Vision and Autism


Look Me in the Eye is the title of a recent best-selling memoir of John Robison; the subtitle is, My life with Asperger’s. The book cover depicts a small boy with his eyes squeezed tightly shut. The prologue begins, “Look me in the eye young man,” and the author proceeds to explain how his inability to do so was consistently interpreted to mean that he “was just not good.” He then admits that to this day he “finds visual input to be distracting.”
What visual behaviours are seen in people within the autism spectrum?
Avoidance of eye contact is not the only common visual behaviour among those in this population. So are:
  • Seeking out visual input, like flashing or rotating lights
  • Flicking hands and watching them
  • Looking at something, then looking away before picking it up
  • Peering out of the sides of the eyes
  • Using peripheral rather than central vision for many activities
A paper vision and autism published in October of 1997 by a College of Optometrists in Vision Development states it succinctly: “vision problems are very common in individuals with autism.”
What is meant by the term vision?
“The deriving of meaning and the directing of action stimulated by light.” Mull over this definition, and you will see that determining whether or not a child can see 20/20 barely scratches the surface of exploring a child’s experience of “vision.” For this reason, although standard eye testing is important to treat or rule out diseases of the eye and asses the need for glasses to see clearly, it is not used to evaluate the ability of the child to use vision in learning and movement.
Who evaluates the derivation of meaning and directing of action, and what are the factors that are examined?
The field known as behavioural or developmental optometry is designed to evaluate the breadth of this visual spectrum. One way to explain some of the factors that are examined over and above 20/20 criterion are use of the mnemonic device of the “Seven F’s:”
Following refers to actively moving both eyes in a smooth and coordinated movement to follow a moving object. When following is tested in the examination room, it is called tracking or pursuits. There is another type of self-directed, point-to point eye movement----a saccade---that occurs when a child tries to navigate a maze or connect the dots. This, too, requires consistent, bilateral control of the eyes.
Fixation refers to the ability to hold both eyes centrally on an object. When reading, an individual must be able to fixate the word long enough to derive meaning.
Focus is necessary to see something clearly. When it is blurry we say it is out of focus. The brain does not like the blurring----it limits our abilities to derive meaning and take direct action.
Fusion is a technical term and means that (a) both eyes are aimed at the same place in space and (b) that the two images are melded into one (hopefully) three—dimensional object in the brain. If an individual has poor or no fusion, she may see two objects, or the world may appear flat and have no contour.
Flexibility of the visual system allows one to quickly and easily look back and forth in space and see clearly and singly.
Field refers to the full breadth of the limits of both eyes---up, down, right and left. There can be organic, usually permanent field losses, but there can also be attentional, variable losses of visual field. For instance, when we are frightened, we have tendency to attend only to what is right in front of us, limiting our field to a “tunnel” area. Using all of our visual fields helps us know where we are in space and where other people and objects are. It helps us to direct out actions.
Fatigue is factors that can visual performance in many areas. If individual with autism is very concentrated in using peripheral vision and ignores the central visual area, he may tire very quickly and not want to do tasks involving in central vision.
Now that we have defined vision and how to evaluate it, what about autism? 
The visual system is usually the dominant form of learning and experience in the world. John Streff, an articulate behavioural optometrist, once said, “When vision is working well, it guides and leads; when it is not, it interferes.” Vision problems are very common in individuals with autism. If this is the case, visual problems will interfere with a child’s learning, ability to play sports, and daily life activities.
In individuals with autism, many of the distinct visual symptoms referred to previously occur for one of two reasons: either because “people with autism use visual information inefficiently” or because the “have hypersensitivity vision and react by being visually defensive.” When a child is defensive to touch, she perceives it as dangerous and avoids it; likewise, to protect oneself from visual overwhelm and perceived danger, a child may look out of the sides of his eyes, and avoid direct visual confrontation. This occurs on a continuum, other children may find interesting and nonthreatening.
What causes the visual problems related to autism? 
The visual symptoms of autism can be explained by poor integration between the separate but equally necessary visual processing pathways: focal and ambient. The focal visual pathway gives information on what is being observed; the ambient one lets us know where we are an object is in space. Although it’s an over simplification, you could say that focal system is the lead player in the derivation of meaning, while the ambient system takes the lead in directing action.
“Autistic and other disabled children often have perfectly normal focal vision---the central vision that allows us to identify objects when we look straight at them---the problem lies instead with ambient vision, which involves the entire field of vision and tells us about the location of objects in space.”
“Children with autism tend to look at other people from the corners of their eyes, not because they are aloof, but because monocular vision makes more sense than trying to interpret data from the tow eyes that are not working together. In addition, they may find it impossible to look at the other people conversing, because they can’t process visual and auditory at the same time.”
“A Behavioural Approach to Vision and Autism.” Concur on the following two stools to be used to re-educate an individual to “organize space” and gain a stable periphery.”
The two tools to be used to re-educate an individual to “organize space” and gain a stable periphery are:
The introduction of yoked prism glasses: lenses that are used to move the world in one direction---up, down, right or left. The use of these lenses disrupts the ambient system and encourages reorganisation and integration of ambient and focal vision. At times, the lenses are prescribed for full-or part-time wear outside of the office. Sometimes they are used as part of in-office vision therapy.
Participation in optometric vision therapy: One tool which has found to be fascinating and fun in the vision therapy room is the use of a full-length mirror mounted on the wall or the back of a door. It seems that looking into a mirror is sometimes more acceptable and autistic child than looking directly at an activity. The mirror allows one to see things at twice the distance and puts the individual and the room into context. Activities can be done by watching one perform in the mirror, or your eyes and a moustache under your nose by using water based markers right on the mirror surface.
Eliminating or ameliorating some of the visual symptoms associated with autism can be definitive step toward the stated vision therapy goal of “improving the patient quality of life”.


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