Autism in eye care: A mixed-methods study of professional knowledge, confidence and clinical experience

Purpose: Autistic people face significant barriers when accessing healthcare, which contribute to health disparities and unmet needs. While emerging research has described the experiences of autistic individuals accessing eye care, little is known about the perspectives of eye care professionals. This study aimed to examine autism-related knowledge, self-efficacy and attitudes among a sample of eye care professionals, and to explore their clinical experiences, perceived challenges and support needs when providing care to autistic patients. Methods: A mixed-methods design was used, combining quantitative survey data and qualitative content analysis. A total of 198 eye care professionals (optometrists, n = 107; ophthalmologists, n = 52) predominantly from Australia (n = 84), the USA (n = 79) and the United Kingdom (n = 20) completed an online survey. Regression analyses examined whether professional role, country, age, experience, personal connection to autism and frequency of contact predicted autism knowledge, self-efficacy and disability attitudes. Correlations explored relationships among these three variables. Open-ended responses were analysed using conventional content analysis. Results: Participants reported moderately high levels of self-efficacy, autism knowledge and positive disability attitudes, yet only 14% perceived they had received formal autism-specific training. Frequent clinical contact with autistic individuals was the strongest predictor of higher self-efficacy (p < 0.001). Qualitative analysis identified common challenges (e.g., sensory sensitivities, time constraints and communication barriers) and practical strategies (e.g., flexible testing, sensory accommodations and clear communication). Participants expressed a strong desire for further training and system-level supports to provide more accessible, person-centred care. Conclusions: Eye care professionals in this sample appeared motivated to support autistic patients, but often perceived a lack of structured training and identified systemic constraints that limited their capacity to provide accessible services. Practical, autism-informed resources, developed in collaboration with autistic people, alongside changes in clinical policy and workflow, may help address these challenges.