Refractive Errors and Ocular Biometric Parameters in Children with Autism Spectrum Disorder in Handan: A Cross-Sectional Study

Purpose: To investigate the differences in refractive status between children with autism spectrum disorders (ASD) and normal children, as well as the differences in the development of ocular characteristic parameters such as axial length(AL), in order to provide some help for eye care and subsequent rehabilitation in this group. Patients and Methods: This cross-sectional study enrolled 95 children aged 4– 12 years with ASD from the Handan region of China, along with 96 matched control children. All participants underwent non-cycloplegic ocular refraction and ocular biometric parameter measurements, aiming to explore the association between ASD and ocular refractive errors as well as ocular biometric parameters. Results: Children with ASD exhibited significantly higher hyperopia, Spherical equivalent (SE: ASD 0.00 ± 1.30 DS vs control − 0.50 ± 1.80 DS, p < 0.01), Cylinder (CYL: ASD − 0.75 ± 1.50DC vs control − 0.50 ± 0.50 DC, p < 0.01), shallower Anterior Chamber Depth (ACD) (ASD 2.93 ± 0.26 vs control 3.03 ± 0.34, p < 0.05) compared to controls. SE was negatively correlated with AL. The axial length-to-crane ratio (AL/CR), ACD, and vitreous thickness (VT) were positively correlated with lens thickness (LT) (p < 0.05). Logistic regression analysis demonstrated that SE, CYL, AL/CR, and ACD were associated with ASD (all p-values < 0.05). The random forest model indicated that SE (25.5%) and ACD (25.3%) were the primary predictors of ASD. Conclusion: The detection of ocular biological characteristic parameters has significant guiding significance for correcting refractive errors in children with ASD. Moreover, the combined diagnosis of SE, CYL, AL/CR, and may help identify children who may benefit from further ASD assessment. However, the predictive utility of these parameters requires validation in prospective, larger-scale studies. Keywords: autism spectrum disorder, refractive errors, ocular biometry, spherical equivalent, anterior chamber depth