Ophthalmic Disease Burden in Adults With Autism Spectrum Disorder

To compare the documented prevalence of common treatable ocular conditions among US adults with and without autism spectrum disorder (ASD) in a large, socioeconomically diverse cohort.

Propensity score-matched cohort study.

Adults aged 18 years or older in the National Institutes of Health All of Us Research Program database, version 8, with electronic health record data.

Adults with ASD were propensity score-matched 1:4 to adults without ASD on age, sex assigned at birth, race and ethnicity, and duration of electronic health record observation. Prevalence of each ocular condition was compared between groups, and absolute prevalence differences were estimated. Logistic regression was used to evaluate the association between ASD and ocular conditions; sequential models adjusted for household income, educational attainment, and health insurance status.

Documented diagnoses of refractive/accommodative error, cataract, glaucoma, strabismus, dry eye disease, and any ocular condition.

Among 5250 matched participants, 1050 adults had ASD, and 4200 were controls; the cohort had a mean age of 39.1 years and was 49.3% male. Adults with ASD had higher documented prevalence of any ocular condition (29.5% vs 17.8%), refractive/accommodative error (22.3% vs 14.0%), cataract (9.9% vs 5.2%), dry eye disease (9.0% vs 5.5%), glaucoma (3.6% vs 1.5%), and strabismus (3.8% vs 1.7%) compared with controls. In fully adjusted models, ASD was associated with increased odds of any ocular condition (odds ratio [OR] = 2.09; 95% confidence interval [CI], 1.78-2.45), glaucoma (OR = 2.56; 95% CI, 1.67-3.88), strabismus (OR = 2.31; 95% CI, 1.53-3.44), cataract (OR = 2.16; 95% CI, 1.68-2.77), refractive/accommodative error (OR = 1.92; 95% CI, 1.61-2.29), and dry eye disease (OR = 1.80; 95% CI, 1.39-2.32). Associations were similar from unadjusted through fully adjusted models.

Adults with ASD had higher documented prevalence and odds of multiple treatable ocular conditions when compared to matched adults without ASD. Greater attention should be directed toward autism-informed adult eye care, including proactive screening, sensory and communication accommodations, and coordinated follow-up to support timely identification and management of ocular diseases in this population.