Background and Objectives: Strabismus, a misalignment of the eyes, is an important risk factor for amblyopia and visual impairment in the pediatric population. Several studies have reported an increased likelihood of strabismus in persons on the autism spectrum, but prevalence estimates in this group vary greatly. Methods: We searched multiple databases to identify peer-reviewed articles published in English through November 1, 2020 that provided estimates of strabismus prevalence in autistic individuals. Prevalence estimates were synthesized using Bayesian random-effects meta-analysis, and sensitivity analysis was also performed using only the subset of studies that recruited participants from non-ophthalmologic settings and identified strabismus using structured ocular exams. Bayesian meta-regression was used to assess potential moderators of prevalence across studies. Results: A total of 151 nonduplicate articles were screened, of which 22 were included in the meta-analysis (k=28 samples, nAUT=113,227). The meta-analytic point prevalence of strabismus in autistic individuals was 13.4% (95% CrI [8.3, 19.4]), and sensitivity analysis produced a very similar estimate (14.0% [7.0, 22.0], nAUT=581). Esotropia was the predominant subtype of strabismus reported, accounting for approximately 55% of cases. Reported prevalence rates were higher in younger samples (BF10=13.43, R2Het=0.273) and samples recruited from optometry/ophthalmology clinics (BF10=11.47, R2Het=0.238). Conclusion: This meta-analysis found a high prevalence of strabismus in autistic individuals, with rates 3-10 times that of the general population. As untreated strabismus is a major risk factor for amblyopia in young children, these findings underscore the importance of timely screening and assessment of ocular problems in persons on the autism spectrum. What's Known on This Subject: Strabismus has been reported to be more prevalent in individuals on the autism spectrum, but estimates have been very imprecise, ranging from 3-84% across studies. What This Study Adds: This study performs the first quantitative synthesis of strabismus prevalence in over 100,000 autistic individuals, generating more precise estimates of the prevalence of strabismus in the autistic population. Factors contributing to the large differences between studies are also examined using meta-regression.

中文翻译：

---

自闭症谱系个体斜视患病率：荟萃分析

背景和目的：斜视是一种眼睛错位，是儿童弱视和视力障碍的重要危险因素。几项研究报告称，自闭症谱系人群发生斜视的可能性增加，但该群体的患病率估计值差异很大。方法：我们搜索了多个数据库，以找出截至 2020 年 11 月 1 日以英文发表的同行评审文章，这些文章提供了自闭症患者斜视患病率的估计值。使用贝叶斯随机效应荟萃分析合成患病率估计值，并且还仅使用从非眼科环境招募参与者并使用结构化眼科检查确定斜视的研究子集进行敏感性分析。贝叶斯元回归用于评估跨研究流行率的潜在调节因素。结果：共筛选了 151 篇非重复文章，其中 22 篇纳入了荟萃分析（k=28 个样本，nAUT=113,227）。自闭症个体斜视的荟萃分析点患病率为 13.4%（95% CrI [8.3, 19.4]），敏感性分析产生了非常相似的估计值（14.0% [7.0, 22.0]，nAUT=581）。内斜视是报告的主要斜视亚型，约占病例的 55%。年轻样本（BF10=13.43，R2Het=0.273）和从验光/眼科诊所招募的样本（BF10=11.47，R2Het=0.238）中报告的患病率更高。结论：这项荟萃分析发现自闭症患者的斜视患病率很高，是普通人群的 3-10 倍。由于未经治疗的斜视是幼儿弱视的主要危险因素，因此这些发现强调了及时筛查和评估自闭症患者眼部问题的重要性。关于该主题的已知信息：据报道，斜视在自闭症谱系中的个体中更为普遍，但估计非常不准确，研究中的比例为 3-84%。本研究新增内容：本研究首次对超过 100,000 名自闭症患者的斜视患病率进行定量合成，从而对自闭症人群中的斜视患病率进行更精确的估计。还使用元回归检查了导致研究之间巨大差异的因素。这些发现强调了及时筛查和评估自闭症患者眼部问题的重要性。关于该主题的已知信息：据报道，斜视在自闭症谱系中的个体中更为普遍，但估计非常不准确，研究中的比例为 3-84%。本研究新增内容：本研究首次对超过 100,000 名自闭症患者的斜视患病率进行定量合成，从而对自闭症人群中的斜视患病率进行更精确的估计。还使用元回归检查了导致研究之间巨大差异的因素。这些发现强调了及时筛查和评估自闭症患者眼部问题的重要性。关于该主题的已知信息：据报道，斜视在自闭症谱系中的个体中更为普遍，但估计非常不准确，研究中的比例为 3-84%。本研究新增内容：本研究首次对超过 100,000 名自闭症患者的斜视患病率进行定量合成，从而对自闭症人群中的斜视患病率进行更精确的估计。还使用元回归检查了导致研究之间巨大差异的因素。据报道，斜视在自闭症谱系中的个体中更为普遍，但估计非常不准确，研究范围为 3-84%。本研究新增内容：本研究首次对超过 100,000 名自闭症患者的斜视患病率进行定量合成，从而对自闭症人群中的斜视患病率进行更精确的估计。还使用元回归检查了导致研究之间巨大差异的因素。据报道，斜视在自闭症谱系中的个体中更为普遍，但估计非常不准确，研究范围为 3-84%。本研究新增内容：本研究首次对超过 100,000 名自闭症患者的斜视患病率进行定量合成，从而对自闭症人群中的斜视患病率进行更精确的估计。还使用元回归检查了导致研究之间巨大差异的因素。