Work

Anisometropia, Strabismus, and Amblyopia in Children with Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, and Their Comorbidity

Year: 2026

Type: article

Abstract: Purpose To explore the association of anisometropia, strabismus and amblyopia with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) and their comorbidity. Design Population-based cross-sectional study. Subjects: children aged 6-10 years in Hong Kong. Methods Participants underwent comprehensive ocular examinations. ADHD and ASD diagnoses were made by qualified physicians using ICD-10 criteria. Main Outcome Measures The prevalence of anisometropia, strabismus and amblyopia. Results A total of 10936 children were included, comprising 153 (1.4%) with ASD-only, 413 (3.8%) with ADHD-only, 276 (2.5%) with comorbid ASD-ADHD, and 10094 (92.3%) healthy controls. The prevalence of anisometropia was 9.8%, 8.7%, 15.2%, and 6.0% across the respective groups (P < 0.001). The corresponding prevalence of strabismus was 4.6%, 2.9%, 4.0%, and 1.7% (P < 0.001), and for amblyopia, it was 7.2%, 2.7%, 4.0%, and 2.9% (P = 0.03). ASD (ASD-only plus comorbidity) was associated with higher risks of anisometropia (OR = 1.51, P = 0.04), strabismus (OR = 2.30, P = 0.01), and amblyopia (OR = 1.91, P = 0.02), whereas ADHD (ADHD-only plus comorbidity) was associated with anisometropia (OR = 1.58, P = 0.008, after adjusting for covariates. In subgroup analyses, the ASD-only group showed associations with strabismus (OR = 2.47, P = 0.04) and amblyopia (OR = 2.46, P = 0.02). The comorbid ASD-ADHD group exhibited a higher risk of anisometropia (OR = 2.17, P < 0.001), whereas children with ADHD-only showed no association with the above ocular disorders. Conclusion Children with ASD-only and ASD-ADHD comorbidity were associated with increased and distinct patterns of anisometropia, strabismus, and amblyopia, while ADHD-only showed no such association.

Source: Ophthalmology Science

DOI: 10.1016/j.xops.2026.101406