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However, it remains unclear if ASD individuals also have structural alterations in the connective tissue of the cornea. This study aims to determine whether the Kobayashi structure (K\u2010structure) characteristics differ between adults with ASD and typically developing controls (TDC) and explore the clinical correlates of the K\u2010structure abnormality. We recruited 30 ASD adults and 35 TDC. Corneal structures, particularly the K\u2010structure in the Bowman's layer, of the participants were examined using in vivo confocal microscopy (IVCM), and a K\u2010grading ranging from 1 to 4 was given to each eye based on the level of morphological mosaicism. The ASD participants' eyes received a significantly higher single\u2010eye K\u2010grading than that of the TDC eyes (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and the medians [25th, 75th percentile] of bilateral\u2010eye summed K\u2010grading were 8 [7, 8] and 5 [4, 6] in ASD and TDC, respectively (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). A significantly higher K\u2010grading in the ASD participants' eyes was still observed after adjusting for the within\u2010subject inter\u2010eye correlation (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Youden Index showed the optimal cutoffs to differentiate ASD from TDC by bilateral\u2010eye summed K\u2010grading and single\u2010eye K\u2010grading was &gt;6 and\u2009&gt;3, respectively. Additionally, a higher K\u2010grading was associated with fewer visual sensation seeking in ASD (Spearman's correlation coefficient \u03c1\u2009=\u2009\u22120.518, <jats:italic>p<\/jats:italic>\u2009=\u20090.008) and low visual registration (i.e., higher sensory threshold) in TDC (\u03c1\u2009=\u20090.446, <jats:italic>p<\/jats:italic>\u2009=\u20090.023). This study provided novel evidence of corneal structural alterations in ASD by IVCM. Our findings may not only support the prior hypothesis of the association between ASD and connective tissue abnormalities but also shed light on the relationship between connective tissue disorder and neurodevelopmental disorders.<\/jats:p>","DOI":"10.1002\/aur.3050","type":"journal-article","created":{"date-parts":[[2023,12,5]],"date-time":"2023-12-05T10:09:05Z","timestamp":1701770945000},"page":"2316-2325","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Corneal structural alterations in autism spectrum disorder: An in vivo confocal microscopy study"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3477-3015","authenticated-orcid":false,"given":"Yi\u2010Ling","family":"Chien","sequence":"first","affiliation":[{"name":"Department of Psychiatry National Taiwan University Hospital and College of Medicine  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Po\u2010Ying","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Kaohsiung Medical University Hospital Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u2010Hsuan","family":"Wu","sequence":"additional","affiliation":[{"name":"Shiley Eye Institute and Viterbi Family Department of Ophthalmology University of California  San Diego California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei\u2010Lun","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chia\u2010Chieh","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology National Taiwan University Hospital  Taipei 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Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei\u2010Li","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology National Taiwan University Hospital  Taipei Taiwan"},{"name":"Advanced Ocular Surface and Corneal Nerve Regeneration Center National Taiwan University Hospital  Taipei Taiwan"},{"name":"Department of Ophthalmology, College of Medicine National Taiwan University  Taipei 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