Eye see a better way

Is there a way to diagnose autism in infants by looking into their eyes? Caring Futures Institute research is breaking ground on retina examinations to spot differences in ERG waveforms that could help identify autism and other neurodevelopmental conditions earlier.

The red, double decker number 19 bus stops and starts its way through London’s busy streets. Miles has a thing for buses; the numbers, the timetable – the certainty that after Haymarket there’s Piccadilly Circus. First Hyde Park Corner. Then Knightsbridge station. Dr Paul Constable, Miles’ dad, remembers one trip on the number 19 bus above all others. The one when Miles cried and cried, inconsolable the whole way home. The one back from his first trip to the optometrist.

Image above: Jane and her son Ned met Dr Paul Constable at Flinders Vision’s autism-friendly optometry.

“I really just wanted to prevent other people from having the traumatic experience that I did.”

- Dr Paul Constable

Better way

Miles’ diagnosis helped Paul and Helle understand a lot of what was happening when Miles was a baby too. At the time, Paul was three years into his PhD at City University of London researching the blood brain barrier. He was using electroretinography (ERG) as a window from the eye into the brain. Paul spoke to colleagues about autism and remembers the day he told his research supervisor Professor Geoffrey Arden about Miles’ diagnosis.

“I told Geoff and he immediately said ‘Autism is neurodevelopmental, let’s google who has done an ERG research related to autism’”. Only one person had, in 1988, and so Geoff turned around and simply said, “That’s the research you must do.”

For the next 13 years, that’s exactly what Paul did. He fought for funding, he fought ethics boards and chased new technology while conducting research in conjunction with Yale University in the US and City University of London in the UK. One of the greatest advances came in the form of the RETeval, a small, handheld device which could read the retina’s response to light by placing it up to the eye for just 45 seconds.


The RETeval allowed more mobility for testing making the trials easier. Importantly, this meant they did not need to use the dilating drops on participants. RETevals were purchased for the three locations allowing the study to compare the ERG waveforms of 89 people with autism and 87 not on the autism spectrum.

ERG waveform differences had previously been detected in other disorders affecting the brain like schizophrenia. Autism is a neurodevelopmental condition and so Paul wasn’t sure what he’d find in his research on people living with autism. 

There are currently no biological markers, differences in genes or molecules, that can simply identify autism. As a result, diagnosis of autism relies on assessment from psychologists and speech therapists. When Paul’s research confirmed subtle variations in the ERG waveforms for adults on the autism spectrum he realised this could be used as a potential biomarker to help identify autism in children much earlier. It could indicate other neurodevelopmental conditions too and Paul’s research is continuing with hopes to get more data from trials with infants.