Eye Abnormalities in Children with Fetal Alcohol Spectrum Disorders: A Systematic Review

ABSTRACT

Purpose

Although eye abnormalities are reported in fetal alcohol spectrum disorders (FASD), no systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines has been undertaken. Our aim was to document the range and prevalence of eye abnormalities reported in children with prenatal alcohol exposure (PAE) and/or FASD.

Methods

Searches of electronic databases and manual searches. Eligible articles were observational studies in children with PAE and/or FASD; peer reviewed journal articles in the English language; and studies reporting quantitative or frequency data on functional/structural eye abnormalities. Pooled prevalence, odds ratio, and mean differences were calculated.

Results

Of the 1,068 retrieved articles 36 were eligible, including articles on children with diagnosed fetal alcohol syndrome/FASD (N = 31); PAE (N = 3); and FASD or PAE without FASD (N = 2). Structural and functional eye abnormalities were identified, the most prevalent being short palpebral fissure length (66.1%), visual impairment (55.5%), epicanthus (53.5%), subnormal stereoacuity (53.0%), abnormal retinal tortuosity (50.5%), impaired fixation ability (33.3%), telecanthus (31.7%), optic nerve hypoplasia (30.2%), and small optic discs (27.0%). Compared to non-exposed controls, strabismus, subnormal vision, ptosis, short palpebral fissure length, microphthalmos, smaller optic disc area, and retinal vessel tortuosity were more prevalent in children with FASD.

Conclusions

Examination of eyes and vision should be considered in children with PAE and suspected or diagnosed FASD to enable early identification and optimal management. This first comprehensive, systematic literature review demonstrates the variety and frequency of eye abnormalities reported in PAE/FASD.

KEYWORDS:

• Fetal alcohol spectrum disorders
• eye abnormalities
• maternal exposure
• prenatal alcohol exposure
• review

Acknowledgments

We acknowledge Trish Bennett for her help in developing the electronic search strategy.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Financial support

We acknowledge the support of the National Health and Medical Research Council (Centre of Research Excellence Grant 1110341, Research Fellowship CB 353625, Practitioner Fellowship EE 1021480, and Medical Research Futures Fund Next Generation Fellowship EE 1135959).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09286586.2022.2123004

Additional information

Funding

This work was supported by the National Health and Medical Research Council [1021480, 1135959,1110341, 353625].