The eye examination: tips for optometrists

1. Clearly communicate the tests

Before conducting tests, describe what you will be doing:

  • Briefly explain the purpose of the test.
  • Explain what the patient will need to do without making assumptions. For example: “I am now going to show you two lenses. Tell me which of these makes the circle appear clearest and roundest. If you can’t choose between the two that is fine, just let me know.”
  • Show the autistic patient the equipment you will be using for the test and describe how it will be used. Tell them if you or the equipment will touch their face.
  • Show and describe any retinal photos or scans to the autistic patient.
  • Report test outcomes as you go along the examination. If this isn’t immediately possible because you need to do further tests to confirm your findings, inform the patient of this.


2. Adapt your routine by considering the autistic patient’s sensory challenges and comfort levels

  • Conduct the more demanding tests earlier in the eye examination.
  • If the autistic patient is struggling with subjective tests, rely more on objective tests such as retinoscopy and cover test.
  • Minimise exposure to stimuli which could cause sensory issues for the patient, but cannot be eliminated. For example, check pupil reactions during direct ophthalmoscopy or slit lamp examination rather than separately at a different point in the eye examination.
  • Substitute tests which cause sensory issues where possible. For example, measure NPC remotely rather than with an RAF rule that can cause touch sensitivity.
  • Offer optional breaks during the examination.
  • Reassure the autistic patient that they can ask questions at any point during the examination.
  • Consider splitting the examination over two visits if the patient is becoming overwhelmed or stressed.


3. Ensure all presenting queries/concerns are addressed in conclusion

  • Refer back to the patient’s presenting complaints and respond to them one by one with your findings or management.
  • Write down or provide a written report of the examination findings so that the patient can digest the information in their own time.
  • Reassure the patient that they can contact you for any further questions.