April is World Autism Month, and it’s a good reminder that children with autism have a higher incidence of undiagnosed eye conditions than some other patient populations. Verbal or non-verbal, these patients need regular comprehensive eye exams.

When treating children who have autism, there is one broad theme to keep in mind to make their exam as productive and comfortable as possible: “It’s all about earning trust,” says Dr. Pooja Patel, OD, FAAO, of Brier Creek Vision Care & The Center for Visual Learning and Rehabilitative Therapy in Raleigh, N.C. But earning the trust of a child who has autism requires different tactics than many optometrists use on a daily basis.

TAP PARENTS FOR SUGGESTIONS

For pediatric patients, the intake form is a place to solicit different suggestions that parents or caregivers might have that will make the exam go smoother, notes Dr. Patel. “We’ll put on the child’s favorite cartoon or offer a favorite toy during a retinoscopy, or to keep the patient engaged as I’m talking to the caregiver,” she says. “Plus, I don’t want to spend that initial time in the exam talking to the caregiver. The attention span of any child is short, so I want to get on with the exam.”

BE READY FOR PATIENT FLOW MODIFICATIONS

“Your regular flow probably won’t work with autistic patients,” warns Dr. Patel. “You’ll be doing things all over the place. For example, most patients undergo imaging in the dark room as the first part of their exam.

“With an autistic patient, I prefer that my tech skip all of that and bring them straight into the exam room,” says Dr. Patel. “The last thing I want is for that child to get scared, especially if they’re already afraid of the dark, because you’ll lose their cooperation right away.”

To get children comfortable, you can play with them, talk to them and ask questions. Or, if they are non-verbal, you can show them different toys and pictures, she notes.

“It’s part of earning the trust of the patient and showing them that this is not a typical doctor’s office — we create a fun atmosphere,” she notes.

TAKE TESTING SLOWLY

When testing for VA, “always start with both eyes first, just to make sure the child doesn’t get scared by an occluder touching their eye, for instance,” recommends Dr. Patel. For non-verbal patients, use VA charts that have pictures, so the child can match, or use Richman paddles where you can simply observe the child.

Parents or caregivers can provide needed help during the exam:

“I may let the parent hold the paddles,” notes Dr. Patel. “Whenever I do testing, I try to mimic that test on a parent, caregiver, or a sibling that might be there,” she offers. “I say ‘OK, I’m going to put this cover over Mommy’s eye, and she’s going to turn into a pirate.”’ And if a patient finds bright light difficult, Dr. Patel advises saving pupils until to the end, after you’ve established a connection. OM