+ve relative convergence improved with stereogram (near fixation)
Bino. convergence improved with convergence exercise
Adding Minus Lens
up to -3.00DS to stimulate convergence by inducing accommodation
to reduce the power of lens gradually until treatment can be discontinued
Prisms (Base In)
Only good for small angle deviation (<10 PD)
Used pre-operatively to obtain control & often combined with orthoptic exercise
Prism should be worn constantly and the strenght of the prism should be gradually reduced over several weeks
For patient who are photophobic
Reducing the amount of light entering the eye can improve patient’s control over exotropia
This so-called push-up is repeated 10 times, 2-4 times a day, until the patient is able to hold fixation to the tip of the nose.
*Be Caution :While doing the pencil push-ups exercise it is important that you do not strain your eyes while looking at the pencil. Straining your eyes causes accommodative insufficiency.
Ambient lenses or Yoked prisms Also known as conjugate prisms or performance or transitional lenses which can be used to help modify ambient vision They are special lenses that bend light in the same direction: up, down, left or right They are used to improve posture, head-tilt, and coordination is autistic youngsters These lenses can have dramatic results by creating a difference in how the world is seen and allows the person to change how their world is perceived
Ambient lenses or Yoked prisms During visual evaluation, an activity such as throwing and catching a ball, walking up and down stairs may be done While wearing different powers of yoked lenses, the same activity is repeated and evaluated Yoked prisms may be prescribed for special activities or for full time wear
Trying out yoked prisms Try five prism dioptres of yoked prism in several different directions to elicit an improvement in walking, sitting down and even playing catch If one direction works best, introduce a lower amount into the spectacle prescription Yoked prism alters the oculomotor state, affecting sensory function
Irlen Lenses Is a non-invasive technology that uses colored overlays and filters to improve the brain's ability to process visual information It improves an individual’s behavior and/or reading ability by filtering out those frequencies of the light spectrum to which the individual is uniquely sensitive It can improve reading fluency, comfort, comprehension, attention, and concentration while reducing light sensitivity It is not a method of reading instruction but a color-based technology that filters out offensive light waves so that the brain can accurately process visual information
Rapid Eye Movement Therapy (R.E.M) It is a non-evasive technique The therapist has an object (a stick or a wand) for the patient to focus on, and quickly moves it back and forth, in various eye levels and positions to simulate the movement and fluttering of R.E.M. The therapist then gives commands to the patient to release the traumas and emotions that are surfacing, and these are released via the eyes through rapid blinking
Attention Training The use of overcorrection avoidance to increase the eye contact of autistic children. Functional movement training (an overcorrection procedure) plus edibles and praise to develop eye contact. With the overcorrection procedure, the child is given food and praise when eye contact occurres within 5 sec of the therapist's verbal prompt: "Look at me."
Question 7 Social gaze looking Also known as social avoidance The autistic child simply chose not to focus on a particular face and gaze randomly Autistic child always seemed to be ‘looking through you’ rather than ‘at you’ Their eyes were working independently, rather than together (depth perception), so they see two pictures instead of one (double vision) In order to avoid visual strain, they choose to look away
How To Develop Social Gaze Looking?? Develop and maintain eye contact Observe if the child makes eye contact with you and if he/she does, note how long he/she could maintain it (This can be your basis of improvement) Make it easy for your child to make eye contact with you by positioning your face or your eyes at his/her eye level. Play with their toys at eye level. This will also help improve eye contact. Eg: If they are lying on the floor, you get on the floor Call for the child’s attention often and don’t be afraid to ask the child to look at you Signal them to look at your eyes while talking with them Positively reinforce eye contact by praising child for looking at you when they talk Eg: Tell them that they are good (Praise them)
Steps To Improving Eye Contact To Overcome Social Gaze Looking STEP 1
Point to your nose when talking by drawing their attention to your face by touching your nose with your finger as you start to talk
This signals children to look at you when you talk
If the child looks away signal them again by pointing to your nose while talking.
This may look silly but getting into this habit can help in improving eye contact for children with autism
Using verbal cues can go a long way to maintaining, sustaining and improving eye contact for children with autism
Constantly and frequently remind child to pay attention to you
Give instructions to child by calling him/her by name and by asking them to look at you
Compliment this by the physical movement of signaling them to look
Eg: ‘This is important’, ‘listen carefully’, ‘let me repeat’, ‘you need to remember’
It means to gently guide child’s head so that their face looks up at yours
Reinforce this positive eye contact with the use of smiling and praise
This is best for children who have difficulty understanding verbal cues and who would prefer physical touch over visual and verbal stimuli
Consistency is part of teaching the child a new skill
It helps in improving eye contact for children with autism by repetition and positive reinforcement
Eg: The child will be given food and praise when eye contact occurred within 5 sec of the therapist's verbal prompt, "Look at me."
Vision evaluation of persons with autism varies depending on their developmental, emotional and physical level Vision evaluation includes visual acuity, eye tracking and fixations, depth perception, colour vision, eye teaming and focusing, the presence of ametropia, eye health and visual fields Due to the variable nature of autism, patient response to treatment also varies Children with less severe autism and better cognitive abilities may respond better than those with more limited capabilities Approximately 15% of patients can achieve a reasonable amount of self-sufficiency as adults, and another 15% to 20% function with minimal support
What to do?? Creativity is key! Don’t be surprised if the examination requires multiple visits to get all the desired information Snellen acuities may not be an option, but tumbling E’s, Randolt C’s, and even Teller preferential acuity cards can be used as an alternative If the patient is averse to wearing glasses during stereoacuity, use the Lang stereo test, which does not require polarise glasses.
Alternative Examination Ways Gross motor testing with a colorful toy Finger puppets can help to assist in attaining pursuits, saccades, cover test, NPC, binocular indirect and many other exam techniques
Alternative Examination Ways Extra ocular muscle testing with a light-up toy Can also be tested by asking the child to follow or point the direction of a moving penlight Eg : Tell the child that the light is a missile and they are playing a missile shooting game
Other method Working with other professionals such as occupational, speech and language and physical therapists as well as the primary care physician, teachers, reading specialist and of course the parents, optometrists can help to make a difference in these autistic children’s lives