4 tips on providing optometric care for children with autism

For more than half of his nearly 40 years in optometry, Carl Garbus, O.D., has been caring for children with special needs. With the recent observance of national Autism Awareness Month, Dr. Garbus shares what his years of experience have taught him about the role of optometry in vision therapy for autistic children.

The need is evident. In 2014, the Centers for Disease Control and Prevention issued a report estimating that 1 in 59 children had been diagnosed with autism by age 8. The earlier the visual deficits of autism are identified, the quicker interventions can be made to improve their educational and occupational opportunities.

Children with autism spectrum disorder have social interaction and communication problems, difficulty relating to people, things and events, according to the American Psychiatric Association.

"Optometry has so much to offer in helping children with developmental disabilities get to a better place," says Dr. Garbus, who chairs the AOA's Vision Rehabilitation Committee and formerly served as president of the Neuro-Optometric Rehabilitation Association. "Doctors of optometry have a piece of the puzzle that needs to be exposed and presented to parents because a lot of the time they don't realize the need for a visual examination for a child who's having learning problems.

"I explain to parents that about 70 to 80% of what we learn is through the visual system," he adds. "If the child is having trouble learning, there's a good chance there's a visual disconnect or poor integration with auditory or vestibular systems. With the right therapy, interactions/connections between visual, auditory and vestibular systems improve and so does learning. Optometric vision rehabilitation, along with occupational therapy, can make significant improvements in the functioning of the autistic child. Multi-sensory stimulation is a key element in the therapy program."

For children on the autism spectrum, sensory overload can be a challenge for them and doctors of optometry. Special care needs to be taken at a practice. Some learnings from Dr. Garbus:

• Earn the trust of the patient first. "Be prepared to find out what the child likes," Dr. Garbus says. "These children are often afraid of doctors and will close down. Find out what interests the child: toys, books, games, and incorporate this into the evaluation. Set up the exam room so that it is child-friendly. Have toys and videos." Not only do these objects occupy and sometimes soothe children, they also present an opportunity for doctors to "be a good observer," he says.
  
  
• Allow for additional evaluation time in an non-hectic environment. Be sensitive to the environment. For instance, patients with autism can be sensitive to lighting. "Don't be in a hurry to do your traditional evaluation." Dr. Garbus says. "Modify and be sensitive to the child's needs. Simple and quick tests are important in the examination, including the Lang Stereo Test; child fixation targets that flash, make sounds and move; the Hirschberg test; and the Bruckner test. Use skiascopy bars to perform retinoscopy."
  
  
• Get a more extensive patient history. "Find out about the child's diet," Dr. Garbus says. "Does the child have a special diet? Are they sensitive to light? Are they squinting? Try to obtain information on the child before their appointment; send the office questionnaire to the parents early. They spend the most time with a child. You need a developmental history, and make sure you have an extensive symptoms checklist and that it is filled out."
  
  
• Collaborate with other care providers. "Does the child's pediatrician specialize in developmental problems?" Dr. Garbus asks. "What types of services are the child currently receiving? Try to obtain information from the occupational therapist, physical therapist or speech therapist."

The typical autism patient seen by Dr. Garbus is between ages 6 and 12, though he sees children younger and older. If he has done his job correctly, Dr. Garbus says, children are no longer scared of this new environment and trust has been established by the evaluation's end.

The work is rewarding. "Sometimes they come up and hug me at the end," Dr. Garbus says.

See the AOA Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination.

Read more about vision problems associated with developmental disabilities.