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Eyoh EE, Failla MD, Williams ZJ, Schwartz KL, Cutting LE, Landman BA, Cascio CJ. Brief Report: The Characterization of Medical Comorbidity Prior to Autism Diagnosis in Children Before Age Two. J Autism Dev Disord 2023; 53:2540-2547. [PMID: 34853956 PMCID: PMC9156724 DOI: 10.1007/s10803-021-05380-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 01/07/2023]
Abstract
In autism spectrum disorder (ASD), medical conditions in infancy could be predictive markers for later ASD diagnosis. In this study, electronic medical records of 579 autistic individuals and 1897 matched controls prior to age 2 were analyzed for potential predictive conditions. Using a novel tool, the relative association of each condition in the autistic group was compared to the control group using logistic regressions across medical records. Generalized convulsive epilepsy, nystagmus, lack of normal physiological development, delayed milestones, and strabismus were more likely in those later diagnosed with ASD while perinatal jaundice was less likely to be associated. Lesser-known conditions, such as strabismus and nystagmus, may point to novel predictive co-occurring condition profiles which could improve screening practices for ASD.
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Affiliation(s)
- Ekomobong E Eyoh
- Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN, USA.
- Institute of Child Development, University of Minnesota, 51 East River Rd, Minneapolis, MN, 55455, USA.
| | | | - Zachary J Williams
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kyle L Schwartz
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Laurie E Cutting
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, USA
| | - Bennett A Landman
- Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, USA
- Departments of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Carissa J Cascio
- Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, USA
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Reynolds M, Culican SM. Visual Autism. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040606. [PMID: 37189855 DOI: 10.3390/children10040606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 05/17/2023]
Abstract
Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder characterized by deficits in social communication and restricted, repetitive behaviors. It affects approximately 2.2% of children. Both genetic and environmental risk factors have been identified for ASD. Visual comorbidities are relatively common among children with ASD. Between 20 and 44% of ASD children have visually significant refractive error, on-third have strabismus, and one-fifth have amblyopia. In addition, ASD is 30 times more common in children with congenital blindness. It is unknown whether the association of ASD with visual morbidity is causal, comorbid, or contributing. Structural and functional abnormalities have been identified in MRIs of ASD children, and ASD children have been noted to have aberrant eye tracking. ASD children with visually significant refractive errors and poor spectacle compliance (present in 30% of ASD children) offer the opportunity for investigation into how improved visual acuity influences ASD behaviors. In this review, we focus on what is known of the visual system, refractive surgery, and ASD.
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Affiliation(s)
- Margaret Reynolds
- Department of Ophthalmology and Visual Sciences, Washington University Saint Louis, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Susan M Culican
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN 55455, USA
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Chen L, Sun L, Xue C, Li S, Wang J, Shen X, Gao S, Zhou Z, Xu Y, Huang S, Li Z, Yang X, Guo Y, Zhang W. Refractive errors and ocular findings in children and adolescents with mental disorders: a retrospective study. BMC Ophthalmol 2023; 23:4. [PMID: 36597100 PMCID: PMC9808948 DOI: 10.1186/s12886-022-02704-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/24/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND An increasing prevalence of mental disorders (MDs) has been reported among children and adolescents. However, only few studies have conducted ocular examinations, including those on refractive status, in these groups of patients. Thus, the purpose of this study was to evaluate the refractive status and ocular findings in children and adolescents with MDs compared with matched controls with similar socioeconomic backgrounds. METHODS A total of 178 participants with MDs and 200 controls were recruited between April 2021 and May 2022. All the children and adolescents underwent cycloplegic or noncycloplegic autorefraction and retinoscopy, slit-lamp biomicroscopy, and dilated fundus examinations. Ocular alignment was assessed using Hirschberg, Krimsky, or prism cover tests. The prevalence of refractive errors and ocular findings was the main outcome. RESULTS Twenty-seven percent of patients with MDs and 8% of controls had ocular findings, the most common of which were conjunctivitis, keratitis, and trichiasis. For refractive status, 70% (124/178) of patients with MDs had myopia ≤-1.00 DS, and 2% (4/178) had hyperopia ≥+2.00 DS. In the control group, 70% (140/200) of patients had myopia ≤-1.00 DS, and 1% (2/200) had hyperopia ≥+2.00 DS. No differences were observed between the MD and control groups. However, the patients in the MD group (14.25±2.69 years) were significantly more susceptible to strabismus (P<0.05) and amblyopia (P<0.01) than those in the control group (13.65±3.04 years). There was a substantial difference between the two groups in the time spent on screen-based devices (P<0.001). Furthermore, mental retardation (OR=3.286, P<0.01), emotional disorders (OR=2.003, P<0.01), and adjustment disorders (OR=2.629, P<0.01) were associated with an increased risk of amblyopia. Depression (OR =1.362, P<0.01) and emotional disorders (OR=2.205, P<0.01) were associated with a higher prevalence of strabismus. CONCLUSION Ophthalmological examinations should be performed in children and adolescents with MDs because MDs are associated with a high prevalence of refractive errors and ocular diseases. Detection and intervention of ocular and refractive findings in children and adolescents with MDs are necessary and effective in alleviating the economic burden in healthcare and improving individuals' quality of life.
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Affiliation(s)
- Liping Chen
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Ling Sun
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.440287.d0000 0004 1764 5550Tianjin Anding Hospital, Tianjin, China ,grid.265021.20000 0000 9792 1228Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Caihong Xue
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Shumao Li
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Junjun Wang
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Xia Shen
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Shiyu Gao
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Zixuan Zhou
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Yuehe Xu
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Shaocun Huang
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Zhulin Li
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Xiaoyan Yang
- grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Yatu Guo
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Wei Zhang
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
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Wang JEH, Tsai SJ, Chen TJ, Wang TJ, Chen MH. Risk of retinal disease in patients with autism spectrum disorder. CNS Spectr 2022; 28:1-6. [PMID: 35678421 DOI: 10.1017/s1092852922000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Ocular abnormalities and visual dysfunction have been associated with autism spectrum disorder (ASD). Our study assessed the risks of developing retinal diseases in individuals with ASD. METHODS In all, 18 874 patients with ASD and 188 740 controls were selected from the Taiwan National Health Insurance Research Database between 2001 and 2009. The control group was matched based on demographic characteristics and medical and ophthalmological comorbidities. The hazard ratios (HRs) with 95% confidence intervals were calculated with Cox-regression analyses adjusted for selected confounders. RESULTS Individuals with ASD had a higher incidence of developing retinal diseases (1.48‰ vs 0.73‰, P < .001), and the diagnosis of retinal diseases occurred earlier than the controls (3.73 vs 6.28 years, P < .001). When compared to the control group, the HR of developing retinal diseases in the ASD group was 1.75 (95%: 1.04-2.94) and 7.84 (95%: 3.51-17.47) for retinal detachment. There was no association between the cumulative daily dose of atypical antipsychotics and the incidence of retinal diseases in the ASD group. CONCLUSION Individuals with ASD have a higher risk of developing retinal detachment and are diagnosed with retinal diseases earlier than controls. Future research is needed to elucidate the mechanisms mediating the progression of retinal diseases in the ASD population.
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Affiliation(s)
- Joyce E-H Wang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Georgetown University School of Medicine, Washington, DC, USA
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Tso-Jen Wang
- Yuli Hospital, Ministry of Health and Welfare, Hualien, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Ekdawi N, Kipp MA, Kipp MP. Mandated Kindergarten Eye Examinations in a US Suburban Clinic: Is It Worth the Cost? Clin Ophthalmol 2021; 15:1331-1337. [PMID: 33824577 PMCID: PMC8018395 DOI: 10.2147/opth.s300725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/08/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The state of Illinois has required an examination by an optometrist or ophthalmologist prior to mandatory kindergarten since 2008. This requirement has allowed us to gather information regarding disease prevalence in a local suburban population. Methods A retrospective chart review was undertaken of kindergarten eye examinations performed at the Wheaton Eye Clinic between September 2008 and February 2017. Inclusion criteria included school eye examination as a reason for the visit, and a cycloplegic refraction was completed. Results Of 3612 patient charts identified, 1085 satisfied the inclusion criteria, of which 48% were female. The average age of the patients was 5.3 years (range, 3.8 to 6.7). Historical characteristics showed 143 (13%) were premature, 28 (3%) patients were autistic and 109 (10%) were developmentally delayed. On examination, 56 (5%) had <20/40 (WHO mild visual impairment) vision in better seeing eye, 34 (3%) had spherical equivalent refractive error in either eye > +3.50 diopters and one < −3.00 diopters. Fifty-eight patients (5%) were diagnosed with amblyopia and 101 patients (9.3%) were given glasses. Abnormal external exam finding was found in 218 (20%) while 16 (1.5%) had an abnormal fundus finding. Thirteen percent (146/1085) had a clinically relevant diagnosis in our examinations, with a cost of $1635/diagnosis. In total, our follow-up rate was 83% (78/94). Conclusion Our rate of treatable ocular conditions discovered via state-mandated kindergarten eye examinations is similar to large-scale screening programs. The cost per condition found with full examinations was substantially higher; however, follow-up was more consistent. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/MkFxH5uqZcw
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