Autism and poor eye tracking: Theories and recommendations for optometrists

In humans, strong eye contact is vital for social interactions and communication with others.¹ Findings from studies indicate that taking in information from others’ eye regions is critical for facial processing, such as identification of others’ identity, expression, and intention.¹ Not making eye contact during social interactions is a common diagnostic criterion for autism spectrum disorder (ASD).² This may result in individuals with ASD struggling to extract information from individuals during face-to-face interactions.^1-4 It is possible that low social skills seen in children with ASD may be caused by the lack of visual cues when they avoid eye contact.³ However, it remains unknown whether the lack of reciprocal gaze is due to social reasons or an alteration in the visual and processing neural pathways in those with ASD.² Multiple conflicting hypotheses exist for the mechanisms responsible for reduced eye contact in individuals with ASD.⁵ In this paper, we examine some of the popular neurophysiological theories for why individuals with ASD make less eye contact.