A study in the journal Nature made headlines yesterday morning. The attention grabber in this piece is that eye fixation patterns that are off the eyes and located elsewhere on the face can be the earliest biomarkers of autism. The researchers involved were Klin’s group which relocated from Yale a few years ago to Emory University in Atlanta. While researches cautioned that more study is necessary, I referenced Klin’s work in an article I wrote for Optometry in 2008.
It should be apparent that since optometrists make liberal use of the neurotypical infants’ preference for looking at faces, and eyes in particular, we are uniquely positioned to be the first clinicians to be scrutinizing infant preference looking behavior. Atypical or inverted PL patterns toward face might therefore constitute one of the earliest visual biomarkers for autism. My mentor Jack Richman and I published more extensively about this in the journal Optometry and Vision Development in 2009.
The origin of the concept of preferential looking toward facial figures rather than other high contrast patterns is attributed to experimental psychologist Robert L. Fantz. For many years optometrists have been using a variety of targets that rely on facial configurations as enticing to infants for fixation and following, nearpoint of convergence, binocular alignment, and visual acuity measures. Examples include the Richman Face Dot Test, Peek-A-Boo Patti, Hiding Heidi, and the Lea Doll. Lea Hyvarinen, a developmental specialist from Finland who spoke at the meeting of the College of Optometrists in Vision Development last year, has most recently picked up on this theme of the association between facial looking patterns and visual development.
Dr. Glen Steele gave a Fall CE Seminar to New Jersey Optometrists on Wednesday, sensitizing attendees to these tools we have at disposal that can serve as potential early biomarkers of autism. Dr. Steele and his colleague, Dr. Andrea Thau have been at the forefront of bringing this message to Optometry and to the public. As the group at Emory have cautioned, sensitive eye trackers are not yet ready for prime time as definitive biomarkers of autism. But it is now clear that the lack of engagement to or aversion of gaze toward eyes is a hallmark feature of autism that is present at even younger ages than was previously thought – as early as one month of age.
Given that the InfantSEE program encourages the public to bring babies to be assessed by Doctors of Optometry within the first 12 months of life, and given that the Affordable Care Act now covers children’s comprehensive eye examinations from birth as an essential benefit, optometrists will be on the front lines of early detection and potential intervention for visual components of autism.