1. LOW VISION PRESENTATIONQuestion 6 & 7 Prepared by : Ting Kiet Han Yap Teck Yuen Hu Li Ping Chang HuiLeng @ Sharon

3. To patch dominant eye if there is a fixation preference. Aim to alternate the squintOptical penalization - cycloplegic drugs

5. Antisuppresion exercise –enable appreciation of pathological diplopia

6. +vefusional range improved with prism

7. Synopthophore exercise

8. +ve relative convergence improved with stereogram (near fixation)

11. Used pre-operatively to obtain control & often combined with orthoptic exercise

14. This so-called push-up is repeated 10 times, 2-4 times a day, until the patient is able to hold fixation to the tip of the nose. *Be Caution :While doing the pencil push-ups exercise it is important that you do not strain your eyes while looking at the pencil. Straining your eyes causes accommodative insufficiency.

15. Ambient lenses or Yoked prisms Also known as conjugate prisms or performance or transitional lenses which can be used to help modify ambient vision They are special lenses that bend light in the same direction: up, down, left or right They are used to improve posture, head-tilt, and coordination is autistic youngsters These lenses can have dramatic results by creating a difference in how the world is seen and allows the person to change how their world is perceived

16. Ambient lenses or Yoked prisms During visual evaluation, an activity such as throwing and catching a ball, walking up and down stairs may be done While wearing different powers of yoked lenses, the same activity is repeated and evaluated Yoked prisms may be prescribed for special activities or for full time wear

17. Trying out yoked prisms Try five prism dioptres of yoked prism in several different directions to elicit an improvement in walking, sitting down and even playing catch If one direction works best, introduce a lower amount into the spectacle prescription Yoked prism alters the oculomotor state, affecting sensory function

18. Irlen Lenses Is a non-invasive technology that uses colored overlays and filters to improve the brain's ability to process visual information It improves an individual’s behavior and/or reading ability by filtering out those frequencies of the light spectrum to which the individual is uniquely sensitive It can improve reading fluency, comfort, comprehension, attention, and concentration while reducing light sensitivity It is not a method of reading instruction but a color-based technology that filters out offensive light waves so that the brain can accurately process visual information

19. Rapid Eye Movement Therapy (R.E.M) It is a non-evasive technique The therapist has an object (a stick or a wand) for the patient to focus on, and quickly moves it back and forth, in various eye levels and positions to simulate the movement and fluttering of R.E.M. The therapist then gives commands to the patient to release the traumas and emotions that are surfacing, and these are released via the eyes through rapid blinking

20. Attention Training The use of overcorrection avoidance to increase the eye contact of autistic children. Functional movement training (an overcorrection procedure) plus edibles and praise to develop eye contact. With the overcorrection procedure, the child is given food and praise when eye contact occurres within 5 sec of the therapist's verbal prompt: "Look at me."

21. Question 7 Social gaze looking Also known as social avoidance The autistic child simply chose not to focus on a particular face and gaze randomly Autistic child always seemed to be ‘looking through you’ rather than ‘at you’ Their eyes were working independently, rather than together (depth perception), so they see two pictures instead of one (double vision) In order to avoid visual strain, they choose to look away

22. How To Develop Social Gaze Looking?? Develop and maintain eye contact Observe if the child makes eye contact with you and if he/she does, note how long he/she could maintain it (This can be your basis of improvement) Make it easy for your child to make eye contact with you by positioning your face or your eyes at his/her eye level. Play with their toys at eye level. This will also help improve eye contact. Eg: If they are lying on the floor, you get on the floor Call for the child’s attention often and don’t be afraid to ask the child to look at you Signal them to look at your eyes while talking with them Positively reinforce eye contact by praising child for looking at you when they talk Eg: Tell them that they are good (Praise them)

24. This signals children to look at you when you talk

25. If the child looks away signal them again by pointing to your nose while talking.

27. Constantly and frequently remind child to pay attention to you

28. Give instructions to child by calling him/her by name and by asking them to look at you

29. Compliment this by the physical movement of signaling them to lookEg: ‘This is important’, ‘listen carefully’, ‘let me repeat’, ‘you need to remember’

31. It means to gently guide child’s head so that their face looks up at yours

32. Reinforce this positive eye contact with the use of smiling and praise

34. Consistency is part of teaching the child a new skill

35. It helps in improving eye contact for children with autism by repetition and positive reinforcementEg: The child will be given food and praise when eye contact occurred within 5 sec of the therapist's verbal prompt, "Look at me."

36. Vision evaluation of persons with autism varies depending on their developmental, emotional and physical level Vision evaluation includes visual acuity, eye tracking and fixations, depth perception, colour vision, eye teaming and focusing, the presence of ametropia, eye health and visual fields Due to the variable nature of autism, patient response to treatment also varies Children with less severe autism and better cognitive abilities may respond better than those with more limited capabilities Approximately 15% of patients can achieve a reasonable amount of self-sufficiency as adults, and another 15% to 20% function with minimal support

37. What to do?? Creativity is key! Don’t be surprised if the examination requires multiple visits to get all the desired information Snellen acuities may not be an option, but tumbling E’s, Randolt C’s, and even Teller preferential acuity cards can be used as an alternative If the patient is averse to wearing glasses during stereoacuity, use the Lang stereo test, which does not require polarise glasses.

38. Alternative Examination Ways Gross motor testing with a colorful toy Finger puppets can help to assist in attaining pursuits, saccades, cover test, NPC, binocular indirect and many other exam techniques

39. Alternative Examination Ways Extra ocular muscle testing with a light-up toy Can also be tested by asking the child to follow or point the direction of a moving penlight Eg : Tell the child that the light is a missile and they are playing a missile shooting game

40. Other method Working with other professionals such as occupational, speech and language and physical therapists as well as the primary care physician, teachers, reading specialist and of course the parents, optometrists can help to make a difference in these autistic children’s lives