The Neuro-Optometric Rehabilitation Association International is an interdisciplinary group of professionals dedicated to providing patients who have physical or cognitive disabilities as a result of an acquired brain injury with a complete ocular health evaluation and optimum visual rehabilitation education and services to improve their quality of life.

BLOG: Autism and visual dysfunction

Susan Daniel
Susan L. Daniel

by Susan L. Daniel, OD

According to the National Center for Health Statistics, one in every 45 children is now diagnosed with autism, compared to about one in 500 20 years ago and one in 10,000 30 years ago, according to the CDC.

That means that optometrists increasingly have children with autism in their patient populations who could benefit from both routine and specialized vision care.

Children on the autism spectrum have a higher-than-average incidence of refractive errors (Simmons et al.) and are nearly six times more likely than neurotypical children to have strabismus (Scharre et al.). Unfortunately, they are less likely than typical children to have a vision exam. This may be due in part to the difficulty of examining a nonverbal child or one with severe autistic behaviors, or it may be that vision is perceived by families to be satisfactory – or simply less urgent than other challenges.

What is often poorly understood is that 70% to 90% of kids with autism have associated problems with visual processing. Significantly underdeveloped visual processing contributes to many other social, academic and communication problems, including some of the behaviors that we associate with autism.

A common problem, for example, is misperception of where the body is in space, or of the body’s midline. That causes posture problems and behaviors such as toe walking, spinning and discoordination. Failure to maintain eye contact — often considered a classic autism behavior — is also closely tied to visual processing. The child may have an eso- or exotropia, see double or have difficulty maintaining fixation. Failure to develop this most basic of visual skills contributes to problems with facial recognition and identification of others’ emotions.

The good news is that these visual processing problems are treatable. As a clinician who focuses my practice on patients with autism and as the mother of a 20-year-old son with autism, I have seen firsthand the dramatic improvements that can be achieved through neuro-optometric rehabilitation or, more aptly, habilitation, as we are often giving children these skills for the first time rather than restoring lost skills.

In visual rehabilitation, specialized lenses and prisms can be combined with therapy to help children reestablish perception of midline, improve convergence and fixation, and learn to process multiple types of sensory information simultaneously, which is called sensory integration (ie, being able to look and listen or look and touch simultaneously).

At a minimum, primary care optometrists should encourage families to bring children with autism in for regular eye exams, on the same schedule as typical children. Through courses offered by the Neuro-Optometric Rehabilitation Association, Optometric Extension Program Foundation and College of Optometrists in Vision Development, more clinicians can learn to help these children improve their visual processing skills, or at least learn what is possible and to whom they could be referred. Children on the spectrum have many challenges, but so very much to gain from vision rehabilitation.

For more information:

Susan L. Daniel, OD, is president of the Neuro-Optometric Rehabilitation Association and in private practice in Carlsbad, Calif. She serves as a consultant for the North Coastal Consortium for Special Education and the Tri-City Medical Center Acute Rehabilitation Services in the visual rehabilitation treatment for brain-injured patients and stroke victims.

Disclosure: Daniel reports no relevant financial disclosures.


CDC. National Health Interview Survey, National Center for Health Statistics, 2014. Updated Sept. 18, 2018. Accessed Sept. 20, 2018.

Scharre JE, et al. Optom Vis Sci 1992;69(6):433-439.

Simmons DR, et al. Vision Res 2009;doi:10.1016/j.visres.2009.08.005.