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Updated: Aug 6, 2025
Eye Tracking Young Children with Autism
Published on: March 27, 2012
Disparities in Vision Screening in Primary Care for Young Children With Autism Spectrum Disorder
Kimberly Hoover1, Matthew D Di Guglielmo1,2, Brittany Perry1,2
1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
Insights
Children with autism spectrum disorder (ASD) are less likely to receive vision screening. Photoscreening can help reduce these disparities, particularly for younger and Black children, and in specific practice regions.
Area of Science:
- Pediatric ophthalmology
- Developmental pediatrics
- Public health
Background:
- Vision screening is crucial for early detection of visual impairments in children.
- Autism spectrum disorder (ASD) may be associated with higher risks of certain vision problems.
- Disparities in healthcare access and utilization exist for children with developmental disorders.
Purpose of the Study:
- To compare vision screening rates in children with and without ASD.
- To evaluate the uptake of photoscreening versus visual acuity screening.
- To identify demographic factors influencing vision screening completion for children with ASD.
Main Methods:
- Analysis of well-child visit data from 63,829 children aged 3-5 years (2016-2019).
- Billing codes used as a proxy for vision screening completion.
- Statistical analyses included chi-squared tests and multivariate logistic regression.
Main Results:
- Children with ASD had significantly lower vision screening rates (36.5%) than those without ASD (59.9%).
- Screening rates were lowest at the 3-year visit and varied by race/ethnicity, with Black children with ASD having lower rates.
- Photoscreening use was higher in Hispanic children and in certain practice regions, correlating with increased overall screening.
Conclusions:
- Children with ASD are underserved regarding vision screening during well-child visits.
- Disparities are more pronounced in younger children and Black children with ASD.
- Photoscreening demonstrates potential as an effective tool to mitigate vision screening disparities in high-risk populations.
Objectives:
To determine the rate of vision screening among children with and without autism spectrum disorder (ASD), the rate of photoscreening compared with visual acuity screening, and the effect of demographic factors on vision screening for children with ASD.
Methods:
Data from well visits for 3- to 5-year-olds between January 2016 and December 2019 were collected via PEDSnet. Billing codes for vision screening were a proxy for the completion of vision screening. χ2 analysis examined the relationship of age, sex, race, ethnicity, region, and socioeconomic status to vision screening rate and rate of photoscreening versus visual acuity screening. Multivariate logistic regression assessed factors that impacted the odds of vision screening.
Results:
We analyzed 63 829 well-child visits. Children with ASD were less likely to have a vision screening (36.5%) compared with children without ASD (59.9%). The lowest rates of screening occurred during the 3-year visit. Of those with ASD, Black children had a lower screening rate (27.6%) than white (39.7%) and other/multiracial children (39.8%). The use of photoscreening was higher in Hispanic children, increasing the overall rate of vision screening greater than non-Hispanic children. Practice region influenced the rates of vision screening for children with ASD because of more photoscreening.
Conclusions:
Children with ASD are less likely to receive vision screening at well visits compared with typically developing children. This disparity was greatest among younger children and Black children. One practice region used more photoscreening and had higher rates of screening. Photoscreening is a useful tool to decrease disparity, especially among high-risk patient groups.
