Sight tests for almost non-verbal child with limited understanding

[ouryve]

DS2's getting to the age that DS1 was when he started to need glasses. DH is very short sighted and DS1 is following in his footsteps (DH didn't even need glasses until his teens)

Thing is, we spotted when DS1 was having trouble with his eyesight because he couldn't read the TV subtitles without walking right up to the telly - and then he was capable of cooperating with enough of an eye test to have his distance vision checked ( I suspect he has some of my family's astigmatism, too, but the tests for that are faffy!)

The problem is, DS2 plainly can't do this. He would need to be tested in the same way as a baby or toddler (whatever that involves). Would I need to ask for a referral to a hospital paediatric opthalmologist (he sees his paed in a few weeks, so we can bring it up, then) or is it normal to be able to self-refer?

I don't know the referral process, but would be inclined to ask at your paed appt in a few weeks.

DS2 had his eyes tested at 2 weeks old, so if they can test his, I am sure they can test your DS's too x

This

I've had that done at optical express when I had lens implants done (the machine thingy) maybe check with them? They have hospitals dotted about the country. Obviously only if you have silly waits for opthalmology.

The optician can do a simple version of that thing zzzz says by using the light they shine in your eye. There's a little dial they twiddle till they get a nice clear look at the back of the eye. When the view is perfect, the number on the dial equals your glasses prescription.

DD has had sight tests, since before she was verbal (and she isn't all that verbal now). Would your DS shout out animals or objects if shown pictures of them? Or numbers/letters? She deffo had a sight test at twelve months, so there are ways (I wasn't at that one).

Ds (2.8, non verbal, delayed understanding) sees a hospital opthamologist (referred via paed, but referral had to be done by gp) every 4-6 months. He has a series of tests where they hold pictures up, and watch the movements of his eyes, they examine the back of the eye (needs drops for this), and they do a test where we go into a dark room, and they point a laser gun thing (honestly,it wouldn't look out of place on Star Trek!) at his eyes and it takes a reading of long and short sightedness.

DS4 couldn't bear the refraction test (drops), so the last time two times it was done was under a General.

Bee was in glasses by the time she was 6 months old - so their ability to answer questions or identify pictures is not actually critical. The prescription can be determined by the use of lenses and a light... and in her case, now that she can be interactive in the testing, that which was done so long ago was remarkably accurate... her prescription has changed, but not to a degree that I would be led to believe that the original one was so far wrong...

As for self-referral, I don't have the first clue, sorry.

you usually need a referral to the hospital but it's not one you'll have to fight for. The hospital eye unit will be used to children who can't manage the standard tests, dd3 has had her vision reliably tested from 4 months and had glasses from 7 months, she still can't do the standard tests at almost 7. She sees a paed orthoptist and opthalmologist.

Thanks for the replies and sorry for not getting back to the thread sooner. It's definitely something I need to discuss with our paed, as she'll no doubt know better what's available in our area. And this is why we don't want him to be discharged. DS1 was straightforward, even if it sometimes takes a couple of visits to get him sorted. DS2 is a law unto himself!

zzzzz - that's another concern. He'd sooner touch a piece of broccoli than allow anything like that to be done to him. He's very defensive.

Mareeya, that looks like the sort of expertise we'd need, though it's completely the wrong end of the country.

Mummytomog - his vocabulary isn't wide enough for that - and there has to be some emotive factor for him to speak. This morning, I got treated to him flapping his arms, shouting "DS2 da bird!" because he's fascinated by birds at the moment. He might be intermittently chatty all day, or we might not get another recognisable word out of him for a few days.

I've had those eyedrops. They're horrible and leave everything really blurry and bright for ages, afterwards.

ninja - that's useful to know - DS2 is the same age. DS1's had glasses since he was 7, so if he has any deterioration in his sight, we want to catch it now, rather than when it gets to a point when it starts to hinder him on top of his own LD.

Of course, if he does turn out to need glasses, are there bigger versions of the ones for tots that hook right around the ears? He has the familial big 'eed. DS1's been wearing teen glasses from the start and looks like he'll need to move up to adult frames in the next year or so.

as far as glasses go, the eye unit may have its own optician which should be able to get hold of them, otherwise the independent opticians can be quite good at sourcing non standard stock but do check prices with them first.

when you get the appointment through give them a ring and see what they will expect of him so you can get some preparation in first. Practicing matching games and covering one eye at a time might be useful for orthoptist tests but don't worry if he can't do that as they can get an accurate prescription from looking in the eye with drops. Sun glasses are good for after the appointment too. You're likely to be there at least an hour for a first appointment if it's anything like our eye unit so take supplies

He tends to play with sunglasses, taking them on and off. In much the same way as he does with hats and gloves.

This is promising to be, er, fun

DD wouldn't let anyone look in her eyes after the drops, then she vomited on the lady with the light. Mind you, the daft bird kept singing (OUT OF TUNE) at DD to try and calm her down, and I was about to vomit if she didn't shut up. DD was quite unwell/unhappy for the rest of the day :( DH and I both fight over who has to take DD to the appointments, because it is pure misery, but it is at least over fairly quickly and they do seem to manage to get data and information despite madam's inability to cooperate.

DARN! I KNEW there was something I wanted to ask the paediatrician this year.

Oh, MTM - that's one where you don't know whether to laugh or cry.

I can imagine DS2 burying his head and presenting her with his bottom. That's his standard defensive pose, usually reserved for medicine (we should get some paracetamol suppositories - might more have luck with those) and vegetables.

saintly our appointment's 3 weeks away. Watch me forget to ask.

I would advise the hospial eye service too, although there may be a specialist peadiatric optometrist locally who could take over in future.
How well the child sees can be assessed even in young babies with the right equipment (e.g. preferential looking cards) - as long as they are awake, eyes visible and calmish for a few moments. Assessing the spectacle prescription if needed usually uses a light(retinoscope - the speed of the reflection from the retina depends on how well focussed the eye is) at adult arms length- the machines are rarely used with small children. Drops are nearly always used, (always on a first visit) to reduce the variables and get a good view quickly when looking into the eye. Drops relax the focusing muscles and dilate the pupil, so the child will probably be blurred for close up viewing and unable to focus. ds (who is more upset by disfunction than pain) hated the blur and got very angry - just to warn you. It recovers over time -by the next day usually depending on the drops.

Yep - I've had the drops and they're far from pleasant.

It's helpful to know in more detail what's likely to be involve. Thanks.

Hi Ouryve - is your DS2 going to the SN eye clinic?

My DD (nearly 3 with Down's) is also largely non-verbal and "stubbornly determined not to cooperate" (SENCO phrase not mine ) when she doesn't want to do something.

We go to the special SN eye clinic & the staff are great & v. Understanding, even when DD spends her whole time signing/saying "no, done!" & "bye bye, mummy coat". She's had glasses since she was 8 mths old & as others have said they prescribe her glasses using a series of different lenses & a light to watch how the beam bounces back. In the clinic they have Peppa Pig playing permanently in the back ground to try and distract DD & a whole range of toys for her to play with / look at whilst they do the tests, which sometimes works...