Refractive Errors, Amblyopia Risk, and Prenatal Factors in Children with Autism Spectrum Disorder: A Cross-Sectional Study.

Purpose: This study aims to investigate the prevalence of ocular features, particularly refractive errors and amblyopia risk factors (ARFs), in children diagnosed with Autism Spectrum Disorder (ASD). Additionally, it seeks to explore their associations with selected prenatal factors. Methods: This cross-sectional study included 436 children diagnosed with ASD and 508 typically developing controls, all aged between 2 and 9 years from the Tianjin region. Refractive status was measured using the Spot Vision Screener, while ARFs were determined following the guidelines set by the American Academy of Pediatric Ophthalmology and Strabismus. Information on prenatal variables, such as the mode of delivery, maternal weight gain, and self-reported maternal emotional symptoms was gathered via parental surveys. The data were analyzed statistically using SPSS version 27.0. Results: The results showed that 42.7% of children with ASD presented refractive errors, a rate notably higher than the 36.8% observed in the control group, with hyperopia and astigmatism being the most prevalent conditions. 15.4% of children with ASD were identified as having ARFs, compared to 8.3% in the control group (P <0.05). Notably, 90% of the children with ASD had refractive errors that required correction but were left uncorrected. Prenatal factors, including cesarean delivery (OR = 2.298, P < 0.05) and self-reported maternal emotional symptoms (OR = 5.150, P < 0.05), were found to be significantly associated with both ASD and the presence of refractive errors and amblyopia in this cross-sectional analysis. Conclusion: Children with ASD exhibit a higher incidence of refractive errors and ARFs, with prenatal influences playing a significant role. Additionally, the high rate of uncorrected refractive errors in this population highlights a critical gap in visual care. Early diagnosis and treatment, along with targeted management of prenatal risk factors, are critical for improving both visual health and overall developmental outcomes in this group. Trial Registration: Registration number: ClinicalTrials.gov ID NCT06122519. Registration date: October 2023.