Monday morning you walk into clinic and find that your first patient is an eight-year-old boy with autism. Don’t worry if your first inclination is to panic and hope that your preceptor handles the bulk of the exam. The number one thing to remember is to BE FLEXIBLE. There are certain visual deficits that optometrists look for in autistic patients but in reality, there are many different signs and symptoms and no one clear-cut way to examine these patients.
“If you’ve seen one autistic patient, you’ve seen one autistic patient,” says Kristy Remick-Waltman O.D., FCOVD, Western University College of Optometry Director of Community Outreach. The wide variety of signs and symptoms of autism is the reason why the term Autism Spectrum Disorders (ASD) was coined, describing the broad range of disorders including learning disabilities, Asperger’s Syndrome, and autism.
Most people may think their unusual behavior is related to the disorder. However, there may be visual problems that, if detected early, can potentially make a difference in enhancing their quality of life. Much of their stimulus is visual. Poor eye contact, side viewing/looking, and visuo-spatial deficits such as hand-flapping and flicking hands near the face are all signs of a vision deficit that, with a comprehensive visual efficiency exam, can determine if lenses, prisms, or optometric vision therapy can functionally help these patients.
April is Autism Awareness Month and organizations such as COVD have spread awareness to the public about ASD and what we, as clinicians, can do to collaborate inter-professionally to enhance the lives of individuals with autism. College of Optometrist in Vision Development (COVD) has made a public announcement video that states, “while we do not offer a cure for autism, when the underlying vision problem is treated, these children become more cooperative, have better eye contact, are better able to interact and adapt to their surroundings, and improves their ability to learn” (2).
Autism spectrum disorder is a whole body disorder that affects the lives of many individuals. The brain, the body, and the eyes are all connected. As optometry students, we learn the importance of proper development and the ability to enhance the visual system through optical devices and/or optometric vision therapy.
What to look for in ASD patients:
- Side viewing/looking
- Poor eye contact
- Toe walking
- Binocular problems (e.g.. Oculomotor dysfunction, convergence problems, accommodative dysfunction)
- Visuo-spatial deficits (e.g. Hand-flapping, flicking of hands near face)
Examination tips with ASD patients:
- Be observant – Observe how the patient walks into the room, if they make eye contact, if they are sensitive to lights or sounds
- Respond, don’t react – Staying calm is a key thing to remember when examining patients on the spectrum.
- Do the exam in free space as much as possible – For example: Retinoscopy with lens rack, prism bars for binocular testing. Careful binocular testing is a must!
- Use few words when giving directions and wait patiently for their response due to a potential delay in processing.
- Demonstrate a test on yourself or a parent first – For example: Stereopsis with polarized glasses.
- Be flexible! – Being able to adjust and modify your examination techniques according to the patient’s needs will help you and the patient greatly.
1. COVD. PSA: Autism and Vision in 60 seconds. Mar 2013. <http://www.youtube.com/watch?v=gQH2UNaNyd8&list=UU8fOlMN0D7NIkVDwlOnIwAw&index=1>