Refractive surgery for ASD

Career Goal: 1. To further define the role of visual morbidity and autism spectrum disorder phenotype. 2. To understand the role of visual development in ASD morbidity guided by fcMRI biomarkers in both sighted and children with visual comorbidities. Research Project: Autism spectrum disorder (ASD), which affects 2% of individuals in the population, is defined by deficits in social communication and restrictive and repetitive behaviors. ASD is characterized by etiologic heterogeneity with contributions from multiple genes, environmental factors, and co-occurring neurological and mental health comorbidities. ASD is 30 times more common in children with congenital blindness, and decreased visual acuity among a population with comorbid social deficits can be particularly burdensome. 20-44% of children with ASD have visually significant refractive error. Yet, 31% of ASD children (vs. 4% typically developing children) are unable to wear glasses even though their vision is secondarily degraded to the point of legal blindness. Refractive surgery can improve visual acuity in this population. We recently published the results of a pilot study of 24 children pre- and 1-month post- refractive surgery. In addition to gains in visual function, we showed that Social Responsiveness-2 (SRS-2) social awareness scores improved by a median of 15 points post-surgery. The objective of the present study is to quantify improvements in visual acuity (Teller acuity testing), adaptive behavior (Vineland), and social responsiveness (SRS-2) post refractive surgery. We hypothesize that in addition to gains in visual function, SRS-2 and Vineland-3 scores will improve in ASD children post-refractive surgery. If these benefits are validated, pediatric refractive surgery could easily be disseminated, with guidelines informed by this study (and subsequent R01), as thousands of centers throughout the world already routinely perform refractive surgery on adults. Furthermore, the proposed study will tangibly impact the basic science of ASD – regarding the role of decreased visual acuity as a comorbid, contributing, or actively reinforcing factor – by clarifying the visual system and cognitive neuroscientific underpinnings of treatment effects on vision and behavior in this population versus other ASD populations. Career Development: This K23 award will provide me with the necessary training in the areas of behavioral phenotyping of ASD children, as well as the concepts and methods of functional neuroimaging. Training will occur at Washington University School of Medicine, which is a highly collaborative scientific environment and a leading institution for ASD, pediatric ophthalmology, and neuroimaging.