Abyann Hashi had initially been hesitant about seeing an optometrist. Her aunt, Deka Gabriel-Abdilleh, who is her guardian, had to cancel an appointment she’d previously made because Hashi, who has autism, hadn’t wanted to leave the house on a cold day.
Now, however, Hashi is sitting in the optometrist’s chair at the Etobicoke location of Surrey Place, a not-for-profit organization that helps people of all ages with autism-, developmental-, and sensory-related concerns. She’s smiling, high fiving the optometrist, Dr. Jonathan Niavis (OD ’19), and Sunpreet Pabla, the fourth-year University of Waterloo optometry student who’s assisting.
The comprehensive eye exam was organized by WEI @ Surrey Place, a collaborative project of the Waterloo Eye Institute (WEI) and Surrey Place, funded by an anonymous foundation. The project aims to increase access to eye and vision care for people with special needs, research the prevalence of eye conditions and best care practices for this population, and provide advanced training for student optometrists.
Making Hashi comfortable took some planning. Gabriel-Abdilleh called ahead and talked to the staff about her niece’s triggers – for example, she’s easily distracted by cups, because she likes to see what’s in them, so there are no cups in the room. The referral form also asked what staff should know about her.
“The staff seemed prepared,” says Gabriel-Abdilleh. “They were very welcoming, very patient and caring. They went at her own pace and didn’t rush her, because she doesn’t do well in new places with new people. Within five, 10 minutes, she was high fiving everybody; she was relaxed. She left happy.”
Barriers to vision care
Good vision can improve anyone’s quality of life and ability to learn. However, it can be hard to know whether people with intellectual and developmental disabilities are seeing well. Health-care practitioners, teachers and parents may therefore not realize if vision problems are contributing to learning, social or behavioural issues.
What’s more, people with some types of developmental disabilities are more likely than the general population to have eye and vision problems. These can include being more nearsighted or farsighted, having problems with eye coordination or movement, or problems with visual processing.
Without regular vision care, eye diseases and visual disorders may go undiagnosed or worsen. However, getting that care is often a challenge for people with disabilities.
“It can be hard to find optometrists who have the training and experience to feel comfortable providing this level of patient care,” says Dr. Lisa Christian, an associate clinical professor at the University of Waterloo School of Optometry and Vision Science and the WEI @ Surrey Place project lead. “Some are also reluctant because, simply put, these appointments take longer but you get paid the same.”
Addressing barriers through training, research and advocacy
The WEI @ Surrey Place project is working to address optometrist training by giving fourth-year students supervised experience with patients who have special needs.
Part of the project’s research aims to address the financial issues.
“We want to get an idea of what percentage of people with intellectual and developmental disabilities need glasses or have eye diseases and disorders,” says Christian. “If we can show the prevalence in this population, we hope to lobby for fair remuneration for these appointments from ODSP (Ontario Disability Support Program).”
The seed of the project was planted when the Ontario Foundation for Visually Impaired Children merged with Surrey Place in 2012 – and Lindsay Hillier, now manager of the Blind-Low Vision Intervention Program at Surrey Place, moved with it.
“It surprised me that we had this whole agency serving people of all ages and nobody was checking their vision,” says Hillier.
Surrey Place fully supported the idea of a vision clinic, but implementation proved challenging. A breakthrough occurred when Hillier contacted the University of Waterloo. Christian, Hillier and Surrey Place’s manager of fundraising, development and donor engagement worked together to secure funding from the anonymous foundation in 2023. After renovations to build two suites of state-of-the-art optometric equipment, the first patients were seen in June 2024.
The clinic has already changed lives. Niavis, a residency-trained optometrist and School clinical instructor, remembers seeing a two-year-old who had been diagnosed with autism but had never had his eyes checked. He found the little boy was extremely farsighted.
“Lo and behold, he came back wearing glasses and he was a completely different kid,” remembers Niavis. “Suddenly very curious to interact with the world, very social.”
A flexible approach to eye care
At Surrey Place, optometrists can take the time to make a patient comfortable and get to know them, which is good for both the patient and clinician, says Niavis.
“Everyone has different needs and no two exams are the same.”
Eye exams do nonetheless present challenges to many.
“Unfortunately, a lot of optometry is hyper-sensory,” says Niavis. “We can try to reduce the light a little or emphasize a distraction, but an eye exam is very difficult for some patients to sit through. We give lots of reassurance and breaks, but sometimes, if we can’t get through the things we need to do, we’ll have them come back on a different day. At least they’ll have experienced the space, so it’ll be more familiar.”
This wasn’t necessary for Hashi, who recently got her first pair of glasses at age 24. Her prescription is relatively mild, and she doesn’t always want something on her face, but her aunt has noticed a difference when she wears her glasses.
“When she wears them, she looks outside,” says Gabriel-Abdilleh. “Her gaze is longer. Especially when we drive in the country, she looks at objects, at trees and vegetation. When she’s not wearing them, it’s just the immediate environment – she listens to her music, looks at her iPad, doesn’t want to look out.”
It’s the sort of result Niavis loves to see.
“It’s a big reason why I went into optometry in the first place,” he says. “To see patients gain confidence, whether in reading or social situations or just being able to interact with the world, is so rewarding.”