Neurodiversity Celebration Week: Seeing the spectrum – Dr Chris Edwards and Dr Tom Tutton discuss how neuroaffirming eye care can make a difference

by Katie Quirk - Communications Coordinator, Optometry Australia with Dr Chris Edwards and Dr Tom Tutton

To acknowledge Neurodiversity Celebration Week (17th to 23rd March), we have put together a series of stories to highlight and champion optometrists, academics, parents and patients across the country who are working to make eye care more accessible, affirming and inclusive for autistic* and other neurodivergent Australians.

Dr Chris Edwards, Research Fellow at Aspect) Research Centre for Autism Practice (ARCAP), Aspect (Autism Spectrum Australia), and Dr Tom Tutton, Head of Autism Friendly at Aspect, share why the traditional, outdated mindset of “this is how we’ve always done it,” needs to shift to “how can we make this experience more accessible and comfortable?” to recognise and respect the needs of neurodivergent people, ensuring they can access eye care in a way that works for them.

Dr Edwards, who is autistic himself, is also part of the research team leading a survey which, in collaboration with Aspect and with input from autistic voices, their families and eye care professionals, is aiming to identify and address challenges in optometry and how eye care services can be adapted to ultimately improve health outcomes and experiences for neurodivergent people.

Why is it important for neurodiverse needs to be considered in an optometry setting?

Estimates suggest that 15-20% of the population is neurodivergent, meaning a significant proportion of patients may experience the world - and eye care - differently.

Autistic people, for example, have higher rates of vision issues and visual processing differences, yet many are double disadvantaged in struggling with accessing care due to overwhelming sensory environments, communication differences and anxiety.

If standard practices don’t account for neurodivergent needs, these patients risk missing out on essential eye health services. At the same time, clinics that don’t adapt may also be limiting their own reach.

Making small, thoughtful adjustments can help ensure more people receive the care they need while also broadening the accessibility of services.

What barriers do autistic individuals face in accessing appropriate eye care?

Key barriers include difficulties with booking appointments (especially phone-based systems), busy and sensory overwhelming clinical environments (bright lights, loud spaces, long wait times) and a lack of practitioner awareness about autism-friendly approaches.

Many autistic patients also experience anxiety around unfamiliar and potentially uncomfortable procedures or fast-paced exams that don’t accommodate information processing needs.

How can optometrists communicate more effectively with autistic patients?

Optometrists can communicate more effectively with Autistic patients by (1) using clear, step-by-step explanations of what is going to happen and why and what this might feel like (2) avoiding vague or open-ended questions.

Instead of asking, "Which is better?"—which can feel ambiguous—they can say, "Is this clearer or blurrier?" and (3) letting people know that uncertainty or similarity is OK i.e. “it is OK if this is the same as last time”.

Providing specific instructions and breaking down each stage of the exam can help reduce uncertainty and anxiety.

Some autistic patients may prefer written, visual or alternative communication methods, such as using a checklist, demonstration or giving responses non-verbally (e.g., pointing instead of speaking).

Offering extra processing time is also important - rushing a response or repeating the question too quickly can increase stress.

Checking for understanding along the way, rather than assuming agreement, ensures that the patient feels comfortable and engaged in the process.

Above all, optometrists should take a patient-led approach, allowing the individual to guide how they prefer to communicate and making adjustments accordingly.

How can optometrists build trust with autistic patients who may have had negative healthcare experiences in the past?

Building trust with Autistic patients who may have had negative healthcare experiences takes time and consistency.

Optometrists can start by demonstrating that their practice is accessible and inclusive, ensuring that patients feel safe and supported from the moment they book an appointment.

Practical steps include providing clear information in advance, offering flexible appointment options and creating a calm, sensory-considerate environment.

Partnering with initiatives like the Hidden Disability Sunflower program can also signal that your practice is autism-aware and welcoming.

Most importantly, trust is built by listening to autistic people, respecting preferences, and allowing people to have control over their experience.

Small actions - such as asking how people would like to communicate, checking in throughout the exam and being patient with responses - can go a long way in rebuilding confidence in healthcare settings.

It can help to provide sensory coping tools (like fidget tools, squishy balls, noise cancelling headphones etc.), encouraging and modelling their use.

What role do parents, carers and support workers play in ensuring Autistic patients receive the best eye care?

Parents and carers can provide essential support by preparing the patient for what to expect, communicating their preferences to the optometrist, and offering reassurance during the exam.

Optometrists should respect their role while also engaging directly with the patient to ensure their needs and comfort are prioritised.

A final thought

Neuroaffirming approaches recognise and respect the needs of neurodivergent people, ensuring they can access eye care in a way that works for them.

This means establishing and upholding a set of principles that acknowledge that everyone is different, with different needs.

The commitment to understanding and meeting these needs will rely on a set of evidence-based practices such as reducing sensory and communication barriers, offering flexibility in appointments and using clear, patient-led interactions rather than expecting neurodivergent patients to adapt to standard procedures.

These practices need to be developed in collaboration with neurodivergent people such as Autistic experts; “not about them without them”.

The ASPECT eye care survey for autistic adults and parents/guardians/caregivers can be accessed here.

*Amplifying autistic voices is crucial because it ensures that conversations about neurodivergence are led by those with lived experience.

Too often, discussions about autism are dominated by non-Autistic perspectives, which can overlook or misunderstand the real needs and strengths of the community.

Listening to and elevating autistic voices not only helps break down stereotypes but also drives meaningful change in policies, practices and perceptions.

It’s about shifting from a “for them, without them” mindset to a collaborative, inclusive approach that respects neurodivergent experiences.

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