LOW VISION PRESENTATION

QUESTION 6 & 7

Prepared by : Ting Kiet HanYap Teck YuenHu Li PingChang Hui Leng @ Sharon

6. TYPE OF VISUAL TRAINING/THERAPY FOR ASD VISUALLY RELATED SYMPTOMS

AMBLYOPIAi. Correcting refractive error

optical should correct the full refractive error as determined with cycloplegic

ii.Patching Forcing use of the poorer eye by limiting use of the

better eye – occlusion of the better eye To patch dominant eye if there is a fixation

preference. Aim to alternate the squint

iii.Optical penalization - cycloplegic drugs

STRABISMUS

Distance Exotopiai. Vision Therapy

Used if angle of deviation < 20 ∆ diopters Antisuppresion exercise –enable appreciation of

pathological diplopia +ve fusional range improved with prism Synopthophore exercise +ve relative convergence improved with stereogram

(near fixation) Bino. convergence improved with convergence exercise

ii. 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

iii. 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

iv. Tinted Glasses For patient who are photophobic Reducing the amount of light entering the eye

can improve patient’s control over exotropia

CONVERGENCE INSUFFICIENCY

o Penci-to-nose exercise 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 talkEg: 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

STEP 2

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’

STEP 3

Guiding child’s glance 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

STEP 4

Be consistent 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