Understanding eye care access for autistic adults and families: A convergent mixed-methods study

Autistic people face persistent barriers to accessing healthcare, yet little is known about their experiences receiving eye care, despite elevated rates of vision conditions. This convergent mixed-methods study explored the eye care experiences of 127 autistic adults and 69 parents of autistic children living in Australia and Aotearoa New Zealand. Through an online survey incorporating both structured and open-ended items, we examined access patterns, perceived barriers and enablers, and unmet needs. Quantitative data revealed widespread challenges, including sensory discomfort, communication difficulties, and financial costs, while qualitative responses foregrounded how provider interaction, clinical pacing, and environmental conditions shaped overall experience. Although participants valued clearer communication and sensory-informed adjustments, these were described as insufficient in the face of structural barriers such as affordability and inaccessible service locations. These findings align with emerging models of autism-informed healthcare that advocate for systemic, rather than ad hoc, approaches to accessibility. Our results underscore the need for proactive, cross-sector solutions developed in partnership with autistic people, which embed neurodiversity-affirming principles into eye care design, delivery, and policy. Addressing these inequities is both an ethical and practical imperative if we are to ensure that eye care services are inclusive, sustainable, and responsive to diverse ways of being.Lay abstractAutistic people often face barriers when using healthcare services, but little is known about their experiences with eye care. This is important because autistic people are more likely to have vision problems like needing glasses, having a lazy eye, or having trouble with how their eyes work together. In this study, we asked 127 autistic adults and 69 parents of autistic children in Australia and Aotearoa New Zealand about their experiences receiving eye care. People completed an online survey that included multiple-choice questions and space to describe their experiences in their own words. Many participants said that eye care could be stressful or confusing. Common challenges included unclear instructions, bright lights, noisy environments, feeling rushed, and staff not understanding autism. Some people avoided going to eye care professionals altogether because they could not afford glasses or found the environment too overwhelming. Participants said that small changes like using plain language, giving more time, and creating a calm environment helped make care more accessible. However, these small changes were not always enough, especially when services were too expensive or hard to get to. To improve access to eye care, changes need to happen at all levels, including how clinics are designed and how staff are trained. These changes should be made together with autistic people to make sure that services meet their needs and feel respectful and welcoming. This study shows the need to redesign eye care so that it works better for autistic people and their families.