Optometric evaluation a challenge but critical in care of autism

February 1, 2010

A comprehensive evaluation of visual development is important for any child affected by an autism spectrum disorder to determine the child's visual abilities and potential interventions.

"Knowing that the patient coming in has autism can allow you to have the exam room ready. Your general working principle should be to get in and get out as quickly as possible. However, never expect these visits to follow any pre-made plan. Rather, be inventive and ready to adapt to the situation by altering your regular routine, and realize that it may not be possible to complete the entire examination," said Dr. Harris, a private practitioner in Cockeysville, MD.

Certain preparations can be made to help the visit with an autistic child proceed as smoothly as possible. For example, because leaving and entering the room can be distracting and disorienting to the child and thereby necessitate terminating the visit, all of the items that may be needed during the examination should be on hand.

Exam goals

The goals of a vision exam for an autistic child should be to answer several fundamental questions. First, to what degree does the child use information from the sensory array?

"One needs to assess how connected the child is to reality because some hallmark behaviors, such as lack of direct eye contact, may be mistaken for disconnectedness," Dr. Harris said.

Recognizing that overstimulation is an issue in this population, another question to consider is how much information can the child handle and organize from the environment. Then, the exam will probe to what degree a lens (including filters, prisms, or an occluder) allows the child to connect better to the environment.

The final question focuses on assessing the need for vision therapy, although all patients with ASD will benefit from some appropriate intervention. Therefore, relevant questions include what type of vision therapy is needed and when it should be started. Also take into account that the child may already be involved in a number of other therapies.

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