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Refractive Status and Amblyopia Risk Factors in Chinese Children with Autism Spectrum Disorder

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Title: Refractive Status and Amblyopia Risk Factors in Chinese Children with Autism Spectrum Disorder
Language: English
Authors: Wang, Jiaxing, Ding, Gang, Li, Ying, Hua, Ning, Wei, Nan, Qi, Xiaoli, Ning, Yuxian, Zhang, Ying, Li, Xue, Li, Jing, Song, Linlin, Qian, Xuehan
Source: Journal of Autism and Developmental Disorders. May 2018 48(5):1530-1536.
Availability: Springer. 233 Spring Street, New York, NY 10013. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-348-4505; e-mail: service-ny@springer.com; Web site: http://www.springerlink.com
Peer Reviewed: Y
Page Count: 7
Publication Date: 2018
Document Type: Journal Articles
Reports - Research
Descriptors: Autism, Pervasive Developmental Disorders, Foreign Countries, Children, Disability Identification, At Risk Persons, Visual Impairments, Comparative Analysis, Ophthalmology
Geographic Terms: China
DOI: 10.1007/s10803-017-3387-7
ISSN: 0162-3257
Abstract: Amblyopia risk factors in children with autism spectrum disorders (ASD) are usually hard to detect in early childhood due to poor cooperation and has not been reported in the Chinese population. We screened 168 Chinese children with ASD, aged between 3 and 8 years, and 264 age-matched neurotypical children with Spot photoscreener and basic ophthalmologic examinations. Children with ASD were found to have normal refractive status but significantly higher incidence of strabismus (16.1%), compared with control children (1.5%) (p < 0.01). Most of the cases of strabismus found in children with ASD were classified as esodeviation. Strabismus in children with ASD should be considered more seriously as an amblyopia risk factor by ophthalmologists and other healthcare professionals.
Abstractor: As Provided
Number of References: 36
Entry Date: 2018
Accession Number: EJ1175273
Database: ERIC
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  Value: &lt;anid&gt;AN0128946076;aut01may.18;2018Apr10.10:10;v2.2.500&lt;/anid&gt; &lt;title id=&quot;AN0128946076-1&quot;&gt;Refractive Status and Amblyopia Risk Factors in Chinese Children with Autism Spectrum Disorder&#160;&lt;/title&gt; &lt;p&gt;Amblyopia risk factors in children with autism spectrum disorders (ASD) are usually hard to detect in early childhood due to poor cooperation and has not been reported in the Chinese population. We screened 168 Chinese children with ASD, aged between 3 and 8&#160;years, and 264 age-matched neurotypical children with Spot photoscreener and basic ophthalmologic examinations. Children with ASD were found to have normal refractive status but significantly higher incidence of strabismus (16.1%), compared with control children (1.5%) (&amp;lt;italic&amp;gt;p&amp;lt;/italic&amp;gt; &amp;lt; 0.01). Most of the cases of strabismus found in children with ASD were classified as esodeviation. Strabismus in children with ASD should be considered more seriously as an amblyopia risk factor by ophthalmologists and other healthcare professionals.&lt;/p&gt; &lt;p&gt;Autism; Children; Amblyopia; Risk factor; Refractive status; Strabismus&lt;/p&gt; &lt;hd id=&quot;AN0128946076-2&quot;&gt;Introduction&lt;/hd&gt; &lt;p&gt;Autism spectrum disorders (ASDs) are a set of neurodevelopmental disorder characterized by impairment of socialization, communication, and behavior that usually begins in infancy or toddlerhood (Barbaro and Dissanayake [&lt;reflink idref=&quot;bib6&quot; id=&quot;ref1&quot;&gt;6&lt;/reflink&gt;] ). Visual perception features including reduced eye contact and a tendency to focus more on small items have been well recognized as characteristics of ASD (Mottron et al. [&lt;reflink idref=&quot;bib27&quot; id=&quot;ref2&quot;&gt;27&lt;/reflink&gt;] ; Elst et al. [&lt;reflink idref=&quot;bib34&quot; id=&quot;ref3&quot;&gt;34&lt;/reflink&gt;] ). There has been debate about whether the children with ASD has normal visual development (Anketell et al. [&lt;reflink idref=&quot;bib3&quot; id=&quot;ref4&quot;&gt;3&lt;/reflink&gt;] ; Milne et al. [&lt;reflink idref=&quot;bib26&quot; id=&quot;ref5&quot;&gt;26&lt;/reflink&gt;] ) or more ophthalmologic abnormalities, including significant refractive errors, strabismus, reduced convergence and amblyopia (Ikeda et al. [&lt;reflink idref=&quot;bib21&quot; id=&quot;ref6&quot;&gt;21&lt;/reflink&gt;] ; Kabatas et al. [&lt;reflink idref=&quot;bib23&quot; id=&quot;ref7&quot;&gt;23&lt;/reflink&gt;] ; Black et al. [&lt;reflink idref=&quot;bib7&quot; id=&quot;ref8&quot;&gt;7&lt;/reflink&gt;] ; Trachtman [&lt;reflink idref=&quot;bib36&quot; id=&quot;ref9&quot;&gt;36&lt;/reflink&gt;] ; Ezegwui et al. [&lt;reflink idref=&quot;bib13&quot; id=&quot;ref10&quot;&gt;13&lt;/reflink&gt;] ). Amblyopia is a permanent visual impairment developed from Ophthalmic abnormalities in early childhood (3-8&#160;years), such as refractive errors and strabismus. Early diagnosis and intervention is the key to the prevention of amblyopia and saves vision. Children with ASD usually struggle to cooperate during ophthalmic examinations, which makes the detection of amblyopia risk factors (ARFs) in early ages a big challenge. So far, very limited data can be found in the literature reporting the ARFs in children with ASD at early ages.&lt;/p&gt; &lt;p&gt;Instrument-based photoscreening is a quick process that has been widely used for vision screening (Donahue et al. [&lt;reflink idref=&quot;bib12&quot; id=&quot;ref11&quot;&gt;12&lt;/reflink&gt;] ; Force [&lt;reflink idref=&quot;bib14&quot; id=&quot;ref12&quot;&gt;14&lt;/reflink&gt;] ). Minimal requirement of cooperation has made it a useful tool for children, especially for children with developmental disorders such as ASD (Singman et al. [&lt;reflink idref=&quot;bib33&quot; id=&quot;ref13&quot;&gt;33&lt;/reflink&gt;] ). Spot is a newly developed portable hand-held infrared photoscreener (Welch Allyn, Skaneateles Falls, NY). By simply asking the subjects to look at the instrument, images of the red reflex can be acquired by the device and noncycloplegic refractive status, pupil size and gaze deviation are automatically calculated. Information about refractive error, anisometropia and strabismus can be used for detecting ARFs with a reasonably high sensitivity and specificity (Peterseim et al. [&lt;reflink idref=&quot;bib30&quot; id=&quot;ref14&quot;&gt;30&lt;/reflink&gt;] ; Garry and Donahue [&lt;reflink idref=&quot;bib17&quot; id=&quot;ref15&quot;&gt;17&lt;/reflink&gt;] ; Silbert and Matta [&lt;reflink idref=&quot;bib32&quot; id=&quot;ref16&quot;&gt;32&lt;/reflink&gt;] ). In previous work from our group, this device was proven to have a high sensitivity and specificity in detecting childhood ARFs in the Chinese population (Mu et al. [&lt;reflink idref=&quot;bib28&quot; id=&quot;ref17&quot;&gt;28&lt;/reflink&gt;] ).&lt;/p&gt; &lt;p&gt;In this study, we performed vision screening on 3- to 8-years-old children with ASD and age-matched neurotypical controls in a Chinese population using Spot photoscreener. Ophthalmic findings including refractive errors and strabismus are reported. ARFs are evaluated based on the AAPOS 2013 guidelines (Donahue et al. [&lt;reflink idref=&quot;bib11&quot; id=&quot;ref18&quot;&gt;11&lt;/reflink&gt;] ).&lt;/p&gt; &lt;hd id=&quot;AN0128946076-3&quot;&gt;Methods&lt;/hd&gt; &lt;p&gt;The study was approved by the Ethics Board of (Unit not shown for the reason of blind review). Written informed parental consent was obtained prior to the start of the study from all participants according to the Declaration of Helsinki. All questions and concerns were addressed before the consent forms were signed.&lt;/p&gt; &lt;p&gt;Children with ASD from six special schools and control children from two schools were screened using Spot photoscreener. The special schools are exclusively for children with ASDs. The diagnosis of ASD was made by qualified pediatrician from children’s hospital according to the DSM-5 Diagnostic Criteria. The Spot photoscreener test was conducted by nonspecialist trained staff who attempted to obtain results from each child in three trials or fewer. Spot gives recommendations of “refer” (complete eye exam recommended) or ‘‘pass’’ (all measurements in range) according to manufacturer criteria. Children from ages 3 to 8&#160;years old were recruited in this study. All subjects were first examined by photoscreening with Spot, performed at a distance of 1&#160;m from the child. Since the measurement range is +/− 7.50 D, any reads out of the range would be displayed and recorded as &amp;gt; 7.50 or &amp;lt; − 7.50 (Mu et al. [&lt;reflink idref=&quot;bib28&quot; id=&quot;ref19&quot;&gt;28&lt;/reflink&gt;] ). Basic ophthalmic examinations including pupil reflex and eye movement were then performed by a pediatric ophthalmology specialist. Children with optical deprivation, such as obvious cataracts or ptosis, were excluded from this study. If a “refer” was given on strabismus by the screening, a cover-uncover test was performed to confirm the deviation. Subjects with unconfirmed strabismus were excluded from this study.&lt;/p&gt; &lt;p&gt;Diopter sphere (DS) and diopter cylinder (DC) were recorded and analyzed. Spherical equivalent (SE) and vector presentation of astigmatism, expressed as J0 and J45, were calculated according to the following formulas: SE = S + C/2; J0 = (− C/2) &#215; cos(2 &#215; θ); J45 = (− C/2) &#215; sin(2 &#215; θ). Anisometropia was calculated as the interocular difference in SE. ARFs were based on the AAPOS 2013 guidelines. For ages within 3-4&#160;years: hyperopia &amp;gt; 4.0 D in any meridian, myopia &amp;gt; − 3.0 D in any meridian, astigmatism &amp;gt; 2.0 D in any meridian; anisometropia &amp;gt; 2.0 D. For ages over 4&#160;years: hyperopia &amp;gt; 3.5 D in any meridian, myopia &amp;gt; − 1.5 D in any meridian, astigmatism &amp;gt; 1.5 D in any meridian; anisometropia &amp;gt; 1.5D. Manifest strabismus in primary position &amp;gt; 8 PD was considered as ARFs for all ages studied (Donahue et al. [&lt;reflink idref=&quot;bib11&quot; id=&quot;ref20&quot;&gt;11&lt;/reflink&gt;] ).&lt;/p&gt; &lt;p&gt;Data are presented as the mean &#177; SD. The one-sample Kolmogorov-Smirnov test was performed to examine whether the data was distributed normally. Differences in photoscreener findings between the ASD group and the control group were analyzed by two independent samples t-test. Differences in ARFs were analyzed using the Chi square or Fisher exact test when appropriate. All statistical analyses were performed using SPSS statistical package 24.0 (SPSS, IBM, Chicago, IL, USA). A value of P &amp;lt; 0.05 was considered statistically significant.&lt;/p&gt; &lt;hd id=&quot;AN0128946076-4&quot;&gt;Results&lt;/hd&gt; &lt;p&gt;A total of 168 children with ASD (336 eyes) and 264 neurotypical control children (528 eyes) were included in this study, with ages ranging from 3 to 8&#160;years (5.01 &#177; 1.5&#160;years in the ASD group and 5.19 &#177; 1.57 in control subjects). Age distribution was mapped, showing no statistical difference in the number of subjects in each age group (Fig.&#160;1; Table&#160;1). In the ASD group, 143 (85%) were boys and 25 (15%) were girls, while in control group, 206 (78%) were boys and 58 (22%) were girls. No statistical difference was found in sex distribution between the two groups (Table&#160;1).&lt;/p&gt; &lt;p&gt;Age distribution of children with ASD and normal controls&lt;/p&gt; &lt;p&gt;&lt;/p&gt; &lt;p&gt;Ophthalmic findings in children with ASD and controls&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table frame=&quot;hsides&quot; rules=&quot;groups&quot;&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;th align=&quot;left&quot; /&amp;gt;&amp;lt;th align=&quot;left&quot;&amp;gt;ASD&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;left&quot;&amp;gt;Control&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;left&quot;&amp;gt;P&amp;lt;/th&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;Age (years)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;5.01&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;1.5&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;5.19&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;1.57&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0.628&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;Sex (M/F)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;143/25&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;206/58&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0.068&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;SE (D)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;0.16&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;0.58&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;0.17&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;0.54&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0.734&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;J0 (D)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;&amp;amp;#8722;&amp;amp;#8201;0.01&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;0.37&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;&amp;amp;#8722;&amp;amp;#8201;0.01&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;0.34&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0.889&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;J45 (D)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;&amp;amp;#8722;&amp;amp;#8201;0.01&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;0.41&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;0&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;0.35&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0.583&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;DS (D)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;0.50&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;0.72&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;0.53&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;0.56&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0.436&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;DC (D)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;&amp;amp;#8722;&amp;amp;#8201;0.83&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;0.77&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;&amp;amp;#8722;&amp;amp;#8201;0.73&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;0.64&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0.054&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;Anisometropia (D)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;0.26&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;0.47&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;0.21&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;0.22&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0.105&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;Horizontal deviation (PD)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;2.79&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;5.80&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;&amp;amp;#8722;&amp;amp;#8201;1.51&amp;amp;#8201;&amp;amp;#177;&amp;amp;#8201;3.43&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0.000&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;N of total deviation (Eso/Exo)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;112/34&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;58/166&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0.000&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;N of referral required strabismus (Eso/Exo)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;24/3&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;1/3&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0.016&amp;lt;sup&amp;gt;a&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;p&gt;ASD autism spectrum disorder, SE spherical equivalence, DS diopter sphere, DC diopter cylinder, D diopter, PD prism diopter, N number, Eso esodeviation, Exo exodeviation&lt;/p&gt; &lt;p&gt; &lt;sups&gt;a&lt;/sups&gt;Fisher’s exact test&lt;/p&gt; &lt;p&gt;The average scores of DS, DC, SE, J0, J45 and anisometropia in the ASD and control groups are summarized in Table&#160;1 and the distribution across age groups is shown in Fig.&#160;2. No statistical differences of these power vectors were found between the ASD and control groups at any age and overall. No obvious change in the refractive status observed with increasing age in either the ASD group or control children (Fig.&#160;2).&lt;/p&gt; &lt;p&gt;Comparison of SE (a), J0 (b), J45 (c), DS (d), DC (e), and Anisometropia (f) between ASD and control group across ages 3-8&#160;years old. Dashed lines: AAPOS ARFs criteria for children over 48&#160;months. Dotted lines: AAPOS ARFs criteria for children of 30-48 months&lt;/p&gt; &lt;p&gt;The distribution of horizontal deviation in ASD and control groups is demonstrated in Fig.&#160;3. Positive values of deviation mean esodeviation and negative values mean exodeviation. In ASD group, 112 children (66.7%) had esodeviation with a mean of 5.71 &#177; 3.26 PD, 34 children (20.2%) had exodeviation with a mean of − 4.71 &#177; 3.50 PD, while 22 children (13.1%) had no deviation. In control group, 58 children (22.0%) had esodeviation with a mean of 3.13 &#177; 2.19 PD, 166 children (62.9%) had exodeviation with a mean of − 3.50 &#177; 2.22 PD, while 40 children (15.1%) had no deviation.&lt;/p&gt; &lt;p&gt;Horizontal deviation in children with ASD and normal controls. Each dot represents a subject, color-coded by age. Dashed lines: AAPOS ARF criteria for strabismus (8 PD)&lt;/p&gt; &lt;p&gt;Children with horizontal deviation of over 8 PD were referred to the pediatric ophthalmology and strabismus clinic. Among those children, there were 24 in the ASD group with esodeviation (10.59 &#177; 2.10 PD), and three with exodeviation (− 14.00 &#177; 3.03 PD). While in the control group, there were only one with esodeviation (12.25 PD) and three with exodeviation (− 11.67 &#177; 3.64 PD) (Table&#160;1; Fig.&#160;3). Overall, the mean horizontal deviation is 2.79 &#177; 5.80 PD in ASD group and − 1.51 &#177; 3.43 PD in control group (P &amp;lt; 0.01) (Table&#160;1). Most of the children with ASD (66.7%) were found to have esodeviation while most of the control children (62.9%) were found to have exodeviation (P &amp;lt; 0.01) (Table&#160;1; Fig.&#160;3).&lt;/p&gt; &lt;p&gt;According to the ARF criteria defined by AAPOS in 2013 (Donahue et al. [&lt;reflink idref=&quot;bib11&quot; id=&quot;ref21&quot;&gt;11&lt;/reflink&gt;] ), 48 (28.6%) children with ASD were found to have ARFs in one eye or both, of which 10.1% were due to astigmatism and 16.1% were due to strabismus. However, only 35 (13.3%) control children were found to have ARFs, of which 10.9% are due to astigmatism and only 2.4% are due to strabismus. The incidence of strabismus as an ARF in children with ASD was significantly higher than in control children (p &amp;lt; 0.01) (Table&#160;2).&lt;/p&gt; &lt;p&gt;&lt;/p&gt; &lt;p&gt;ARFs identified using AAPOS criteria in children with ASD and controls&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table frame=&quot;hsides&quot; rules=&quot;groups&quot;&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;th align=&quot;left&quot;&amp;gt;AAPOS criteria31-48 months:&amp;amp;#62;&amp;amp;#8201;48&amp;amp;#160;months:&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;left&quot;&amp;gt;Hyperopia&amp;amp;#62;&amp;amp;#8201;4.0 D&amp;amp;#62;&amp;amp;#8201;3.5 D&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;left&quot;&amp;gt;Myopia&amp;amp;#62;&amp;amp;#8201;&amp;amp;#8722;&amp;amp;#8201;3.0 D&amp;amp;#62;&amp;amp;#8201;&amp;amp;#8722;&amp;amp;#8201;1.5 D&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;left&quot;&amp;gt;Astigmatism&amp;amp;#62;&amp;amp;#8201;2.0 D&amp;amp;#62;&amp;amp;#8201;1.5 D&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;left&quot;&amp;gt;Anisometropia&amp;amp;#62;&amp;amp;#8201;2.0 D&amp;amp;#62;&amp;amp;#8201;1.5 D&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;left&quot;&amp;gt;Strabismus&amp;amp;#62;&amp;amp;#8201;8 PD&amp;amp;#62;&amp;amp;#8201;8 PD&amp;lt;/th&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;ASD N(%)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;1 (0.6%)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;1 (0.6%)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;17 (10.1%)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;2 (1.2%)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;27 (16.1%)&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;Control N(%)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0 (0.0%)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;2 (0.8%)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;29 (10.9%)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0 (0.0%)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;4 (1.5%)&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td align=&quot;left&quot;&amp;gt;P&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0.389&amp;lt;sup&amp;gt;a&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;1.000&amp;lt;sup&amp;gt;a&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0.873&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0.151&amp;lt;sup&amp;gt;a&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;char&quot; char=&quot;.&quot;&amp;gt;0.000&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;p&gt;ARFs amblyopia risk factors, ASD autism spectrum disorder, D diopter, PD prism diopter&lt;/p&gt; &lt;p&gt; &lt;sups&gt;a&lt;/sups&gt;Fisher’s exact test&lt;/p&gt; &lt;hd id=&quot;AN0128946076-5&quot;&gt;Discussion&lt;/hd&gt; &lt;p&gt;This is the first study reporting ophthalmic findings in Chinese children with ASD. In this study, the age was equally distributed between the children with ASD and controls, and the male to female ratio was 5.6:1, consistent with the male gender bias of ASD (4.5:1) reported by the CDC (Christensen et al. [&lt;reflink idref=&quot;bib10&quot; id=&quot;ref22&quot;&gt;10&lt;/reflink&gt;] ) (Fig.&#160;1; Table&#160;1).&lt;/p&gt; &lt;hd id=&quot;AN0128946076-6&quot;&gt;Refractive Status in Children with ASD&lt;/hd&gt; &lt;p&gt;Children with ASD are reported to have normal visual acuity compared with neurotypical children in many studies (Milne et al. [&lt;reflink idref=&quot;bib26&quot; id=&quot;ref23&quot;&gt;26&lt;/reflink&gt;] ; Albrecht et al. [&lt;reflink idref=&quot;bib2&quot; id=&quot;ref24&quot;&gt;2&lt;/reflink&gt;] ; Anketell et al. [&lt;reflink idref=&quot;bib3&quot; id=&quot;ref25&quot;&gt;3&lt;/reflink&gt;] ). However, they are also reported to have significant refractive errors and other ophthalmic abnormalities (Ikeda et al. [&lt;reflink idref=&quot;bib21&quot; id=&quot;ref26&quot;&gt;21&lt;/reflink&gt;] ; Kabatas et al. [&lt;reflink idref=&quot;bib23&quot; id=&quot;ref27&quot;&gt;23&lt;/reflink&gt;] ; Black et al. [&lt;reflink idref=&quot;bib7&quot; id=&quot;ref28&quot;&gt;7&lt;/reflink&gt;] ; Trachtman [&lt;reflink idref=&quot;bib36&quot; id=&quot;ref29&quot;&gt;36&lt;/reflink&gt;] ; Ezegwui et al. [&lt;reflink idref=&quot;bib13&quot; id=&quot;ref30&quot;&gt;13&lt;/reflink&gt;] ). Compared with neurotypical children, Whether or not children with ASD have normal refractive status remains controversial.&lt;/p&gt; &lt;p&gt;Spherical equivalence and J0 and J45 are widely used power vectors for statistical analysis of refractive error (Mu et al. [&lt;reflink idref=&quot;bib28&quot; id=&quot;ref31&quot;&gt;28&lt;/reflink&gt;] ; Thibos et al. [&lt;reflink idref=&quot;bib35&quot; id=&quot;ref32&quot;&gt;35&lt;/reflink&gt;] ). In this study, all those power vectors in children with ASD were found to have no differences compared with control children from 3 to 8&#160;years old. Spherical diopter, cylindrical diopter and anisometropia were also analyzed, but no difference was found between ASD and control children (Fig.&#160;1). Although we were unable to directly test the visual acuity of any of the children in this study, this finding provides strong evidence to that clinicians should not anticipate reduced visual acuity when assessing children with ASD (Anketell et al. [&lt;reflink idref=&quot;bib3&quot; id=&quot;ref33&quot;&gt;3&lt;/reflink&gt;] ).&lt;/p&gt; &lt;hd id=&quot;AN0128946076-7&quot;&gt;Strabismus in Children with ASD&lt;/hd&gt; &lt;p&gt;The prevalence of strabismus in general children population is 0.85-3.55% (McKean-Cowdin et al. [&lt;reflink idref=&quot;bib25&quot; id=&quot;ref34&quot;&gt;25&lt;/reflink&gt;] ; Chia et al. [&lt;reflink idref=&quot;bib9&quot; id=&quot;ref35&quot;&gt;9&lt;/reflink&gt;] ; Friedman et al. [&lt;reflink idref=&quot;bib16&quot; id=&quot;ref36&quot;&gt;16&lt;/reflink&gt;] ; Garvey et al. [&lt;reflink idref=&quot;bib18&quot; id=&quot;ref37&quot;&gt;18&lt;/reflink&gt;] ). Increased prevalence of strabismus has been reported in children with ASD by numbers of studies. Black et al. reported that in 44 ASD patients with ages ranging from 2 to 20&#160;years, 41% were found to have some form of strabismus, of which half are esodeviation (Black et al. [&lt;reflink idref=&quot;bib7&quot; id=&quot;ref38&quot;&gt;7&lt;/reflink&gt;] ). However, other studies have reported relatively lower prevalence, from 8.6 to 21% (Milne et al. [&lt;reflink idref=&quot;bib26&quot; id=&quot;ref39&quot;&gt;26&lt;/reflink&gt;] ; Kabatas et al. [&lt;reflink idref=&quot;bib23&quot; id=&quot;ref40&quot;&gt;23&lt;/reflink&gt;] ; Ikeda et al. [&lt;reflink idref=&quot;bib21&quot; id=&quot;ref41&quot;&gt;21&lt;/reflink&gt;] ). This increased prevalence of strabismus is also reported in other neurodevelopmental disorders including cerebral palsy (Lew et al. [&lt;reflink idref=&quot;bib24&quot; id=&quot;ref42&quot;&gt;24&lt;/reflink&gt;] ), developmental delay (Sandfeld Nielsen et al. [&lt;reflink idref=&quot;bib31&quot; id=&quot;ref43&quot;&gt;31&lt;/reflink&gt;] ) and Fetal alcohol spectrum disorders (Autti-Ramo et al. [&lt;reflink idref=&quot;bib5&quot; id=&quot;ref44&quot;&gt;5&lt;/reflink&gt;] ). Although the mechanism of strabismus is still unclear, this is a strong evidence that strabismus can be a neurodevelopmental disorder of the oculomotor system and can be more commonly seen in children with ASD.&lt;/p&gt; &lt;p&gt;Generally, the prevalence of esotropia is much lower than exotropia in Asia children population, with the esotropia to exotropia ratio of 1:6-1:9 (Chen et al. [&lt;reflink idref=&quot;bib8&quot; id=&quot;ref45&quot;&gt;8&lt;/reflink&gt;] ; Hashemi et al. [&lt;reflink idref=&quot;bib20&quot; id=&quot;ref46&quot;&gt;20&lt;/reflink&gt;] ). However, in this study, we found that children with ASD tended to have more esodeviation (66.7%) than exodeviation (20.2%), with a mean deviation of 2.79 &#177; 5.80 PD, compared with − 1.51 &#177; 3.43 PD in control children (Table&#160;1; Fig.&#160;3). This finding is in consistence with other studies that had reported strabismus in children with ASD. Two studies reported that the esodeviation is about twice as many as exodeviation in children with ASD (Ozer et al. [&lt;reflink idref=&quot;bib29&quot; id=&quot;ref47&quot;&gt;29&lt;/reflink&gt;] ; Ikeda et al. [&lt;reflink idref=&quot;bib21&quot; id=&quot;ref48&quot;&gt;21&lt;/reflink&gt;] ), while other studies reported almost equal prevalence of esodeviation and exodeviation (Kabatas et al. [&lt;reflink idref=&quot;bib23&quot; id=&quot;ref49&quot;&gt;23&lt;/reflink&gt;] ; Milne et al. [&lt;reflink idref=&quot;bib26&quot; id=&quot;ref50&quot;&gt;26&lt;/reflink&gt;] ; Black et al. [&lt;reflink idref=&quot;bib7&quot; id=&quot;ref51&quot;&gt;7&lt;/reflink&gt;] ). Other than ASD, esotropia is also reported to be the most common type of strabismus in other neurodevelopmental disorders such as Sanjad-Sakati syndrome (Al Dhoyan et al. [&lt;reflink idref=&quot;bib1&quot; id=&quot;ref52&quot;&gt;1&lt;/reflink&gt;] ), psychomotor retardation (Arias-Cabello et al. [&lt;reflink idref=&quot;bib4&quot; id=&quot;ref53&quot;&gt;4&lt;/reflink&gt;] ), cerebral palsy (Ghasia et al. [&lt;reflink idref=&quot;bib19&quot; id=&quot;ref54&quot;&gt;19&lt;/reflink&gt;] ; Jackson et al. [&lt;reflink idref=&quot;bib22&quot; id=&quot;ref55&quot;&gt;22&lt;/reflink&gt;] ) and developmental delay (Sandfeld Nielsen et al. [&lt;reflink idref=&quot;bib31&quot; id=&quot;ref56&quot;&gt;31&lt;/reflink&gt;] ). The reason and mechanism are unclear. Our speculation is that the children with ASD are more likely to focus on small items (Mottron et al. [&lt;reflink idref=&quot;bib27&quot; id=&quot;ref57&quot;&gt;27&lt;/reflink&gt;] ; Kabatas et al. [&lt;reflink idref=&quot;bib23&quot; id=&quot;ref58&quot;&gt;23&lt;/reflink&gt;] ; Anketell et al. [&lt;reflink idref=&quot;bib3&quot; id=&quot;ref59&quot;&gt;3&lt;/reflink&gt;] ), despite having a reduced ability for convergence (Milne et al. [&lt;reflink idref=&quot;bib26&quot; id=&quot;ref60&quot;&gt;26&lt;/reflink&gt;] ). In such conditions, they may involuntarily display esodeviation. In other words, they become adapted to a more comforting environment through esodeviation. Esodeviation could also be due to poor cooperation of the children with ASD, leading to inaccurate Spot test results. Even though we have confirmed all the included “refer” strabismus results (&amp;gt; 8 PD) by cover-uncover test, the amount of deviation we used for analysis is from the results of Spot. Prism nulling cover tests were not performed due to lack of cooperation.&lt;/p&gt; &lt;hd id=&quot;AN0128946076-8&quot;&gt;Detecting ARFs Using AAPOS Criteria&lt;/hd&gt; &lt;p&gt;Spot has been used for vision screening in children by many studies and was proven to have good sensitivity and specificity in detecting ARFs (Peterseim et al. [&lt;reflink idref=&quot;bib30&quot; id=&quot;ref61&quot;&gt;30&lt;/reflink&gt;] ; Silbert and Matta [&lt;reflink idref=&quot;bib32&quot; id=&quot;ref62&quot;&gt;32&lt;/reflink&gt;] ), even for children younger than 3&#160;years of age (Forcina et al. [&lt;reflink idref=&quot;bib15&quot; id=&quot;ref63&quot;&gt;15&lt;/reflink&gt;] ). Using the AAPOS criteria (Donahue et al. [&lt;reflink idref=&quot;bib11&quot; id=&quot;ref64&quot;&gt;11&lt;/reflink&gt;] ), we identified very low incidence of ARFs including hyperopia, myopia, and anisometropia (0.6%, 0.6 and 1.2%, respectively) in both ASD and control children, with no differences between the two groups. Many children (about 10%) in both the ASD and control groups are found to have astigmatism as an amblyopia risk factor, but no differences were shown between the two groups. Strabismus was the only ARF we found specifically in children with ASD, with an incidence of 16.1%, which is significantly higher than 1.5% in control children. Strabismus has also been found to have a high incidence in children with ASD by many other studies, suggesting that there may be a bigger chance of abnormal alignment and mobility of eyes in children with ASD that may lead to amblyopia. Another reported ARF is optic deprivation. During this vision screening, two children were identified to have suspected leukocoria and were excluded from this study. They were referred to the clinic for further full ophthalmic examination.&lt;/p&gt; &lt;hd id=&quot;AN0128946076-9&quot;&gt;Detecting ARFs Using Optimized Criteria&lt;/hd&gt; &lt;p&gt;In previous work from our group, we evaluated 155 children with Spot and compared the results with complete ophthalmologic examinations and cycloplegic retinoscopy refraction. Receiver operating characteristic (ROC) curves were calculated and optimized ARF criteria were generated based on the ROC curves (Mu et al. [&lt;reflink idref=&quot;bib28&quot; id=&quot;ref65&quot;&gt;28&lt;/reflink&gt;] ). By using the optimized ARF criteria, the overall sensitivity and specificity of Spot in detecting ARFs were improved. Since we used the same device and the same protocol for photoscreening as in our previous study, these optimized ARF criteria were also used for detection of ARFs in the ASD and control children in this study (Table&#160;3).&lt;/p&gt; &lt;p&gt;&lt;/p&gt; &lt;p&gt;According to the optimized criteria, the observed incidences of hyperopia, astigmatism, and anisometropia as ARFs increased in both the ASD group and control group, while the incidences of strabismus as an ARF decreased. This change may simply reflect that, with the optimized criteria, the sensitivity to detection of hyperopia, astigmatism, and anisometropia was increased, while greater specificity decreased the diagnosis of myopia and strabismus. However, the statistical differences seen in this study were found only in strabismus but not refractive errors (Table&#160;3), in accordance with the results using AAPOS criteria. This further confirmed the findings that children with ASD tend to have the same risk of amblyopia from refractive errors as neurotypical children, but more risk of amblyopia from strabismus.&lt;/p&gt; &lt;hd id=&quot;AN0128946076-10&quot;&gt;Limitations&lt;/hd&gt; &lt;p&gt;Due to lack of cooperation during examination from such young children with ASD, only basic ophthalmic examinations including pupil reflex and eye movement were performed as controls for the quality of photoscreening. Visual acuity, cycloplegia refraction, retinoscopy, and prism alternate cover test were not performed.&lt;/p&gt; &lt;hd id=&quot;AN0128946076-11&quot;&gt;Conclusion&lt;/hd&gt; &lt;p&gt;In this study, we found that compared with neurotypical children, Chinese children with ASD at 3-8&#160;years of age tend to have normal refractive status but a higher incidence of strabismus as a risk factor of amblyopia. Strabismus in children with ASD should be considered more seriously by ophthalmologists and other healthcare professionals.&lt;/p&gt; &lt;hd id=&quot;AN0128946076-12&quot;&gt;Author Contributions&lt;/hd&gt; &lt;p&gt;Study concept and design: JW and XQ. Acquisition of data: GD, NH, NW, XQi, YN, YZ, XL, JL, LS and XQ. Analysis or interpretation of data: All authors. Drafting of the manuscript: JW and YL. Critical revision of the manuscript for important intellectual content: All authors.&lt;/p&gt; &lt;hd id=&quot;AN0128946076-13&quot;&gt;Compliance with Ethical Standards&lt;/hd&gt; &lt;hd id=&quot;AN0128946076-14&quot;&gt;Conflict of interest&lt;/hd&gt; &lt;p&gt;The authors declare that they have no conflict of interests.&lt;/p&gt; &lt;hd id=&quot;AN0128946076-15&quot;&gt;References&lt;/hd&gt; &lt;hd id=&quot;AN0128946076-16&quot;&gt;Citations&lt;/hd&gt; &lt;p&gt;1 Al Dhoyan N, Al Hemidan Al, Ozand PT, Ophthalmic manifestations of SanjadSakati syndrome, Ophthalmic Genetics, 2006, 27, 3, 83, 87, 10.1080/13816810600862568&lt;/p&gt; &lt;ulist&gt; &lt;item&gt;2 Albrecht MA, Stuart GW, Falkmer M, Ordqvist A, Leung D, Foster JK, Brief report: Visual acuity in children with autism spectrum disorders, Journal of Autism and Developmental Disorders, 2014, 44, 9, 2369, 2374, 10.1007/s10803-014-2086-x&lt;/item&gt; &lt;item&gt;3 Anketell PM, Saunders KJ, Gallagher SM, Bailey C, Little JA, Brief report: Vision in children with autism spectrum disorder: What should clinicians expect?, Journal of Autism and Developmental Disorders, 2015, 45, 9, 3041, 3047, 10.1007/s10803-015-2431-8&lt;/item&gt; &lt;item&gt;4 Arias-Cabello B, Arroyo-Yllanes ME, Perez-Perez JF, Fonte-Vazquez A, Clinical features of strabismus in psychomotor retardation, Cirugia y Cirujanos, 2016, 84, 1, 9, 14, 10.1016/j.circir.2015.06.030&lt;/item&gt; &lt;item&gt;5 Autti-Ramo I, Fagerlund A, Ervalahti N, Loimu L, Korkman M, Hoyme HE, Fetal alcohol spectrum disorders in Finland: Clinical delineation of 77 older children and adolescents, American Journal of Medical Genetics. Part A, 2006, 140, 2, 137, 143, 10.1002/ajmg.a.31037&lt;/item&gt; &lt;item&gt;6 Barbaro J, Dissanayake C, Autism spectrum disorders in infancy and toddlerhood: A review of the evidence on early signs, early identification tools, and early diagnosis, Journal of Developmental and Behavioral Pediatrics, 2009, 30, 5, 447, 459, 10.1097/DBP.0b013e3181ba0f9f&lt;/item&gt; &lt;item&gt;7 Black K, McCarus C, Collins ML, Jensen A, Ocular manifestations of autism in ophthalmology, Strabismus, 2013, 21, 2, 98, 102, 10.3109/09273972.2013.786733&lt;/item&gt; &lt;item&gt;8 Chen X, Fu Z, Yu J, Ding H, Bai J, Chen J, Prevalence of amblyopia and strabismus in Eastern China: Results from screening of preschool children aged 36-72 months, The British Journal of Ophthalmology, 2016, 100, 4, 515, 519, 10.1136/bjophthalmol-2015-306999&lt;/item&gt; &lt;item&gt;9 Chia A, Dirani M, Chan YH, Gazzard G, Au Eong KG, Selvaraj P, Prevalence of amblyopia and strabismus in young singaporean chinese children, Investigative Ophthalmology and Visual Science, 2010, 51, 7, 3411, 3417, 10.1167/iovs.09-44613979488&lt;/item&gt; &lt;item&gt;10 Christensen DL, Baio J, Braun KN, Bilder D, Charles J, Constantino JN, Prevalence and characteristics of Autism Spectrum Disorder among children aged 8 years-autism and developmental disabilities monitoring network, 11 Sites, United States, 2012, Journal of Development and Behavioral Pediatrics, 2016, 65, 3, 1, 23, 10.1097/DBP.0000000000000235&lt;/item&gt; &lt;item&gt;11 Donahue SP, Arthur B, Neely DE, Arnold RW, Silbert D, Ruben JB, Guidelines for automated preschool vision screening: A 10-year, evidence-based update, Journal of American Association for Pediatric Ophthalmology and Strabismus, 2013, 17, 1, 4, 8, 10.1016/j.jaapos.2012.09.012&lt;/item&gt; &lt;item&gt;12 Donahue SP, Ruben JB, Strabismus O, US Preventive Services Task Force vision screening recommendations, Pediatrics, 2011, 127, 3, 569, 570, 10.1542/peds.2011-0020&lt;/item&gt; &lt;item&gt;13 Ezegwui IR, Lawrence L, Aghaji AE, Okoye OI, Okoye O, Onwasigwe EN, Refractive errors in children with autism in a developing country, Nigerian Journal of Clinical Practice, 2014, 17, 4, 467, 470, 10.4103/1119-3077.134042&lt;/item&gt; &lt;item&gt;14 Force USPST, Vision screening for children 1 to 5 years of age: US Preventive Services Task Force Recommendation statement, Pediatrics, 2011, 127, 2, 340, 346, 10.1542/peds.2010-3177&lt;/item&gt; &lt;item&gt;15 Forcina BD, Peterseim MM, Wilson ME, Cheeseman EW, Feldman S, Marzolf AL, Performance of the spot vision screener in children younger than 3 years of age, American Journal of Ophthalmology, 2017, 178, 79, 83, 10.1016/j.ajo.2017.03.014&lt;/item&gt; &lt;item&gt;16 Friedman DS, Repka MX, Katz J, Giordano L, Ibironke J, Hawse P, Prevalence of amblyopia and strabismus in white and African American children aged 6 through 71 months the Baltimore Pediatric Eye Disease Study, Ophthalmology, 2009, 116, 11, 21282134, 10.1016/j.ophtha.2009.04.034&lt;/item&gt; &lt;item&gt;17 Garry GA, Donahue SP, Validation of spot screening device for amblyopia risk factors, Journal of American Association for Pediatric Ophthalmology and Strabismus, 2014, 18, 5, 476, 480, 10.1016/j.jaapos.2014.07.156&lt;/item&gt; &lt;item&gt;18 Garvey KA, Dobson V, Messer DH, Miller JM, Harvey EM, Prevalence of strabismus among preschool, kindergarten, and first-grade Tohono O’odham children, Optometry, 2010, 81, 4, 194, 199, 10.1016/j.optm.2009.10.0102847803&lt;/item&gt; &lt;item&gt;19 Ghasia F, Brunstrom-Hernandez J, Tychsen L, Repair of strabismus and binocular fusion in children with cerebral palsy: Gross motor function classification scale, Investigative Ophthalmology and Visual Science, 2011, 52, 10, 7664, 7671, 10.1167/iovs.10-6906&lt;/item&gt; &lt;item&gt;20 Hashemi H, Nabovati P, Yekta A, Ostadimoghaddam H, Behnia B, Khabazkhoob M, The prevalence of strabismus, heterophorias, and their associated factors in underserved rural areas of Iran, Strabismus, 2017, 25, 2, 60, 66, 10.1080/09273972.2017.1317820&lt;/item&gt; &lt;item&gt;21 Ikeda J, Davitt BV, Ultmann M, Maxim R, Cruz OA, Brief report: Incidence of ophthalmologic disorders in children with autism, Journal of Autism and Developmental Disorders, 2013, 43, 6, 1447, 1451, 10.1007/s10803-012-1475-2&lt;/item&gt; &lt;item&gt;22 Jackson J, Castleberry C, Galli M, Arnoldi KA, Cerebral palsy for the pediatric eye care team part ii: Diagnosis and treatment of ocular motor deficits, American Orthoptic Journal, 2006, 56, 86, 96, 10.3368/aoj.56.1.86&lt;/item&gt; &lt;item&gt;23 Kabatas EU, Ozer PA, Ertugrul GT, Kurtul BE, Bodur S, Alan BE, Initial ophthalmic findings in turkish children with autism spectrum disorder, Journal of Autism and Developmental Disorders, 2015, 45, 8, 2578, 2581, 10.1007/s10803-015-2428-3&lt;/item&gt; &lt;item&gt;24 Lew H, Lee HS, Lee JY, Song J, Min K, Kim M, Possible linkage between visual and motor development in children with cerebral palsy, Pediatric Neurology, 2015, 52, 3, 338, 343, 10.1016/j.pediatrneurol.2014.11.009&lt;/item&gt; &lt;item&gt;25 McKean-Cowdin R, Cotter SA, Tarczy-Hornoch K, Wen G, Kim J, Borchert M, Prevalence of amblyopia or strabismus in asian and non-Hispanic white preschool children: Multi-ethnic pediatric eye disease study, Ophthalmology, 2013, 120, 10, 2117, 2124, 10.1016/j.ophtha.2013.03.0014848013&lt;/item&gt; &lt;item&gt;26 Milne E, Griffiths H, Buckley D, Scope A, Vision in children and adolescents with autistic spectrum disorder: Evidence for reduced convergence, Journal of Autism and Developmental Disorders, 2009, 39, 7, 965, 975, 10.1007/s10803-009-0705-8&lt;/item&gt; &lt;item&gt;27 Mottron L, Dawson M, Soulieres I, Hubert B, Burack J, Enhanced perceptual functioning in autism: An update, and eight principles of autistic perception, Journal of Autism and Developmental Disorders, 2006, 36, 1, 27, 43, 10.1007/s10803-005-0040-7&lt;/item&gt; &lt;item&gt;28 Mu Y, Bi H, Ekure E, Ding G, Wei N, Hua N, Performance of spot photoscreener in detecting amblyopia risk factors in chinese pre-school and school age children attending an eye clinic, PLoS ONE, 2016, 11, 2, e0149561, 10.1371/journal.pone.01495614755657&lt;/item&gt; &lt;item&gt;29 Ozer PA, Kabatas EU, Bicer BK, Bodur S, Kurtul BE, Does correction of strabismus improve quality of life in children with autism spectrum disorder: Results of a parent survey by ophthalmologists, Seminars in Ophthalmology, 2016&lt;/item&gt; &lt;item&gt;30 Peterseim MM, Papa CE, Wilson ME, Davidson JD, Shtessel M, Husain M, The effectiveness of the spot vision screener in detecting amblyopia risk factors, Journal of American Association for Pediatric Ophthalmology and Strabismus, 2014, 18, 6, 539, 542, 10.1016/j.jaapos.2014.07.1764507562&lt;/item&gt; &lt;item&gt;31 Sandfeld Nielsen L, Skov L, Jensen H, Visual dysfunctions and ocular disorders in children with developmental delay. II. Aspects of refractive errors, strabismus and contrast sensitivity, Acta Ophthalmologica Scandinavica, 2007, 85, 4, 419, 426, 10.1111/j.1600-0420.2007.00881.x&lt;/item&gt; &lt;item&gt;32 Silbert DI, Matta NS, Performance of the Spot vision screener for the detection of amblyopia risk factors in children, Journal of American Association for Pediatric Ophthalmology and Strabismus, 2014, 18, 2, 169, 172, 10.1016/j.jaapos.2013.11.019&lt;/item&gt; &lt;item&gt;33 Singman E, Matta N, Fairward A, Silbert D, Evaluation of plusoptiX photoscreening during examinations of children with autism, Strabismus, 2013, 21, 2, 103, 105, 10.3109/09273972.2013.786736&lt;/item&gt; &lt;item&gt;34 Elst LT, Bach M, Blessing J, Riedel A, Bubl E, Normal visual acuity and electrophysiological contrast gain in adults with high-functioning autism spectrum disorder, Frontiers in Human Neuroscience, 2015, 9, 460&lt;/item&gt; &lt;item&gt;35 Thibos LN, Wheeler W, Horner D, Power vectors: An application of Fourier analysis to the description and statistical analysis of refractive error, Optometry and Vision Science, 1997, 74, 6, 367, 375, 10.1097/00006324-199706000-00019&lt;/item&gt; &lt;item&gt;36 Trachtman JN, Background and history of autism in relation to vision care, Optometry, 2008, 79, 7, 391, 396, 10.1016/j.optm.2007.10.015&lt;/item&gt; &lt;/ulist&gt; &lt;p&gt;PHOTO (COLOR)&lt;/p&gt; &lt;p&gt;PHOTO (COLOR)&lt;/p&gt; &lt;p&gt;PHOTO (COLOR)&lt;/p&gt; &lt;aug&gt; &lt;p&gt;By Jiaxing Wang; Gang Ding; Ying Li; Ning Hua; Nan Wei; Xiaoli Qi; Yuxian Ning; Ying Zhang; Xue Li; Jing Li; Linlin Song and Xuehan Qian&lt;/p&gt; &lt;/aug&gt; &lt;nolink nlid=&quot;nl1&quot; bibid=&quot;bib6&quot; firstref=&quot;ref1&quot;&gt;&lt;/nolink&gt; &lt;nolink nlid=&quot;nl2&quot; bibid=&quot;bib27&quot; firstref=&quot;ref2&quot;&gt;&lt;/nolink&gt; &lt;nolink nlid=&quot;nl3&quot; bibid=&quot;bib34&quot; firstref=&quot;ref3&quot;&gt;&lt;/nolink&gt; &lt;nolink nlid=&quot;nl4&quot; bibid=&quot;bib3&quot; firstref=&quot;ref4&quot;&gt;&lt;/nolink&gt; &lt;nolink nlid=&quot;nl5&quot; bibid=&quot;bib26&quot; firstref=&quot;ref5&quot;&gt;&lt;/nolink&gt; &lt;nolink nlid=&quot;nl6&quot; bibid=&quot;bib21&quot; 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Refractive Status and Amblyopia Risk Factors in Chinese Children with Autism Spectrum Disorder
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Wang%2C+Jiaxing%22&quot;&gt;Wang, Jiaxing&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Ding%2C+Gang%22&quot;&gt;Ding, Gang&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Li%2C+Ying%22&quot;&gt;Li, Ying&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Hua%2C+Ning%22&quot;&gt;Hua, Ning&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Wei%2C+Nan%22&quot;&gt;Wei, Nan&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Qi%2C+Xiaoli%22&quot;&gt;Qi, Xiaoli&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Ning%2C+Yuxian%22&quot;&gt;Ning, Yuxian&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Zhang%2C+Ying%22&quot;&gt;Zhang, Ying&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Li%2C+Xue%22&quot;&gt;Li, Xue&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Li%2C+Jing%22&quot;&gt;Li, Jing&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Song%2C+Linlin%22&quot;&gt;Song, Linlin&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Qian%2C+Xuehan%22&quot;&gt;Qian, Xuehan&lt;/searchLink&gt;
– Name: TitleSource
  Label: Source
  Group: Src
  Data: &lt;searchLink fieldCode=&quot;SO&quot; term=&quot;%22Journal+of+Autism+and+Developmental+Disorders%22&quot;&gt;&lt;i&gt;Journal of Autism and Developmental Disorders&lt;/i&gt;&lt;/searchLink&gt;. May 2018 48(5):1530-1536.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Springer. 233 Spring Street, New York, NY 10013. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-348-4505; e-mail: service-ny@springer.com; Web site: http://www.springerlink.com
– Name: PeerReviewed
  Label: Peer Reviewed
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 7
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2018
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles&lt;br /&gt;Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Autism%22&quot;&gt;Autism&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Pervasive+Developmental+Disorders%22&quot;&gt;Pervasive Developmental Disorders&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Foreign+Countries%22&quot;&gt;Foreign Countries&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Children%22&quot;&gt;Children&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Disability+Identification%22&quot;&gt;Disability Identification&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22At+Risk+Persons%22&quot;&gt;At Risk Persons&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Visual+Impairments%22&quot;&gt;Visual Impairments&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Comparative+Analysis%22&quot;&gt;Comparative Analysis&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Ophthalmology%22&quot;&gt;Ophthalmology&lt;/searchLink&gt;
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22China%22&quot;&gt;China&lt;/searchLink&gt;
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10803-017-3387-7
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0162-3257
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Amblyopia risk factors in children with autism spectrum disorders (ASD) are usually hard to detect in early childhood due to poor cooperation and has not been reported in the Chinese population. We screened 168 Chinese children with ASD, aged between 3 and 8 years, and 264 age-matched neurotypical children with Spot photoscreener and basic ophthalmologic examinations. Children with ASD were found to have normal refractive status but significantly higher incidence of strabismus (16.1%), compared with control children (1.5%) (p &lt; 0.01). Most of the cases of strabismus found in children with ASD were classified as esodeviation. Strabismus in children with ASD should be considered more seriously as an amblyopia risk factor by ophthalmologists and other healthcare professionals.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 36
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2018
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1175273
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1175273
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    Identifiers:
      – Type: doi
        Value: 10.1007/s10803-017-3387-7
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 7
        StartPage: 1530
    Subjects:
      – SubjectFull: Autism
        Type: general
      – SubjectFull: Pervasive Developmental Disorders
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Disability Identification
        Type: general
      – SubjectFull: At Risk Persons
        Type: general
      – SubjectFull: Visual Impairments
        Type: general
      – SubjectFull: Comparative Analysis
        Type: general
      – SubjectFull: Ophthalmology
        Type: general
      – SubjectFull: China
        Type: general
    Titles:
      – TitleFull: Refractive Status and Amblyopia Risk Factors in Chinese Children with Autism Spectrum Disorder
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            NameFull: Wang, Jiaxing
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            NameFull: Ding, Gang
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            NameFull: Qian, Xuehan
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          Dates:
            – D: 01
              M: 05
              Type: published
              Y: 2018
          Identifiers:
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            – TitleFull: Journal of Autism and Developmental Disorders
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