AS THE CO-OWNER of an office specializing in pediatric care and the parent of a child with a chromosome defect and autism, I know dispensing to children with special needs often requires a different set of tools and strategies. My son, Henry, has worn glasses since he was five and is very sensitive to the fit and feel of his spectacles.
It’s estimated that between 40 and 60 percent of all children with a disability also have a refractive or accommodative error. Persons with certain specific chromosome or genetic disorders, or those children born prematurely, are at a higher risk for developing eye problems.
Many children with disabilities experience heightened anxiety during visits to medical offices. An optometric exam can be particularly challenging for patients with sensory processing difficulties.
Helping a child with special needs know what to expect before an eye exam can ease some of the distress. We enlisted Henry’s help in creating a social story, available on our website, which illustrates each step of an eye exam and shopping for glasses. Social stories are important learning tools. It gives the child a clear visual narrative about what to expect, and short, simple text which reinforces what is going to happen at each point in the process. (If you don’t want to produce your own, Autism Speaks has a good one: invisionmag.com/052001.)
Next, it’s important to appropriately schedule the exam based on the needs of the child. We prefer to see children with different needs early or in the evening.Allow a little extra time for kids with special needs. They may take longer to navigate hallways and might require more frequent breaks. Waiting can be particularly distressing for children with special needs, so it is important to get them into the exam room on time and efficiently.
Fitting spectacles can be particularly challenging. Frames tend to be designed to fit most of the population but it can be difficult to find glasses that fit children with Down’s Syndrome and other disorders with associated craniofacial differences. A good optician can make adjustments to a traditional frame design. Metal frames with nose pads are the easiest to manipulate and can also be changed to something softer and less likely to cause slippage. Altering the curve of the temples can help with wider face shape or wide-set eyes. It’s also important to be able to adjust the temple length.
Lastly, it’s important to find the right set of lenses. Those on the autism spectrum typically experience differences in sensory integration and how they process visual experiences. Many have extreme light sensitivity, and some are sensitive to flickers fluorescent lights produce. These patients benefit from Transitions XTRActive lenses. The slight tint indoors reduces sensory input, and because these are the darkest Transitions lenses outside, they help reduce the discomfort of extreme photophobia.
In the end, there’s no substitute for being confident, gentle and having good dispensing skills. Make the process positive and fun. Taking the time to address the needs of children with disabilities, identifying suitable frame and lens selections, and working to keep kids happy and content will leave the parents feeling comfortable with your office and ensure every patient gets what they require.