Eye care for everyone: Accessible eye care for children with special needs


Parents may hesitate to book an eye exam for their child with special needs, thinking the child may find the optometrist’s office and equipment uncomfortable or off-putting. 

These concerns should not stand in the way of children receiving their annual comprehensive eye exam. While there is usually a set structure to the exams, many optometrists are adaptable and capable of providing accessible care.

Technically speaking, all optometrists have the knowledge to treat a child with special needs since a comprehensive optometric education prepares them to care for all types of patients. Some optometrists have advanced, post-graduate training and experience in paediatric vision care. However, according to optometrist Dr. Catherine Chiarelli, member of the Ontario Association of Optometrists (OAO), parents should notify the optometrist of their child’s special needs when booking an appointment. 

“It opens the dialogue to figure out a child’s personality before the exam, so that the optometrist can mold the exam to suit their needs,” explained Dr. Chiarelli. “Many optometrists recognize the importance of treating children with special needs because they’re at a higher risk for vision and eye health problems.” 

Children with special needs are prone to strabismus and structural abnormalities of the eye, such as optic nerve under-development. They are also at a higher risk for farsightedness, nearsightedness and astigmatism. 

“Fifty to 80 per cent of children with special needs require glasses. This is especially high when you compare it to the 25 per cent of children without special needs who wear glasses,” Dr. Chiarelli stated.

The first visit may be nerve-wracking for the parent and child, but optometrists have different ways to communicate and conduct their exams.  

“I try to create a calming environment and keep aspects of the exam that require physical contact last. While I’m speaking to the parent about medical history, I am carefully observing the child. Does he tilt his head? Does she favour one eye over the other? This is still part of the exam - only thing is, the child doesn’t realize it.” 

For aspects of the exam that usually require verbal communication, an optometrist can use pictures to play the matching game while simultaneously testing visual acuity. “So, while it may be an hour-long exam, it’s done in increments of five to 10 minutes, alternating between observation and fun activities as to not overwhelm the child,” said Dr. Chiarelli. 

Alternatively, children who are non-verbal can communicate using sign language, if the optometrist knows common signs. They can also point or use gaze preference, having the optometrist observe where the child is pointing or focusing their attention. 

Regardless of the circumstances, optometrists make sure to communicate with the child’s parents, pediatrician, speech-language pathologists and other health-care providers to allow as much communication between the optometrist and child as possible. It also ensures the eye exam addresses any concerns they might have about the child’s vision and eye health. 

OAO recommends children with special needs start having comprehensive eye exams at 6 months, and every year thereafter. Eye exams for children are covered by OHIP up to 19 years-old. Upon turning 20, individuals with special needs can apply for extended coverage through various programs such as the Ontario Disability Support Program (ODSP). 

Comprehensive eye exams for children with special needs may seem like a daunting process, but the end result is knowing that the child has received the eye care he or she requires.

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