• Therapeutic Cataract & Refractive
  • Lens Technology
  • Glasses
  • Ptosis
  • Comprehensive Eye Exams
  • AMD
  • COVID-19
  • DME
  • Ocular Surface Disease
  • Optic Relief
  • Geographic Atrophy
  • Cornea
  • Conjunctivitis
  • Myopia
  • Presbyopia
  • Allergy
  • Nutrition
  • Pediatrics
  • Retina
  • Cataract
  • Contact Lenses
  • Lid and Lash
  • Dry Eye
  • Glaucoma
  • Refractive Surgery
  • Comanagement
  • Blepharitis
  • OCT
  • Patient Care
  • Diabetic Eye Disease
  • Technology

Pearls for exams with autistic children


About one out of every 68 people fall somewhere along the autism spectrum, says Glen T. Steele, OD FCOVD. It’s best to know ahead of time how to best tailor your treatment for autistic children.

Boston-About one out of every 68 people fall somewhere along the autism spectrum, says Glen T. Steele, OD FCOVD. It’s best to know ahead of time how to best tailor your treatment for autistic children.


The commonality of the disorder is also rising in prevalence-it was one out of every 1500 people six years ago.


“I think the autism gene is in each one of us,” Dr. Steele says, adding that it’s just a matter of whether we have been exposed to whatever it is that activated that gene. The cause for autism is multifactorial.


While it is not the optometrist’s role to diagnose autism in young children, it is the OD’s job to be aware of the specific signs to watch for in case follow-up visits or referrals are needed.


Communication pearls

Prompting a child on the autism spectrum to look you in the eye is very uncomfortable and can be scary and intimidating. Allowing children with autism to look away will make them feel more comfortable with you.


Dr. Steele recalls an autistic person who once said, “I can listen to you, or I can see you. Which do you want?” indicating that often the children may set gaze on your body or particularly your mouth when you are speaking, but it does not mean they are not listening to what you are saying.


A child may look at you more when she indirectly invited as opposed to directly told.


By positioning yourself in front of the child at his eye level in his field of vision, he may voluntarily look at you.


The worst thing you can do with children with autism is demand eye contact when you are angry. This has potential long-term effects on the child in which she negatively associate eye contact with tense emotions.


Don’t assume that children with autism simply cannot pay attention, says Dr. Steele. These are some of the brightest children; they have a different way of expressing it and acting in social scenarios.


Don't over communicate



Don’t over communicate

Children on the autistic spectrum are very good at picking up nonverbal cues and communication. Because of this, don’t over talk. Animate your facial expressions, and slow down your usual pace of trying to get things done in the exam.


First moments

Dr. Steele says it’s easy to miss a lot of information about your pediatric autistic population if you are not paying attention. Particularly when you first walk into the room, watch the patient. See how he reacts to the door opening and you stepping inside the room. Sometimes, you may see a reaction (or even exotropia, in one of Dr. Steele’s patients) that will not be present for the remainder of the visit.


Those first few seconds are key, he says.


Also recognize that these children use facial referencing instead of targeting gaze. They may glance at you but not maintain that gaze. When they do glance your way, smile to encourage them that you are only there to help them.


Pay attention to these five things with autistic patients: 

·         History

·         Ocular motility

·         Binocular function

·         Refraction

·         Visual scuity

·         Eye health (for example, pupil responses)





A careful history is crucial, which would include a family history. Emphasize eye movement control, and take note whether the patient’s unprompted visual gaze is towards people or objects.


Evaluate careful looking behavior.


A retinoscope can be used to address how they look at you, Dr. Steele says. Papillary reflexes and blink reflexes are also good indications of potential visual symptoms.


If some factors show an inclination toward autistic characteristics, remember that it is not your job to make the diagnosis. Follow up with the patient, and if persisting, refer the parents to more specific autistic resources for further exams.


Because optometrists are looking at visual characteristics every day, it is only fit that they pay special attention to these characterizes to potentially detect the disorder early on.

Related Videos
Nazlee Zebardast, MD, MSc, overviews her ARVO 2024 presentations on glaucoma and polygenic risk scores
Shelley Cutler, OD, FAAO, outlines her key takeaways from this year's IKA symposium
© 2024 MJH Life Sciences

All rights reserved.