started when she started researching animal behavior. First, she noticed that cattle are often frightened by the trivial visual details they see.

Grandin made some deductions on this subject by starting from herself. She says she always has an extraordinary vision but never really thinks of anything. For example, she says that when she sits in a desk in the classroom, she usually examines scratches on the desks, flying dust, lines on the teacher’s face. Even more, when driving at night, she sometimes forgets to turn on the headlights because she sees everything so clearly.

This ‘eagle-eyed’ vision, characteristic of many people on the autism spectrum, stems at least in part from abnormal variations in the early stages of visual processing. When individuals with autism look at simple line diagrams, they occur in a shorter time than the interaction of their peers’ brains, who have successfully completed the development of interaction in their brains. In addition, adults with high-functioning autism score twice as high in standard visual acuity tests. That is, the ability to decode fine details in an image is greater.

Let’s say, a person with autism walks into a room, the first thing they see is a stain on the coffee table, dust on the air, a scratch on the couch, and the brand of the furniture which is written very small. It means that people with autism have a tendency to focus more on local and tiny details.

Previous studies on visual perception in autism have focused on ‘higher level’ visual perception. In other words, the focus is on individuals who use visual information to solve relatively complex cognitive tasks. There is a greater need for researches where low levels of visual processing are measured. The subsequent findings should be integrated with studies on higher visual processing levels.

In the human brain, rays of light go through a biological journey before our brains turn them into something meaningful. There are many different stops on this trip. Some problems that occur during this trip lead to visual impairments, visual and vision problems.

In eye examinations, a ‘block design’ test is applied to the patients. This test contains three-dimensional blocks with different edges to match a drawing. According to these test results, people with autism perform better. According to some researchers, people on the spectrum might have enhanced visual acuity because of densely packed photoreceptor cells in their retinas. But, on the other hand, others are skeptical about it.

Vision Testing for People with Autism

Just like methods for evaluating everything about the people on the spectrum, methods for evaluating the vision varies depending on the person. Because, as the name implied, autism is a spectrum disorder and, everyone and everything is different from one person to another. Their levels of emotion and physical development differ greatly. Visual testing is done while the individual performing specific tasks while wearing special lenses. 

A comprehensive examination should be identified. After this examination, it is determined whether there are vision problems and then treatment can start according to those problems. The goal of treatment should be to assist the individual with autism in ways that do not bother him. For example;

  • Organizing visual space
  • Gaining peripheral stability: Peripheral stability gives us information about the relationship with the environment. It helps us understand where we are based on the location of people, places and things in our immediate surroundings. It can provide important information about how these can affect us. It provides accurate information about size, shape, and direction of movement when working comfortably and effectively.
  • Attending to and appreciate central vision: The central view allows us to see the details sharply when we focus on anything. It also makes it easier for us to make some important judgments. For example, to predict the remaining distance on the road ahead, to understand the details.
  • Gaining more efficient eye coordination
  • Improving visual information processing: Visual information processing is the ability to interpret what is seen. It is a vision that directs action. Good visual information processing means being able to quickly and accurately process and analyze what is being seen, and store it in visual memory for later recall

Achieving the goals mentioned above is much more important for individuals in the autism spectrum. Life outside becomes more challenging for them due to visual impairments when it is already difficult enough for them. Therefore, reducing the visual stimuli that overwhelm them can enable them to communicate more comfortably with the world around them. Although it is not a 100% success, it helps at least.

Depending on the results of their visual examination, lenses can be prescribed or vision therapy activities may be recommended. You don’t need to worry about it because many doctors are experienced in examining and treating both patients with autism and individuals who are developmentally delayed or nonverbal. In the end, it is their jobs and they know how to deal with them.

Individuals with Asperger syndrome perform at the same level as controls do on tests of visual ability. This result adds to growing evidence against the claim that individuals with autism spectrum disorder have an eagle-eyed vision. Individuals with autism perceive visual details differently than controls do, often focusing on details at the expense of the big picture. For example, according to a study individuals on the spectrum are better than controls at detecting fine symmetry within complex patterns.

In another small study, researchers asked participants to locate a gap in a circular ring that progressively shrinks in size and concluded that people with autism literally have an eagle-eyed vision. There was a small controversial in that study which was it met with serious criticism of its methodology. For instance, the researcher who designed the test later reported that the participants were seated too close to the screen for the results in order to be valid.

And later, another study was published in order to correct that methodology, to correct those errors. This study reported that the visual skills of 34 individuals with autism are the same as that of 26 controls and 16 individuals with schizophrenia.

Lastly, researchers used a more traditional eye-chart test in order to measure the vision of 24 individuals with Asperger syndrome and 25 controls. The researchers first confirmed that all the participants have the same language and reading skills before giving them the test. According to results, the individuals with autism and controls on the average score the same on the eye test. None of the participants have visual abilities beyond the normally accepted range of human perception. Differences in perception between individuals with autism and individuals as a control group may be based on which details in a scene they attend to, and not on their fundamental visual skills, the researchers suggest.

Visual Skills Superior in Autism

As we mentioned earlier, individuals with autism are more successful in focusing on details. In addition to being good at small details, they can effectively detect large models. According to research, they are also very successful in detecting symmetry patterns.

People with autism also process visual information, just like people who complete their development normally. Our only difference is that they have difficulty recognizing familiar faces and interpreting facial expressions correctly. They can be superior to us in their non-social visual processing skills. They can have both strengths and weaknesses in visual operation. This may be related to the underlying genetic deficiencies.

Individuals with autism may be better at recognizing certain patterns and certain designs. This is easier for them, especially if those patterns consist of horizontal and diagonal symmetry lines. They process visual information differently from us. They have better visual acuity which means clearness of vision. On the other hand, it was found that their performance on higher-order processing tasks, such as face recognition, is impaired. Because there are social cues involved.

If you remember, one of the diagnostic criteria of autism is to focus on an object. So we can say that individuals with autism can look at objects for a very long time, even without blinking. This can be an example of their superior visual performance. However, focusing on this object for a long time can vary from object to object, from place to place, from time to time, and even to the individual’s current state. In other words, researchers have two different views on this subject. While one side argues that there is a visual problem, the other side argues that it is about sociability.

There are studies claiming that individuals with autism generally have superior visual processing. The problem with these studies is that measurement is done using non-social tasks. Individuals with autism can better visualize objects rotating in space but have difficulty understanding the emotion of the person facing him by looking at him. In addition, noticing tiny changes in the environment immediately doesn’t mean that they have a high-level vision. It is something completely related to autism itself.

Visual Problems in People with Rett Syndrome

Rett Syndrome is one of the disorders on the autism spectrum. It is a complex neurological disorder that occurs only in girls and affects them all their lives. These people are extremely disabled and versatile. It depends on others to meet all their requirements.

There is mostly a gradual decline in vision and too much inhibitory signaling in the visual cortex in people with Rett Syndrome. This abnormality in the visual area of the brain could be one of the first steps in a developmental cascade in people with Rett syndrome. But, in general, their abnormalities and retardedness start suddenly, without any obvious reason. If you ask parents of children with Rett Syndrome, they would say that their children develop seemingly normally until some point, and then they suddenly diverge.

On the other hand, still, there is no study has ever reported visual problems in people with Rett syndrome. Visual problems on people on the spectrum are always needed to investigate more. Sights, sounds, and sensations are essential for shaping the circuits of the developing brain. Beginning at birth, there are windows of time in which certain regions of the brain are ‘plastic,’ or extremely sensitive to sensory inputs. Once these so-called critical periods end, the circuits become stable and, by and large, inflexible.

More than a decade ago it was shown that critical periods are activated by gamma-aminobutyric acid, or GABA, a chemical messenger that dampens electrical signals in the brain. It was very low early in life and came on at different times in different brain regions. For example, the critical period of the primary cortex, where light signals are initially processed, occurs before that of regions needed for more complex processing in later stages.

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