How important is an eye test for someone with complex disability?
Young man with Down syndrome leaning in to touch noses affectionately with an older father figure.
Families living with complex disability already have a lot on their plate. They spend a lot of their time sitting in hospitals and specialist’s waiting rooms, so an eye test might feel like yet another thing to add to their burden. However, checking vision is super important and shouldn’t be an arduous process. Here are some reasons why it’s so important.
If vision issues are not addressed they can form a very real barrier
If someone has vision issues that have not been identified, they will be living with a sensory impairment - i.e. there is a barrier to their receiving input from their visual senses. Think about how much we use vision day to day. Around 80% of learning actually comes from visual input, so if you can’t see properly, then this is a huge barrier to learning and making sense of the world around you. If you have a child who is learning how to use a communication system such as a POD (short for Pragmatic Organisation Dynamic Display) or PECS (Picture Exchange Communication System), an undetected sensory visual impairment could seriously limit their progress in learning how to use this system. And when they don’t progress, will anyone think to check if they can see the symbols clearly? How would you even go about doing that if the person in question cannot communicate this information to you? In some cases, family and carers may end up giving up on the communication system totally, concluding that their child was just not capable, when a simple adjustment such as glasses, or changing the position of the device could have led to a very different outcome.
Vision issues are much more common in people with complex disability
Just like in the general population, some people with complex disability are short or long sighted, and these problems can be fixed easily through prescription of glasses. And yes, it is perfectly possible to measure what strength the glasses need to be, even in someone who cannot speak, we just use objective methods, which means we assess without the need for input from the person we are testing. Of course, if the person can provide any level of input, we will fully support them to do so, and this will be taken into consideration, along with our objective measurement.
Presbyopia also occurs just the same in people with complex disability. This is a natural process, which we all experience throughout our lifetime, whereby the crystalline lens inside the eye hardens, preventing us from being able to adjust our focus for different distances. Usually this is experienced as increased difficulty in seeing things at close distances, such as looking at pictures, reading, and locating personal possessions. Most people start to need reading glasses somewhere around the age of 40-45 years, so if someone has not had an eye test before, and they are approaching this age, an eye test is important to ensure they can continue undertaking near tasks that they enjoy.
In addition to the above mentioned causes of vision impairment, for any person whose complex disability affects their brain, such as brain damage occuring at birth, following prematurity, people born with global developmental delay, those with cerebral palsy, or Down syndrome, there is an increased risk of Cerebral Visual Impairment, or CVI. This condition can cause reductions in acuity - the level of detail you can make out, but also difficulties seeing in a particular area of your visual field, such as on one side, or in the lower half of your vision, below eye level. You might have difficulties seeing when the scene is complex, such as picking out the items you need from a supermarket shelf, or finding a friend in a crowd, or your might have difficulties processing more than once sense at a time, so if things get too loud, you become unable to process visual information and seeing becomes too difficult.
Image of a supermarket shelf displaying an array of different products.
People with complex disability are not able to tell you if there is a problem with their vision
Imagine if your vision gradually declined, but you had no way of communicating this to anyone. For someone living with intellectual disability, or with a communication disability, this could be their reality. Without the ability to convey their changed situation, they may just stop doing an activity which they previously enjoyed. Maybe everyone just assumes that they are no longer interested, when in fact, they have developed cataracts, which could easily be removed. Behaviour changes can be a clue that someone’s vision has changed, so this should be considered an indication that an eye test is needed in someone who is not able to communicate this information for themselves.
What does an eye test involve?
Having an eye test usually involves one or maybe two visits to the optometry practice. We can discuss beforehand how best to support the person having the eye exam and come up with a plan; we are also aware of the need to be flexible on the day and adjust as needed. If someone cannot answer questions or undertake tasks such as reading letters off a chart then there are lots of alternative methods we can use to determine what they can and cannot see.
Importantly, most recommendations following an eye test are for small adjustments to the person’s environment, rather than extensive therapy sessions. We might recommend that, when attempting to show the person something, it is best to present it within a particular area of their visual field - this is how far out to the sides, and above and below a person can see - since this may have been assessed to be where the person’s vision is most reliable. Similarly, we might highlight that someone needs to hold things very close in order to see them as well as possible. We might make recommendations for what would be the best lighting levels (lights on full, or reduced) and give advice on controlling glare. A few relatively small tweaks to the environment can make a surprisingly big difference. Of course, if we find that glasses would be beneficial, we will make that recommendation as well.
If you are interested in learning more, please get in touch via phone: 07 35446167, or email: reception@specialeyesvision.com.au.