title: Eye examination testability in children with autism and in typical peers.
abstract: OBJECTIVE
  To compare testability of vision and eye tests in an examination protocol of 9- to 17-year-old patients with autism spectrum disorder (ASD) to typically developing (TD) peers.
  
  
  METHODS
  In a prospective pilot study, 61 children and adolescents (34 with ASD and 27 who were TD) aged 9 to 17 years completed an eye examination protocol including tests of visual acuity, refraction, convergence (eye teaming), stereoacuity (depth perception), ocular motility, and ocular health. Patients who required new refractive correction were retested after wearing their updated spectacle prescription for 1 month. The specialized protocol incorporated visual, sensory, and communication supports. A psychologist determined group status/eligibility using DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) criteria by review of previous evaluations and parent responses on the Social Communication Questionnaire. Before the examination, parents provided information regarding patients' sex, race, ethnicity, and, for ASD patients, verbal communication level (nonverbal, uses short words, verbal). Parents indicated whether the patient wore a refractive correction, whether the patient had ever had an eye examination, and the age at the last examination. Chi-square tests compared testability results for TD and ASD groups.
  
  
  RESULTS
  Typically developing and ASD groups did not differ by age (p = 0.54), sex (p = 0.53), or ethnicity (p = 0.22). Testability was high on most tests (TD, 100%; ASD, 88 to 100%), except for intraocular pressure (IOP), which was reduced for both the ASD (71%) and the TD (89%) patients. Among ASD patients, IOP testability varied greatly with verbal communication level (p < 0.001). Although IOP measurements were completed on all verbal patients, only 37.5% of nonverbal and 44.4% of ASD patients who used short words were successful.
  
  
  CONCLUSIONS
  Patients with ASD can complete most vision and eye tests within an examination protocol. Testability of IOPs is reduced, particularly for nonverbal patients and patients who use short words to communicate.
authors.affiliation: *OD, MS, FAAO †OD, FAAO ‡OD §PsyD ∥MAS, FAAO **DrOT, OTR/L ††DPA, OTR/L ‡‡MA, CCC-SLP §§PhD ∥∥BA College of Optometry (RAC, AB, YT, GF, DA, EJ, JR, CG, IR), and College of Health Care Sciences (NQ, SD), Nova Southeastern University, Fort Lauderdale, Florida; Neurocognitive Consultants, North Miami, Florida (KKL); The Ohio State University College of Optometry, Columbus, Ohio (GLM); Soaring Eagle Academy, Burr Ridge, Illinois (MR); CasaBlanca Academy, Hollywood, Florida (JT); and Educational Specialist, Fort Lauderdale, Florida (BK).
authors.forename: Rachel Anastasia
authors.initials: RA
authors.lastname: Coulter
authors.forename: Annette
authors.initials: A
authors.lastname: Bade
authors.forename: Yin
authors.initials: Y
authors.lastname: Tea
authors.forename: Gregory
authors.initials: G
authors.lastname: Fecho
authors.forename: Deborah
authors.initials: D
authors.lastname: Amster
authors.forename: Erin
authors.initials: E
authors.lastname: Jenewein
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Rodena
authors.forename: Kara Kelley
authors.initials: KK
authors.lastname: Lyons
authors.forename: G Lynn
authors.initials: GL
authors.lastname: Mitchell
authors.forename: Nicole
authors.initials: N
authors.lastname: Quint
authors.forename: Sandra
authors.initials: S
authors.lastname: Dunbar
authors.forename: Michele
authors.initials: M
authors.lastname: Ricamato
authors.forename: Jennie
authors.initials: J
authors.lastname: Trocchio
authors.forename: Bonnie
authors.initials: B
authors.lastname: Kabat
authors.forename: Chantel
authors.initials: C
authors.lastname: Garcia
authors.forename: Irina
authors.initials: I
authors.lastname: Radik
mesh_terms: D000293:Adolescent; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000150:complications*; D003867:Depth Perception / Q000502:physiology; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D010379:Peer Group; D010808:Physical Examination; D010865:Pilot Projects; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D042262:Retinoscopy; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000175:diagnosis*; D014787:Vision Tests / Q000379:methods*; D015348:Vision, Binocular / Q000502:physiology*; D014792:Visual Acuity / Q000502:physiology