Faculty for Autism Collaboration & Education (FACE)

Optometry Perspective

Vision Therapy

Portrait of Elizabeth Hoppe, OD, MPH, DrPH

  Elizabeth Hoppe, OD, MPH, DrPH
Dean of the College of Optometry
Western University of Health Sciences



If you would like to view the Vision Therapy sections of the recent episode “Autism Intersection”, choose your specific topic below:

PSA Autism and Vision 60 seconds video, COVD

Many of the first signs and symptoms noted by parents of children with autism have a visual or perceptual component. Frequently, parents notice that a child with ASD does not look at their eyes and may prefer to watch their mouth when they are talking or may instead look at their ear or even view faces with their head turned. Individuals on the spectrum may tend to focus their eyes on a small detail while missing information from their surroundings or by using their peripheral vision. In early development, children on the spectrum may be missing the typical point response to indicate objects of interest or to share a visual experience in their environment with a parent. For example, they may not initiate pointing to indicate observation of a bird or they may not respond typically when a parent points out a neighborhood dog or the pretty flower across the sidewalk. Kids with autism frequently have difficulty both with visually recognizing facial expressions of emotions, but also even identifying individuals based on their facial features.

Each of these frequently encountered descriptions is an indicator of visual and perceptual differences between kids on the spectrum and children who are developing neuro-typically. Researchers have identified these differences in visual and perceptual functioning as a potential means for early and objective diagnosis. Individuals with ASD appear to be utilizing different cognitive strategies and even different brain areas to process responses to both visual and auditory stimuli. Differences in face recognition strategies and abnormalities in gaze fixation have been demonstrated using functional imaging techniques. In an effort to improve early detection, researchers have begun to note that children who develop autism show signs of different brain responses as early as the first year of life. A recent study conducted in Great Britain found that some babies showed unusual patterns of brain activity associated with the development of ASD. Babies who were found to be typically developing had a significant difference in the type of brain activity that occurred in response to a face looking towards them compared with a face that was looking away, as a simulation of social eye contact. Babies who later developed symptoms of ASD showed much less difference in brain activity when exposed to eye contact or a face that was looking away. The investigators hypothesize that direct brain measures might help predict the future risk of autism in babies as young as six months old. A variety of visual and perceptual therapies may be prescribed and integrated within the overall care for individuals with autism.

Stay tuned for future segments of “Autism Intersection” that will focus on examples of various types of therapies. Examples include:

  • Therapies to improve visual motor integration
  • Techniques to enhance eye focusing and eye aiming skills
  • Strategies to improve eye tracking and peripheral awareness
  • And enhancements in visual perception such as for improved depth perception or awareness of the space around them that could impact gait and balance or other behaviors such as toe-walking.
  • Stayed tuned for more information from WesternU!