Visual sensory and eye examination experiences

We conducted focus groups to understand autistic adults’ visual sensory experiences and their opinions about eye examinations.

Who took part?

A total of 18 autistic adults without learning disabilities took part in this study, of which 6 were female and 12 were male. Most of the participants wore spectacles and some had eye conditions.

There were between 4 and 6 participants in each session, with an age range of 25-67 years.

What we asked

Our participants discussed their responses to the four key questions provided below.

Do you feel you experience any visual problems or unusual visual experiences?

The discussion covered participants’ visual experiences and vision-related knowledge.

• Visual experiences

The participants expressed a range of visual sensitivity issues associated with light and patterns, varying from person to person. They also discussed issues surrounding eye movements, for example eye tracking, visual location and preventing double vision.

• Vision-related knowledge

The level of vision-related knowledge varied among our participants and correlated with an emotional response. The greater a participant’s understanding about the normal ageing processes of the eye, the less stressed they felt about their vision and eye health.

Do you feel you can do anything to improve these symptoms?

Participants explained that visual symptoms usually occur as part of the larger multisensory experience.

They discussed the effectiveness of strategies to cope with visual symptoms, such as:

• avoiding visually cluttered environments;
• preferring certain types of spectacle frames and lenses;
• tinted lenses and alterations to lights.

How do your visual issues impact your daily routine?

The discussion was about wellbeing, personal life and the public’s perception of autism.

• Wellbeing

The participants described the negative impact of their visual experiences on their physical, mental and emotional wellbeing.

• Personal life

Visual experiences can impact an autistic person’s home life, social life, ability to visit public places and travel.

Although most participants spoke of the disadvantages caused by their visual issues, some did describe the advantages associated with them. For example, sensitivity to detail was seen to be beneficial in an artistic capacity.

• Public perception of autism

Participants were generally disappointed with the public’s understanding of autism, with a particular emphasis on anxiety caused by discussing sensory issues with potential employers or service providers.

What are your experiences of eye examinations?

Participants discussed a number of issues that had arisen during eye examinations and ways in which these examinations could be be changed to make them more autism-friendly.

• The optometric practice

Participants described the importance of an accessible layout in an optometric practice. Practice staff need to be more aware of issues faced by autistic individuals to enable them to provide more accessible services. For example, many autistic individuals prefer booking appointments online.

• Testing techniques

Optometrists should provide clear information and have a robust questioning technique during eye examinations, especially when an autistic person is required to respond to images.

Although some participants said that they enjoyed the structure of an eye examination, others expressed that it could cause stress and anxiety.

• Patient-practitioner relationship

Practitioner continuity is recommended as it can take time for autistic individuals to get used to a new person. The practitioner should be attentive, compassionate and understanding so that they can build a good rapport with the patient.

The practitioner should also provide a clear explanation of each stage of the eye examination and a breakdown of the results.

• Patient education

Participants said that practices should provide autistic patients with information about what to expect prior to their eye examination, enabling them to feel prepared for each stage of their visit.

Practitioners should also ensure that their patients’ queries are addressed to avoid any unnecessary stress.

What we concluded

Our focus groups concluded that:

• in their current format, eye examinations are inaccessible for many autistic individuals;
• autistic adults are largely dissatisfied with their vision and experience a range of visual symptoms, but these vary from person to person;
• visual symptoms can occur alone or as part of a larger multisensory response; vision contributes to sensory overload and emotional responses;
• autistic adults employ a variety of strategies to cope with their visual symptoms;
• visual symptoms or experiences can both positively and negatively impact autistic adults;
• to make eye examinations more autism-friendly, improvements should be made to practice layout, the manner of the staff, testing procedures and information provision.