Today I examined a 9 year old boy with autism. He had been examined 2 years ago and glasses were prescribed for full-time wear. But his parents never had the glasses made. They sought a second opinion and were told he only needed the glasses for reading. Mom would often read with him and never noticed any difficulties and so decided that he probably didn’t need the glasses at all. Now, two years later, his teacher called home because he was having difficulty seeing anything written on the board unless he walked to the front of the classroom. So mom brought him back.
This child is VERY hyperopic and astigmatic. Without lenses, his visual acuity at both distance and near is significantly reduced. He also has an exotropia (his eye is turned outward) which is much worse when he does not have appropriate lenses. When I put the lenses on, his vision improved. But he is amblyopic. Because he has always had blurry vision, he has not developed the ability to see the smaller letters or use his vision effectively. I expect his vision to improve as he wears the lenses.
I wanted to laugh and cry. I was happy that I will have a positive impact on this young child’s vision and his life! He will be able to participate much more actively in all his activities. His autism surely poses other difficulties in his daily life and I am thrilled to eliminate (or at least mitigate) any visual deficiencies. I am giving him a chance to interact with his world in a much more meaningful way. But 2 years lost……… what if he had received those glasses 2 years ago? What opportunities to learn and grow have been lost because he could not see?
It takes two. I can do my part but I need help! I need parents too. I need parents to bring their children in for comprehensive eye examinations. I need parents to ask questions if they don’t understand. I need parents to comply with treatment plans (even if their children are not happy), I need them to return for follow-up care.
Parents, please help me help your child. Schedule that exam. Make sure your child wears the glasses in school. Call me if you have questions or concerns. Together we can accomplish so much, but I can’t do it alone.
Mindsight 
Hi Shelly,
Thank you for sharing this story. It brings up a very real challenge for all clinicians: How do we COMMUNICATE so that the message we are trying to share is received??
The heartbreaking aspect of this tale (and many other similar ones) is that the individual who is impacted, the child, has little or no role in the final decision. And when it comes to vision, the child may be unable to communicate a problem, or unaware that a problem exists, because s/he never had an opportunity to know any other way of seeing!
In most cases, the parent probably never makes a clear decision to go against the doctor’s recommendations. These are busy people, and life keeps moving. So often, they just put off the decision to act on the recommendations… and they put it off for so long that it became a moot point.
How differently might this boy’s development have progressed if the parents had taken the time to ask you to re-inforce the reason for your recommendations?
Part of the challenge to us clinicians is the health care system. Time is not frequently available for clear communication between doctor and patient. It’s a two-way street, indeed, making sure that the message is not only given, but also received. How might the subsidizing of doctor-patient-communication time save on future health care expenditures?
Food for thought…
Warm regards-
Samantha
Hi Shelly, Thanks so much for your posts. This one also made me want to laugh and cry! It is a good reminder that we can never educate our patients enough about the power of lenses!
My son, now 15, needed glasses early on as he was very farsighted and I remember his dad saying are you sure he needs glasses? I had to explain how glasses would help his fine motor and reading that small print. I laugh and cry since my husband has about the same amount of farsightedness as my son and he didn’t get glasses until he met me after struggling through college.
My second, now 13, has one eye that sees fine and the other was aniso-amblyopic. To this day, she wonders why she needs to wear a contact lens on that eye when she plays sports. I’ve had to tell her over and over that it’s so critical for accurate depth perception since she plays softball and basketball.
And, just today, my youngest daughter, now eight, who needs +0.75 for near said to me, “I see fine, why do I need to wear glasses?” I had to tell her how important it is to use them to prevent vision problems later in life, so that she won’t need glasses to see far away and that her eyes won’t get so tired when reading. This is something that I tell patients all the time, but my daughter looke skeptical.
I’m sure there are many moms and dads out there that get the same questions from their kids, spouses, teachers, grandparents. Thanks for asking them to help us help their children! Well said!
Dr. Mozlin, Thank You! As an occupational therapist who specializes in handwriting assessment and remediation, I have witnessed the difference that a vison assessment – and adherence to the optometrist’s recommendations – have made in a child’s life! You are so right – it DOES take two!
Thanks so much Katherine, and I am beginning to think it takes three…. or four…… many times it takes a village.