1. What questions should I ask when I am trying to find an optometrist for my child?

It is important to know if the optometrist is willing to examine a pediatric patient on the autism spectrum. A parent or guardian should ask what experience the doctor has working with this special population. Does the clinic have hours that would be convenient (early, evenings, Saturdays?) What is the cancellation policy? Is the optometrist willing to communicate with the teachers or other professionals on the team? It is most important that the child and their family feel comfortable and welcome in the office and the doctor and staff are friendly and accommodating.

2. Would an optometrist be open to consulting with a parent before the appointment, to review and plan best strategies in order to ensure the visit is a success for both the child and optometrist? Would there be an additional fee for this meeting?

Most optometrists would be open to scheduling this type of meeting, so this is another question that should be asked when searching for an optometrist. This would not be covered under OHIP, and different offices may have varying policies regarding fees. Our office does not charge for this service, but we ask that as much information as possible is provided in advance (e.g. by email) in order to have the most productive meeting possible. It is helpful to know medical/ocular health history, sensory issues, behavioural triggers, level of functioning etc. A phone consultation is often the most convenient method.

3. Children with autism often have difficulties with transitions and new environments. Is it reasonable for a parent to request that their child visit the office prior to the appointment?

Absolutely! Depending on the needs of the patient, several visits may be appropriate. Sometimes the patient will come and play with the toys in the reception area, and meet the doctor and staff. The next visit may include a “tour” of the exam room, to see the equipment, & touch or sit in the chair. Often it is helpful if a parent or sibling has an eye examination while the ASD child observes. They can receive some positive reinforcement (stickers, jelly beans, toys etc.) as an enticement to return to the office for their appointment. We would recommend scheduling it when the office isn’t as busy, such as mid-morning or around noon, and when the child is well rested.

4. Many children with autism have sensory issues, how can an optometrist accommodate this?

Knowing in advance what particular sensory issues there are would be helpful. For example, if noise is a concern, then the stereo system would be turned down or off during the visit. Lighting can be dimmed in the examination room. Some bright lights are used to assess the health of the eyes, but the intensity can also be reduced as much as possible. Children who are uncomfortable sitting on a vinyl surface would be encouraged to bring a soft blanket they like that they could sit on. If perfumes or other scents are a concern, they would be eliminated as much as possible during the visit. If a child has a particular comfort object/toy, they are encouraged to bring it with them. We have ”examined “ many stuffed animals’ eyes before the child has his turn.

5. Are optometry services covered by OHIP? What other fees may I need to pay?

Children are covered for one complete eye examination per year until they turn 20 years of age. Partial re-assessments are covered as needed. After the age of 20, people on disability are covered every two years. Fees would be charged for eye glasses or contact lenses.

6. How often should my child see an optometrist?

Children grow very quickly, and should be seen at least once a year for a routine eye exam or more often if recommended by the doctor. It is not unusual for several shorter visits to be necessary to obtain and confirm all the information regarding visual acuity, refraction, binocular vision & ocular health, especially if they are new to the office. If any changes or problems are detected, then the child should return to the office as soon as possible.

7. How do you test the eyesight of children who are non-verbal or who have difficulty expressing themselves verbally?

It is necessary to rely on objective tests if the child is non-verbal. Some of these tests are observational – for example, ocular motility can be assessed while watching the child follow a toy moving side to side or in different positions of gaze. Refraction can be determined by “neutralizing” the reflection of light from the back of the eye. Ocular health can be checked by looking inside the eye. In certain cases, it is necessary to put drops in the eyes to determine the refraction and ocular health (which is only done with parent/guardian permission). The more co-operative the child, the more accurate and complete the tests results will be.

Dr. Linda Kwasnick, O.D. received her degree from the University of Waterloo and was named on the Dean’s Honour Role. Her private practice in Orleans has been operating for over 30 years. She is the mother of two sons, who are both studying at Carleton University and she developed a special interest in ASD after her eldest son was diagnosed with Asperger’s Syndrome 10 years ago. Linda has been active in local parent support groups, attending seminars, and working with charities that support children on the spectrum and their families.