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Peer-reviewedCC BY-NC-NDOphthalmology science

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

  • Xiu Nian Chen1
  • Yuzhou Zhang1
  • Xiu Juan Zhang1,2
  • Charlene Yim1
  • Ka Wai Kam1,3
  • Mandy P H Ng1
  • Patrick Ip4
  • Ian C K Wong5
  • Wei Zhang6
  • Alvin L Young1,3
  • Clement C Tham1,3,7,8,9,10
  • Chi Pui Pang1,7,9
2 more authors
  • Li Jia Chen1,2,7,9
  • Jason C Yam1,3,7,8,9,10
10 affiliations
  1. 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
  2. 2Department of Ophthalmology, The University of Hong Kong, Hong Kong SAR, People's Republic of China.
  3. 3Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, People's Republic of China.
  4. 4Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China.
  5. 5Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China.
  6. 6Tianjin Eye Hospital, Tianjin, People's Republic of China.
  7. 7Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, People's Republic of China.
  8. 8Hong Kong Eye Hospital, Hong Kong, People's Republic of China.
  9. 9Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong, People's Republic of China.
  10. 10Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
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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. Attention-deficit/hyperactivity disorder and ASD diagnoses were made by qualified physicians using International Classification of Diseases 10 criteria.Main outcome measures

The prevalence of anisometropia, strabismus and amblyopia.Results

A total of 10 936 children were included, comprising 153 (1.4%) with ASD only, 413 (3.8%) with ADHD only, 276 (2.5%) with comorbid ASD-ADHD, and 10 094 (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). Autism spectrum disorder (ASD only plus comorbidity) was associated with higher risks of anisometropia (odds ratio [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 aforementioned ocular disorders.Conclusions

Children with ASD only and ASD-ADHD comorbidity were associated with increased and distinct patterns of anisometropia, strabismus, and amblyopia, while children with ADHD only showed no such association.Financial disclosures

The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.

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Cite

BibTeXRIS
BibTeX
@article{chen2026anisometropia,
  title = {{Anisometropia, Strabismus, and Amblyopia in Children with Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, and Their Comorbidity.}},
  author = {Xiu Nian Chen and Yuzhou Zhang and Xiu Juan Zhang and Charlene Yim and Ka Wai Kam and Mandy P H Ng and Patrick Ip and Ian C K Wong and Wei Zhang and Alvin L Young and Clement C Tham and Chi Pui Pang and Li Jia Chen and Jason C Yam},
  journal = {Ophthalmology science},
  year = {2026},
  month = sep,
  doi = {10.1016/j.xops.2026.101406},
  url = {https://europepmc.org/article/MED/42921403},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Anisometropia, Strabismus, and Amblyopia in Children with Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, and Their Comorbidity.
AU  - Xiu Nian Chen
AU  - Yuzhou Zhang
AU  - Xiu Juan Zhang
AU  - Charlene Yim
AU  - Ka Wai Kam
AU  - Mandy P H Ng
AU  - Patrick Ip
AU  - Ian C K Wong
AU  - Wei Zhang
AU  - Alvin L Young
AU  - Clement C Tham
AU  - Chi Pui Pang
AU  - Li Jia Chen
AU  - Jason C Yam
PY  - 2026
DA  - 2026/09/09
JO  - Ophthalmology science
DO  - 10.1016/j.xops.2026.101406
UR  - https://europepmc.org/article/MED/42921403
AB  - 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. Attention-deficit/hyperactivity disorder and ASD diagnoses were made by qualified physicians using International Classification of Diseases 10 criteria.Main outcome measures  The prevalence of anisometropia, strabismus and amblyopia.Results  A total of 10 936 children were included, comprising 153 (1.4%) with ASD only, 413 (3.8%) with ADHD only, 276 (2.5%) with comorbid ASD-ADHD, and 10 094 (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). Autism spectrum disorder (ASD only plus comorbidity) was associated with higher risks of anisometropia (odds ratio [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 aforementioned ocular disorders.Conclusions  Children with ASD only and ASD-ADHD comorbidity were associated with increased and distinct patterns of anisometropia, strabismus, and amblyopia, while children with ADHD only showed no such association.Financial disclosures  The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.
SN  - 2666-9145
ER  -