An eye test is recommended for all children, and for adults every two years. This article provides guidance on what to expect from an eye care appointment and is written by eye care professionals who work with individuals on the autism spectrum. Most of the information which follows is aimed at parents and carers, but the article includes a section with guidance for adults on the spectrum. An eye test is important for all children before the age of eight because the visual system is still developing and early detection of any problems can mean that the visual system develops fully.
A visual problem is not always obvious in children, because one eye may see well and compensate for the weaker eye. Also, children consider their own visual experience to be ‘normal’, so often do not complain about visual symptoms such as blur or eye strain. It may not be possible for a child with an autism spectrum disorder to express that something is wrong with their vision, due to language difficulties.
A number of eye care professionals may be involved in assessing vision. Optometrists (also known as opticians) work in the community and in hospital eye clinics. Orthopists mostly work in hospital eye clinics.
What signs might I see if my child is having difficulty with their vision?
- do they hold objects such as books or games very close to them (10-15 cm)?
- do they not like to look at things up close?
- do they have an aversion to bright lights?
- do they rub their eyes a lot?
- do they blink a lot?
- do they have unusual head or eye movements?
- does one eye turn inwards or outwards? This can happen intermittently and may be worse at the end of the day, or occur if they have been doing long periods of close work. It may appear that both eyes are not looking in the same direction.
- has there been a change in their visual behavior?
- is there a history of wearing glasses in the family?
Young children with an ASD
(aged 0-6 years)
Young children with an ASD may be under the care of a pediatrician and attend child development clinics. At these appointments there may have been some assessment of vision. However, if you have any concerns about your child’s vision, please discuss it with your pediatrician, GP or optometrist and they can advise on how you can get a more in-depth assessment of vision. This may mean an appointment with the ophthalmologist, optometrist or orthoptist at an hospital eye clinic. At the eye appointment you may see several professionals in one visit or over a series of visits.
What may happen at the eye appointment?
At this kind of appointment, your child’s vision will be measured. This can be done using a range of techniques, from simple ones which only require your child’s silent attention, to your child naming or matching pictures or letters on a chart. Your child will only need to pay attention for short periods of time. Ideally, vision will be checked for each eye individually. This requires a temporary patch or hand to be placed over one eye. Sometimes this is not possible but vision with both eyes open can still be a useful measurement. How your child’s eyes work together will be assessed, using a range of pictures and lights.
The power of the eye can be measured by the use of a light which the examiner shines into your child’s eyes. This is called refraction. This only requires silent attention and lenses will be placed in front of your child’s eyes during this measurement. In some cases, drops may be used to ensure the most accurate measurement is obtained. This means your child then only has to give a minimum level of attention.
Refraction results will determine if your child would benefit from wearing glasses. The eye care professional will discuss this with you. The health of the eyes will also be assessed. There are a range of methods to examine the eyes, with some techniques not requiring the examiner to be close to your child or to make physical contact. However, all of these techniques will use a bright light.If your child has a specific toy that holds their interest, please bring it along to the appointment as it may be of use during the assessment.
Older children with an ASD
(aged 7-18 years)
If you have any concerns about your child’s vision then talk to your optometrist, optician, GP or pediatrician and they can advise the most appropriate arrangement for an eye test. All children’s sight tests are free under the National Health Service. The appointment may be at your local eye hospital or local optometrist, depending on your child’s needs and the services in your local area.
What may happen at the eye appointment?
Eye-care professionals have a range of tests to assess your child’s vision. These may require the child to name or point at a letter or picture on a card that they can see on the chart. More simple tests rely on observation of your child’s eyes and do not require any language or communication. Vision will be tested both eyes open and one eye at a time (it may take a few visits before this is possible). To cover one eye of the child, spectacles with one lens tinted or a pirate patch may be used. Often it is easier if the child covers their own eye with their hand. This is something you could practice at home.
Eye movements and how the eyes work together will also be assessed. This is usually performed by covering and uncovering each eye whilst your child looks at something of interest, such as a toy or book or computer game. If your child has a specific book, toy or computer game that holds their interest please bring it along to the appointment as it may be useful at this point.
A range of other tests may be used, including assessment of 3D vision, color vision and focusing ability of the eye. All of these tests can be adapted for children with limited communication. To see if glasses are required a refraction will be undertaken. No verbal response is required, but the ability to hold the child’s interest at something in the distance or up close will make the test more accurate. In some cases, drops may be used to ensure the most accurate measurement is obtained. This means your child then only has to give a minimum level of attention. Refraction results will determine if your child would benefit from wearing glasses. The eye care professional will discuss this with you.
After these measurements, the eye care professional should be in a position to advise you about your child’s vision and what steps to take next. It may take a series of visits for your child to be comfortable with all the tests and for the eye care professional to develop a full picture of your child’s vision but this will ensure your child gets the best eye care and management.
Drops can be put into the eyes to stop the natural focusing of the eyes temporarily. The most commonly used eye drop is called cyclopentolate hydrochloride. This can be important to ensure an accurate measurement for some children, especially young children. These drops can be uncomfortable for a few seconds when they are put in. The drops enlarge the pupils and make near vision blurry for a few hours afterwards and your child may be sensitive to bright light until the pupils return to normal. The use of drops is sometimes clinically necessary to give your child the best treatment and will be at the discretion of the eye-care professional. The use of the drops will be discussed with you before their use.
Adults with an ASD
(aged over 18 years)
With time several changes occur with vision which are normal and to be expected. Typically if you reach the age of 25 without glasses then your vision should remain fine until approximately 45 years old. At about the age of 45 most people will begin to notice difficulties with reading newspapers and the small print on labels. This is due to the hardening of the lens inside the eye and the weakening of some of the muscles inside the eyes, a condition called presbyopia. In most cases the prescription of reading glasses is all that is required. Eye tests are recommended for all adults every two years. Optometrists will complete a full eye examination including checking for common eye conditions related with age. If you notice any difficulties with your vision it is important that you see an optician, who will be able to help.