Can the hospital check eye health without shining a light in them?

[AnotherTrickyOne]

Hi,

I wondered if I could ask a question about how the hospital examine people's eyes if we go to the clinic there?

My son has a problem with his eyes just now. He can't look at screens even in his peripheral vision without getting severe pain in his eyes. He also can't read without severe pain. He is okay with sunlight and with ordinary light bulbs.

He's in a complicated situation, because he is out of school with anxiety. The anxiety is partly medical trauma from baby-years surgery and partly school trauma. It makes it very hard for him to access medical help.

Here is what happened:

He needed new glasses about 3 years ago but the new glasses (four different pairs) always caused distortion and motion sickness so he never made the transition.

Finally he entirely grew out of his old glasses a few weeks ago, and we went to a new optician who made up yet more glasses for him to try. While he was waiting for them to come, he had to do all his home school work with no glasses and his eyes got very sore. I think it was because he was sitting very close to the screen reading, and also doing that with his new glasses to try to get use to them.

The optican then adjusted the interpupillary distance on the glasses, which they had not managed to meaure before. The new glasses arrived and he can't put them on because the prescription change is too big to adapt too, and his eyes are really sore.

Sometimes he gets vision distortion like a fish eye lens (but only once) and yesterday we came out from visiting a neighbour and he had lost his 3D vision entirely, It took several minutes to get back to normal.

He hasn't used a screen or read a book for more than a week but it is getting better only a little and only extremely slowly.

He is worried about asking the optician to check his eyes because we think they would want to shine a light into his eyes.

I wondered if you think there is any way they could look inside hs eyes without shining a light?

We have been to see two opticians since this happened and they said it is just eye strain and dry eye and definitely not anything urgent. There is no redness or anything.

We are not sure about putting in artificial tears, because he does tend to have reactions to things.

We would just like to find a way to get his eyes better.

We have contact with an access nurse at the hospital and we will talk to her tomorrow. She could ask for use to go to the eye clinic, but she and I are just not sure if there is anything that they could do and we don't want to stress him needlessly. We'd have to walk there, which is a 7 miles round trip on foot, so if there is no point going, we're rather not.

I would be grateful for any ideas.

Thanks!

What kind of glasses prescription does he have? It sounds very severe to have the kind of reactions you describe. They should not cause distortion or motion sickness. I’ve heard of varifocals causing this, but does your son need varifocals?

What has your optician advised ex your son getting used to the glasses?

I’m a bit confused by your son being ok in sunlight and with lighting but being unable to see a screen. Sounds like his eyes have been strained by being without glasses for a week and his close vision has been affected?

re the anxiety, the optician may well have to use a light to shine in his eyes. Isn’t this an opportunity to show that the light is harmless? He can’t avoid everything he may be anxious about.

His prescription is -5 for myopia and just 0.5 for astigmatism in one eye. I think he's going up from -3.5.

Telling someone with very disabling medical trauma PTSD and severe eye pain from lights to stop being anxious and look at the very bright light, is not really realistic.

My question really is whether they have a way to examing people who cannot look at very bright lights. Given that some eye problems cause photophobia and severe pain on looking at lights, I figured that they would have found a way.

Thanks.

I also don't understand why screens are a problem even from a distance in his peripheral vision and lightbulbs aren't. He doesn't either.

In my experience they need to see inside the eye and that meant using light to do so.

Are the clinic aware of your son’s PTSD? Does he have any other additional needs that need to be considered?

Unfortunately if he wants relieve from the problems he is having he will have to be uncomfortable for a few minutes whilst being examined which may include a light being shined into each eye.

The same as a needle phobic has to allow a blood test.

I am needle phobic and I deal with it by telling them at the reception that when my name is called I will be closing my eyes and would the nurse guide me to the chair.

It makes the whole thing easier for them and for me if my eyes are shut and I cannot see.

You will have to look at ways that your son can overcome his fear so that he can be looked at.

Might be worth having a look at SeeAbility website advice https://www.seeability.org/sites/default/files/2022-09/Making%20eye%20tests%20easier.pdf

My son has level 1 ASD and cPTSD. I think part of the problems are to do with the sensory problems of the ASD which have been heightened by the PTSD and then sent right off the scale by the school trauma.

He had surgery twice as a baby and had many many examinations by medics and became extremely afraid of medical examinations. He's never been able to do things like going to see Santa at the garden centre, because it is a man alone in a room and that is a very frightening concept for him.

Then he went to secondary school where they use constant screen work and lots of "horrible histories" style teaching and lots of actual distressing material and he had a nervous breakdown at 13. The school were not sympathetic and the process of leaving was very very traumatic and left his trust in adults in the public services at rock bottom. This seems to have made his sensory problems go right off the scale. At the moment he can't cope with the sound of baking paper being cut very gently with scissors and plastic bags being taken out of the freezer seems to be really excruciating just because of the sound.

I think that all this may be partly why sensory things around his eyes are so extremely difficult just now, because the school and medical trauma has just made his sensory sensitivities go off the scale. The ASD also means that he can't communicate verbally very well with medics.

If it was me, then I could explain to the optician what I can and cannot tolerate. However, my son will go into an optician's office and roll up on the floor with his eyes shut and his hands over his ears, and nothing will shift him from there except the annoucement that it is time to leave.

I am just wondering if there is anything that they can do that doesn't involve pointing bright lights in his eyes.

Maybe they could tell just from a patient history over a zoom call or something?

We're partly wondering because he is an absolute whizz at computer science and wants to sit his mock GCSE exam soon. He can do it with a scribe and reader as if he was fully blind, but obviously it would be easier if his eyes were working again.

Hi OP, the light is so they can see into the back of the eye and look for any damage/issues with his retina and optic nerve. I'm very light sensitive and ask them to turn it down as much as possible but they do still need it. I would suggesting finding a good local independent optician who can take the time to explain everything to your son. It is also def worth trying the eye drops because it can make a huge difference.

How is he being tested for these glasses? It doesn't matter how much of a change a prescription is, if the new prescription is correct it should be much easier to see than the old one. Is it possible the discomfort is coming from wearing the glasses themselves? Pressure on the side of the head or bridge of the nose?

@LivingDeadGirlUK Thank you very much for such a kind explanation.

Your last question does actually help me to think it through a bit. Would it be okay if I think aloud a bit and that might help me figure it out?

I think that yes, the problem is partly the experience of seeing in focus at all.

My DS has this odd kind of ASD that comes with special skills built in. He has tremendous pattern matching abilities that allow him to read foreign languages that he has never seen before. He also reads written music very fast and was able to read chapter books in reception right from the get go, when I had not taught him to read.

His language decoding skill is curently being focussed on computer programming and he is learning to program in many different languages at the same time.

The flip side is that when he sees things that are not meant to be read, his pattern matching brain latches on to the patterns, and tries to interpret them like written language, and then his brain gets the jimjams. I mean things like the branching patterns of trees.

He loves to read books, but we can't enter the book shop, because he is so fast at reading that he can read all the titles on the spines of the books at once, and many of them are about nasty subjects which he finds scary. So we never go into the book shop.

Just recently he has found it useful to leave his glasses off because that turns off the fiercely strong pattern matching machine in his brain. That way he isn't bothered by trees and bits of text, and adverts and things.

The therapist said that DS has a brain like a hoover and we need to get a filter for it so he doesn't hoover up a lot of rubbish and mess up his motor. I think that taking off his glasses provides that filter.

Conversely, I think the very strong new glasses give him such sharp vision that it really is a bit of a problem for him, because then he is overwhelmed with detail. Maybe he is happier without them than with them?

The problem is that without glasses, he also can't cycle anywhere so we have to walk everywhere and that is a lot of walking. He also doesn't have glasses to read or use the screen and that is a problem.

I have asked him if he would like glasses with less myopia correction so that he could cycle and read, but not see all the fine detail that bothers him. He told me to boil my head, which I think is because the whole thing is just very stressful and he is 15.

Maybe I should ring the optician and just ask them to make up glasses with a reduced myopia correction so he could try them without having to have the discussion?

The problem with the old glasses was not that he couldn't see far enough. The problem was that his head had grown so much that his eyes were a full half centimetre further apart then the lenses were.

Maybe the thing is to get new glasses with a less strong myopia prescripton, but with the lenses the correct distance apart?

I think that could be good actually.

This might be no help at all, but what about an optician that can come to your house, and as a first step focus solely on getting glasses that your DS can tolerate? So no eye examination, just trying out different lenses.

Thanks for the suggestion. He did actually have a full eye test really recently so we are confident that we have the right prescription. He has also had the interpupillary distance measured, so that part is definitely right.

I think the problem is that when he was waiting for the glasses to arrive and then trying to adapt to them, he sort of sprained and burned his eyes from staring at the screen to close without glasses, and by staring at the screen with his new glasses.

The optician says it is severe eyestrain and dry eyes, so that would actually fit with what they said.

Thank you for listening to this. It is helping me a lot to think out loud.

I'm now trying to work out how to get a second frame in the right size. It's really hard to get teen sized frames which is one of the things that got us in this mess in the first place.

Why are you using glasses?

my ASD child could not adjust to glasses. The sensory issues were too much. We even did CBT for glasses for months and it did not help at all. We taught her to put in daily disposable contacts by age 10. Vision problems solved. No more eye strain. No more sensory issues.

my child got to the point where she could understand that she needed to have the medical thing happen and would consent to me holding her firmly while the doctor very quickly did what was necessary. Her issue was needles and she got over it. Me holding her plus CBT eventually worked, but it takes time and needs must.

I also often contact medical providers in advance and explain the situation. She gets very angry if I talk about her when we are there, like if I go back without her or speak in front of her. So I call ahead and warn them that we need special provisions. Then they are ready for us when we arrive and we don’t have to talk about the ASD or the phobias.

No advice from me, other than my adult son, 34 cannot stand light being shone in his eyes from an early age. We were lucky after a disaster visit to opticians to get to see an elderly optician who also worked at our eye hospital, he was very kind and considerate and DS was a lot better, but he’s never let them properly look at the back of his eyes, he’s ok with all the other equipment. I would try and get other glasses that are not so strong.

With my ASC dd we prepare her for a long time. At a hospital they should have a team specialising in disabled patients. When my daughter was briefly in hospital they were brilliant. They are skilled at working through procedures and explaining.

Is there any reason why you can’t communicate for him? I do that for my dd. So you explain about the fears beforehand.

My dd also did some neuroaffirming therapy, which really helped her understand her anxiety, the purpose of anxiety and ways of managing it. She is now much less scared of being anxious.

Thank you very much @FoxRedPuppy @Lennonjingles and @Ponderingwindow, I will have a think about all that.

-How old is he? At first I thought he was a young child, but I assume he is an older teen?
-Is he having any counselling, support, meds, therapy for his trauma?
-Would he allow you to go into the room with him?
-I agree that the light is to check the back of the eye health. I'm not aware of an alternative, but then I'm not an optician
-Does he already have an appointment date/time? I'd ring, explain and situation and ask if there is a quieter time of day? First appointment of the day or maybe last of the day? Ask if there is another option to the bright light or can it be turned down? Is there a home visit option?
-To echo what someone else said, I recently had 2 pairs of new glasses. 1 pair was a few mm's tighter on my temples and gave me a headache as soon as I'd put them on. The opticians managed to mould the arms slightly and they are perfect now
-If he has multiple allergies and you are worried about moisturising eye drops, maybe test them on his inner wrist area (like a patch test for hair dye etc) with n occlusive dressing over the top and see if he gets any rash/redness before putting into eyes.

The reaction to light is not anxiety but pain plus disorientation. I suffer in a similar way. Awful for him to be so misunderstood ! Hes lucky to have your thoughtful support OP.

I already commented up thread but can't amend it now.

We'd have to walk there, which is a 7 miles round trip on foot
Is there a reason you can't use public transport, a friend/family to drive you or a taxi?

For dry eye
i take an injection every 2
weeks that causes severe dry eye, ironically the injection is to treat my allergies.

i have multiple allergies and am still able to find eyedrops that I can use. You have to read every label and patch test, but really most eye drops are just water, salt, and a preservative. You just have to find the right one.

dry eye treatment isn’t just about drops. You also clean your eyes with light friction and extremely mild soap. I buy a product to help with this but it is cheaper to diy. The eye doctor should explain everything.

also 10 minutes a day of warm compresses. I listen to short podcasts and have a microwave safe eye pad because a wet cloth on my face triggers my ASD sensory issues so the dry eye mask works better.

I’ve had petite frames from specsavers before as I have a small face. They are great. Im sure they do kids ones too

It’s always worth double checking if you are worried about your child’s health but I’ve had eye strain and dry eye in the past and it does sound like that to me. It’s really hard to look at screens and books with eye strain. If possible he needs to take eye breaks where he looks away to something in the distance. I also have struggled with anxiety which seems to exacerbate instances of eye strain. Not having a comfortable prescription will make it worse so I’d concentrate on getting glasses he is happy with and being consistent in getting him to wear them. I’m not sure about the reasoning behind not giving artificial tears. You can get them over the counter. They are not a long term thing but will help over short periods.

This might be out of left field op but if it's light from screens that is the main issue it might be worth considering blue light lenses, they're designed for people using computers a lot as they reduce eye strain. As for day to day wear if he'd tolerate it then tinted lenses might help too, as it would dim detail a little without being the wrong prescription and risking further eye strain. In order to check his eyes they do need to shine the light, my granddaughter has albinism and her eyes are very photosensitive and they still have to use it for her, but if he's had a recent eye test it's unlikely it is anything more than eye strain.