Welcome to question of the day #388

Eyetools question of the day #388

I work in community eye care and am sometimes asked to examine patients with autism. I usually struggle to get meaningful results. Do you have any tips?

Recently I was asked to examine a 16-year-old girl with autism in her own home with the attendance of her mother. Then when I got home and opened up my email I had been sent an article on tips for examining patients with autism. The full article can be found here https://eyesoneyecare.com/resources/optometry-exam-for-patients-on-autism-spectrum-with-cheat-sheet/?utm_campaign=%5Beoe-marketing%5D%20how%20to%20perform%20an%20exam%20on%20patients%20with%20autism&utm_medium=email&_hsmi=223578425&_hsenc=p2ANqtz-9vfkE8GQKtNSPpL2s3z3qq7kiRnLxTN2s-58kqj6_AUDe88c8kiuH3R18KEMAeI73NhNKx95LS_cLdOMZt46gBRT8iTA&utm_content=223578425&utm_source=hs_email

Here I offer some tips that I have found useful. Once I was informed that my patient had autism I slowed my movements down while setting up my equipment quietly in the main living room of the house. There were some books and drawings on the floor which the young girl had laid out and her mother advised me to avoid moving them if I could.

I sat down about 1.5 m from the girl and her mother who sat together on a sofa. I then quietly and slowly asked her mother if she had any worries about her daughter’s eyesight and asked if she’d been rubbing her eyes, blinking a lot, or had complained about her vision. The answers were all no.

With the help of her mother, I managed to get monocular visions of 6/5 for each eye. I managed to get monocular occlusion by placing the trial frame on me first and then the mother and then slowly on the girl. I slowly placed an occluder in the trial frame and said she was like a pirate.

I also measured her best near print size using some numbers and she managed N4 with each eye in turn.

I tried retinoscopy but the girl turned her head away from my light so I removed the trial frame.

Next, I demonstrated the light from my direct ophthalmoscope on my arm and then shone it on the girl’s arm, before asking her to look at it at the same time I moved slowly closer to her eye. I could see that her eyes were aligned and there were no obvious external eye abnormalities although I had not seen the internal structures as the girl moved her head to avoid the light but I had seen a red reflex in each eye and some pupil constriction and dilation.

Unfortunately at this point I accidentally trod on some of the books on the floor and they moved. My patient was then distracted and spent some minutes putting the books back in their original position. I made use of this time and wrote up my notes.

I tried again to view the internal structures of the eye this time demonstrating on the mother first. I didn’t get a good view.

I advised the mother that the distance and near vision was good in each eye and based on what I’d seen and what I’d be told I didn’t think there was a need for glasses and didn’t think there was any eye condition to be concerned about. I informed her of my limited information on the internal structures of the eye and advised her to contact me if there were any signs of problems with vision or eye health.

I know this was conducted in the patient’s home but the same approach can be used in a practice:

Keep things quiet

Talk slowly

Move slowly

Avoid any sudden changes in sound and/or light

Get the help of a carer

Demonstrate techniques on yourself and the carer

Warn the patient when you are going to look with a bright light

Offer plenty of praise

Bring the patient back for more tests if necessary

Be very very patient.