Outcomes of Vision Therapy on Visual Skills and Oculomotor Functions in Children with Autism Spectrum Disorder: A Prospective Study

Purpose: Visual skills and Oculomotor function deficits are common in children with Autism Spectrum Disorder (ASD), potentially affecting their development and quality of life. This study aimed to evaluate the effectiveness of vision therapy in visual perceptual skills and oculomotor function in children with ASD. Patients and Methods: This prospective interventional study was conducted using a convenience sampling method between February and May 2025. All children with a prior diagnosis of ASD who met the inclusion criteria were included in the study and underwent 45 sessions of vision therapy guided by the Developmental, Individual-Differences, Relationship-Based (DIR) model. Visual skills and oculomotor functions were assessed before and after vision therapy using the Wachs Analysis of Cognitive Structures (WACS) and the Northeastern State University College of Optometry (NSUCO) Oculomotor test, respectively. The paired t -test with Hedge’s g effect size was used to compare pre and post vision therapy outcomes for normally distributed data, while the Wilcoxon signed-rank test with effect size r was applied for non-normally distributed variables. Analysis of Covariance was used to examine the effect of ASD severity on post-therapy outcomes while controlling for age and gender. Results: Among the 42 children with ASD enrolled in the study, 36 completed all 45 sessions of vision therapy. Significant post-therapy improvements with large effect size were observed in visual perceptual skills (WACS) and oculomotor functions (NSUCO). Children with mild to moderate ASD showed greater improvements than those with severe ASD. Analysis of covariance revealed a significant effect of ASD severity on post-therapy outcomes: WACS (F(1,32) = 36.80, p < 0.001, R2 = 0.55), saccades (F(1,32) = 36.75, p < 0.001, R2 = 0.54), and pursuits (F(1,32) = 35.54, p < 0.001, R2 = 0.54). Age and gender showed no statistically significant effects on the outcomes. Conclusion: This prospective study provides preliminary evidence that DIR-guided vision therapy, particularly when combined with occupational and behavioral therapy, may enhance visual perceptual and oculomotor functions in children with ASD. However, randomized controlled studies with longer follow-up are needed to confirm these results. Keywords: ASD, visuomotor, spatial awareness, saccade, pursuit, DIR model