This study looks at the effect of an online preview of visiting the optometrist on the levels of anxiety in children and adolescence with Autism Spectrum Disorder (ASD). It is hypothesised that those who use the online preview will experience less anxiety before and during the visit resulting in more reliable assessments and improved service for this group.   The level of anxiety of those using the online preview is compared to those who had no intervention before the appointment. Before the visit half of those given appointments were given access to an online interactive walkthrough of the examination environment. Others received no contact before the visit. On arrival both groups used a simple visual method to describe their level of anxiety and the self-reporting used to determine any effect of the online preview on the reported level of anxiety.   A reduction in the level of anxiety during the visit will bring more accurate and confident results in the testing. This research will have extensive implications for future testing and assessment of health issues for children and adolescents with ASD.

1. Dr Greg Carey
(greg.carey@flinders.edu.au)
Disability and Community Inclusion Unit
School of Health Science
Faculty of Medicine, Nursing and Health Science
Can a virtual Tour reduce anxiety
in young Optometry patients with ASD?

2. Can a virtual Tour reduce anxiety
in young Optometry patients with ASD?
This study looks at the effect of an online preview of visiting the optometrist on the levels
of anxiety in children and adolescence with Autism Spectrum Disorder (ASD). It is
hypothesised that those who use the online preview will experience less anxiety before
and during the visit resulting in more reliable assessments and improved service for this
group.
The level of anxiety of those using the online preview is compared to those who had no
intervention before the appointment. Before the visit half of those given appointments
were given access to an online interactive walkthrough of the examination environment.
Others received no contact before the visit. On arrival both groups used a simple visual
method to describe their level of anxiety and the self-reporting used to determine any
effect of the online preview on the reported level of anxiety.
A reduction in the level of anxiety during the visit will bring more accurate and confident
results in the testing. This research will have extensive implications for future testing and
assessment of health issues for children and adolescents with ASD.
Abstract for this presentation
Carey, Constable, Sprick & Parker

3. Can a virtual Tour reduce anxiety
in young Optometry patients with ASD?
We looked at:
......... the effect of an online preview of visiting the optometrist on the
levels of anxiety in children and adolescence with Autism Spectrum Disorder (ASD) …….
We hypothesised that:
…….. those who use the online preview will experience less anxiety before
and during the visit resulting in more reliable assessments and improved service
…….
Our methodology examined:
……… The level of anxiety of those using the online preview is
compared to those who had no intervention before the appointment ……….
The result was:
……… A reduction in the level of anxiety during the visit ………...

4. Who are we?
Dr Greg Carey
School of Health Science
Disability and Community Inclusion Unit
Dr Paul Constable
School of Health Science
Optometry Unit
Dr Cyle Sprick
School of Medicine
Clinical Skills and Simulation Unit
Dr Steve Parker
School of Nursing & Midwifery
Faculty of Medicine, Nursing and Health Sciences

5. A new dedicated Autism friendly Optometry Centre
The motivation

6. What do we know about
anxiety and autism

7. DENTAL Visits
Autism Spectrum Disorder (ASD) can greatly inhibit a child's
communication and social interaction skills, impacting their comfort
during dental hygiene treatment and services. Children with ASD may
exhibit sensory sensitivities, fear of the unfamiliar and lack of socio-
cognitive understanding, leading to anxiety and corresponding behavioral
deficits.
(Elmore, Bruhn, & Bobzien, 2016 p 111)
Outpatient Visits
Special considerations in the outpatient visit and peri-operative
setting in the management of ASD patients can enhance the
patient-provider relationship and improve the quality of care
delivered
(Biyani, Morgan, Hotchkiss, Cecchini & Derkay 2015 p 798)
Medical Visits
Medical visits can be difficult for a child with autism, his/her parents, as well as
providers. Medical visits can be particularly challenging because they are not
in the child's normal routine, and may entail encounters with many unfamiliar
people and expectations
(Chebuhar, McCarthy, Bosch & Baker, 2013p126)

8. What do we know about VR
and anxiety?

9. One of the most effective treatments of anxiety is exposure
therapy….. This exposure process may be done through actual
exposure, with visualization, by imagination or using virtual
reality (VR)
(Gorini & Riva, 2008p 215 ).
Virtual reality exposure (VRE) is potentially an efficient and cost-
effective treatment of anxiety disorders
(Rothbaum, & Hodges 1999, p507)
Virtual reality exposure therapy (VRET) is a promising intervention for
the treatment of the anxiety disorders
(Opris, Pintea, Garcia-Palacios, Botella, Szamoskozi & David, 2012p 85).
… exposure to virtual environments bridges the gap between
an imagined situation and a real one; it allows the patient to be
exposed to anxiety-generating stimuli as if he or she were in
a real situation
(Gebara, Barros-Neto, Gertsenchtein, & Lotufo-Neto, 2016p24).

10. What did we decide to do?

11. Since opening all clients of the Clinic are given a
visual time table
We wondered if an interactive online virtual tour
would further reduce anxiety.

12. Methodology:
Clients aged between 5 and 18 with initial appointments
at the Flinders Vision Autism Centre were divided
randomly (coin toss) into two groups
Control Group*:
Received no extra support before the visit.
Experimental Group*:
Were given access to an online interactive
walkthrough of the examination environment.
*Both groups had access to the visual time table

13. On arrival, a simple 5 point “How do you feel scale?” was used
Adapted from Buron, K. D., & Curtis, M. (2003). The incredible 5-point scale.Shawnee Mission

14. Participants from the Flinders Vision Autism center –
either self referral, OT or Autism SA.
N = 34 included with a Diagnosis of ASD.
Control Group Experimental
Male 15 12
Female 2 5
total 17 total 17
*Clients must have a recognised diagnosis of Autism Spectrum
Disorder to be eligible to attend this clinic.

15. How did we do it?

16. 10 Go Pro cameras
(pushed along with a broom stick)

17. https://www.youtube.com/watch?v=DQdlMARA6ck&feature=youtu.be
The interactive tour (2:35)

18. What did we find?

19. Total 34 (17 in each group) all diagnosed as being on the Autism Spectrum
No significant difference for age (p>0.4)
Case summaries
Group (N=17) M:F Age Anxiety
Video (N=17) 15:2 8.8 ±3.0 3.1 ± 0.8
No Video (N=17) 12:5 9.7 ± 3.7 2.4 ± 0.9
ANOVA >0.4 .01

20. Significant difference between groups at p= 0.01

21. In plain English:
There appears to be a significant difference in
reported levels of anxiety between the interactive
virtual tour group and control group

22. What does this mean?

23. The use of an interactive online virtual tour
when visiting the optometrist reduced levels of
anxiety in children with Autism Spectrum Disorder (ASD)
Preliminary results

24. The introduction of a short 3D virtual video of an
unfamiliar health care setting can reduce the overall
anxiety levels of children with ASD
Reported average number of views by parents was 2-3
times and children arrived looking for the
doorways/passages to the consulting room on arrival and
seemed more at ease with the surroundings.
Recommend the use of 3d virtual interactive videos for
places for children who are likely to have anxiety.

25. What next?
This preliminary study may have extensive implications
for future testing and assessment of health issues for
children and adolescents with ASD

26. Immersive
Interactive
3D experience
AU$6:00 AU$120
Big Bucks Mega Bucks

27. New equipment makes further research much easier
Old (high quality)
10 GoPros @ Au$550 each (Au$5500)
14 hours to stitch together
Very large file
Expertise required to stitch and upload
Powerful computer system required
New 360FLY (good quality)
1 camera @ Au$650
<15 minute to stitch together
Upload to a Youtube-like web page
Can be seen on a mobile phone
Little expertise
Can be uploaded from the camera

28. Can a virtual Tour reduce anxiety
in young Optometry patients with ASD?
We looked at:
......... the effect of an online preview of visiting the optometrist on the levels of anxiety in
children and adolescence with Autism Spectrum Disorder (ASD) …….
We hypothesised that:
…….. those who use the online preview will experience less anxiety before and during the
visit resulting in more reliable assessments and improved service …….
Our methodology examined:
……… The level of anxiety of those using the online preview is compared to those who
had no intervention before the appointment ……….
The result was:
……… A reduction in the level of anxiety during the visit

29. References
Biyani, S., Morgan, P. S., Hotchkiss, K., Cecchini, M., & Derkay, C. S. (2015). Autism spectrum
disorder 101: A primer for pediatric otolaryngologists. International journal of pediatric
otorhinolaryngology, 79(6), 798-802.
Elmore, J. L., Bruhn, A. M., & Bobzien, J. L. (2016). Interventions for the Reduction of Dental
Anxiety and Corresponding Behavioral Deficits in Children with Autism Spectrum
Disorder. Journal of dental hygiene: JDH/American Dental Hygienists' Association, 90(2),
111-120.
Chebuhar, A., McCarthy, A. M., Bosch, J., & Baker, S. (2013). Using picture schedules in
medical settings for patients with an autism spectrum disorder. Journal of pediatric
nursing, 28(2), 125-134.
Gebara, C. M., Barros-Neto, T. P. D., Gertsenchtein, L., & Lotufo-Neto, F. (2016). Virtual reality
exposure using three-dimensional images for the treatment of social phobia. Revista
Brasileira de Psiquiatria, 38(1), 24-29
Gorini, A., & Riva, G. (2008). Virtual reality in anxiety disorders: the past and the future. Expert
Rev Neurother, 8(2), 215-233. doi: 10.1586/14737175.8.2.215
Rothbaum, B. O., & Hodges, L. F. (1999). The Use of Virtual Reality Exposure in the Treatment
of Anxiety Disorders. Behavior Modification, 23(4), 507-525. doi:
10.1177/0145445599234001
Opris, D., Pintea, S., Garcia-Palacios, A., Botella, C., Szamoskozi, S., & David, D. (2012).
Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis.
Depress Anxiety, 29(2), 85-93. doi: 10.1002/da.20910

30. Dr Greg Carey
(greg.carey@flinders.edu.au)
Disability and Community Inclusion Unit
School of Health Science
Faculty of Medicine, Nursing and Health Science

32. Sum of
Squares df
Mean
Square F Sig
Years Between Groups
Within Groups
Total
6.618
374.000
380.618
1
32
33
6.618
11.688
.566 .457
Months Between Groups
Within Groups
Total
4.971
309.647
314.618
1
32
33
4.971
9.676
.541 .479
Anxiety scale Between Groups
Within Groups
Total
4.971
21.647
26.618
1
32
33
4.971
.676
7.348 .011
ANOVA
Significant difference between control and experimental group at p= 0.011

33. Significant difference between video and non-video groups (p=0.011)