My youngest son, Daniel, was diagnosed with autism at the age of 3 1/2 years old. Our family was thrown into our own “how to navigate our autism” journey. Although my son has limited language now, he was essentially non-verbal in those early years. Communication was difficult. Thankfully, here and there, we met wonderful providers, teachers, friends, and others who reached out to us, took time to share their knowledge and expertise, and tried to prepare us for what was soon to come (like IEPs – WHEW!!!).
I don’t remember who suggested or referred us to a developmental ophthalmologist, but getting my son an eye exam was not my idea at that time. It had been recommended, and having an eye exam to rule out any need for further intervention was important. I also knew that regular eye exams can reveal problems in the early stages to avoid serious complications. But I had LOTS of questions. Thinking about how to execute this plan for getting my son into the office for the eye exam, getting through the wait time to be seen, getting through the examination by the doctor and staff, etc. – it was all more than stressful. How does a child who does not speak, cannot sit still, does not follow directions – for anything – cooperate or have meaningful participation in the eye exam? My son at that time could not identify colors, letters, answer to his name, etc.
What? How exactly was this going to work?
Let me tell you that it all came together and worked out remarkably well. We discovered that an eye exam is possible even if your child is non-verbal. Our eye doctor used different eye chart symbols (shapes, letters or pictures) that my son could use to communicate. Verbal directions were clear and concise, paired with pictures and gestures, and additional time was extended to allow him to process what was said. The doctor did not need a great deal of communication from my son to be able to determine his eye health. I was amazed. If you have not attended to your child’s vision health needs, please act and schedule an appointment for an eye exam. Here is a recommended schedule for eye exams.
Strategies and tips to prepare for your visit:
- When scheduling your appointment, request more time for the appointment if you think it will be necessary. Let the office staff know if your child/adult needs an available quiet space.
- How long you will have to wait for your appointment is often unpredictable – request the first appointment of the day or immediately after when office staff first return from lunch to minimize your child/adult’s wait time.
- Prepare your individual for their eye exam visit with social narratives, visual supports or videos. Examples are included in the “Social Stories/Visuals” section below.
- Ahead of your appointment, play pirate with eye patches to prepare for the upcoming exam.
- Visit the website ahead of your appointment date for views of the office building, waiting rooms, exam rooms, and any pictures of staff your child or adult may be interacting with soon.
- If possible, go by the office days ahead of your appointment and do a walkthrough. Consider requesting a first appointment to show the child/adult it is a safe place and to get them comfortable. Walk into the waiting room, exam room, etc. The second appointment would be for the actual eye exam.
- Request any patient paperwork to fill out ahead of your visit and bring with you. Or register online before your appointment date.
- Bring your list of questions, vision concerns, or things you have noticed to the appointment.
- Bring the child/adult’s preferred communication device with them to the visit – PEC system, communication board, communication device, iPad, etc.
- If the child or adult has previously had glasses or contacts – bring them with you to the visit.
- Eye drops may be used as part of the exam and will make the child/adult more sensitive to light for a few hours – bring along sunglasses or a cap when exiting out of the office.
Social Stories/Visuals for Eye Exams or Eyeglasses:
A social story or visual aid may focus on the main points of the exam or may describe each step in getting an eye exam – from arriving at the office or clinic, entering the exam room, meeting with the doctor, and preparing for each procedure or test. Here are some options to consider:
- The Autism Society of North Carolina maintains a library of social narratives
- The Autism Friendly Initiative at Boston Medical includes many health-specific social stories, available in five languages. Some relevant stories:
- Presentation/social story from The Eye Center at the Southern College of Optometry
- Social Story Developed by the Centre for Optometry and Vision Science at Ulster University
- Visual Supports from the Indiana Resource Center for Autism
- YouTube video: Optometry Chair Tour – A Guide to All the Toolsand Equipment Used At An Eye Exam
- YouTube video: What Happens at the Eye Doctor?
Options for covering the costs of eye exams and eyeglasses, etc.:
- Private insurance policies – check with your carrier for coverage details. Ask about benefits for vision and medical exams.
- Be sure to bring in your current insurance card for your appointment.
- Medicaid–https://nc.preventblindness.org/medicaid-eyecare-benefits-for-children/
- Medicaid Benefits / Children: (age 20 or younger)
- Annual routine eye exam and prescription glasses if eligible.
- For additional information about replacement glasses and other vision services, please call NC Medicaid at 1-888-245-0179.
- Medicaid Benefits / Adults: (age 21 or older)
- May be eligible for a routine eye exam and prescription glasses once every two years. Co-payments apply for adults.
- Medicaid Benefits / Children: (age 20 or younger)
- Medicare:
- For adults under Medicare:
- Medicare does not cover vision exams nor glasses.
- Medicare will pay for eye exams for adults if you have a medical diagnosis, (i.e. such as pink eye, diabetes, glaucoma, cataracts, headache, macular degeneration, dry eyes, etc.), but a deductible does apply.
- For adults under Medicare:
- If the individual is not covered by Medicaid –
- The Medical Eye Care Program uses every available resource to prevent blindness and restore vision in people who are at risk for losing sight or have lost sight.
- Check with community programs/organizations that assist with paying for vision health services:
- Prevent Blindness NC has a directory of national financial resources for vision care.
- VISION NC (formerly Vision USA) provides free eye exams to low-income, uninsured individuals in NC. If you need an eye exam, do not have insurance, and cannot afford one, work with your social worker, case worker, charitable organization, or agency to submit an application on your behalf for VISION NC services.
- Vocational Rehabilitation for the Blind
Additional Resources:
- Pathfinders for Autism: Going to the Eye Doctor Fact Sheet
- American Academy of Ophthalmology: Eye Exam and Vision Testing Basics
- Autism Parenting Magazine: My Child with Autism is Afraid to Have Vision Checked
- American Academy of Ophthalmology: Screen Use for Kids
Jan Combs is an Autism Resource Specialist in the Triangle region. Autism Resource Specialists are available to help individuals and families in every county of North Carolina. To be connected to the Autism Resource Specialist near you, please fill out this form.
Tags: autism, autism health care, autism insurance, autism medicaid, autism north carolina, autism resources, Autism Society of North Carolina, eye exams, vision health