Autism Patients More Than Twice as Likely to Be Diagnosed with Keratoconus

To help prevent vision loss, authors of this study say healthcare providers should be more aware of the increased ocular manifestations, such as keratoconus, in autism patients, and that routine follow-up is particularly important for this population. Photo: Irving Martínez Navé, OD. Click image to enlarge. Many individuals with autism often have difficulty communicating and display repetitive behaviors, some which can disturb the ocular surface, and ocular manifestations of the condition have been proven in previous studies—including strabismus and refractive errors. Astigmatism is one of the most frequent refractive errors in these patients, but little is known about the presence of early-stage keratoconus. In a recent study, Norwegian researchers decided to examine if there is an association between this disease and autism. They found a high prevalence, with autism patients 2.5 times more likely to be diagnosed with keratoconus, based on estimates conducted in Norway. The findings were reported recently in Journal of Cataract & Refractive Surgery.The keratoconus prevalence among people with autism was estimated from the total number of those with keratoconus from the Norwegian Patient Registry between 2010 and 2019 and compared to the prevalence in the country’s general population during the same time.Out of 23,763 autistic individuals (0.5% of the population), 115 were diagnosed with keratoconus—a prevalence of 484 per 100,000. The majority (83.5%) were men and the average age at diagnosis was 27.3.In addition to a higher proportion of men with keratoconus and autism in this study, several previous studies on ocular manifestations in autism found a predominance among men and boys; the total autism group of this study was 73.6% male.Previous studies have suggested that eye rubbing is a risk factor for keratoconus and contributes to the development of the disease. “If individuals with autism truly have a higher prevalence of both keratoconus and eye rubbing, one could ask if it is the act of eye rubbing itself that leads to the increased risk of keratoconus, if it is related to something inherent about this population that makes them more susceptible to the condition, or possibly a combination,” the authors wrote in their JCRS paper. “Some have speculated that repetitive behavior, such as eye rubbing, can be modified with behavioral therapy and thereby possibly prevent progression of keratoconus.”The authors hypothesize that the lack of focus on keratoconus in those with autism is due to the condition’s varying functional levels, as those with severe autism may struggle to communicate vision problems, potentially leading to undiagnosed keratoconus.“Conversely, unrecognized keratoconus may worsen autism symptoms by further impairing functioning through poor vision,” the authors explained in their article. A study on ophthalmologic disorders in children with autism found that 60% of the patients did not cooperate for visual acuity testing, and of these children, 39% were found to have an ophthalmologic disorder, such as strabismus or refractive error—potentially indicating that examining this patient group can be challenging.Additionally, a study on keratoconus prevalence among university students and faculty members found that 78.6% of those with keratoconus were unaware of their disease. “Considering this, along with the communication difficulties often associated with autism, one could argue that routine follow-up for ocular manifestations, such as keratoconus, is particularly important in this population in order to prevent deterioration of vision that may be preventable,” the researchers concluded in their paper. “Early detection and correction of refractive errors may enhance visual function, improve daily activities and social interactions and ultimately improve quality of life.”This is achievable, they said, if healthcare providers are aware of the increased risk of ocular manifestations in this population.Click here for the journal source. Bjerkreim H, Loberg Thorbjornsen B, Naerland T, et al. Nationwide study of the association between keratoconus and autism spectrum disorder. J Cat Refract Sur.  July 11, 2025. [Epub ahead of print.]