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. True dyslexia is a neurological dysfunction marked by the inability of the brain's language centers to efficiently decode print or phonetically make the connection between written symbols and their appropriate sounds. Not all children who struggle to read, however, suffer from phonological processing problems. Although the symptoms are similar, the culprit for many may be vision, not a language-based deficit. Margaret Livingstone, et al, from the Department of Neurobiology, Harvard Medical School and the Dyslexia Research Laboratory, Beth Israel Hospital in Boston reports that poor visual processing plays a significant role in a large majority of children who struggle to read: "Several perceptual studies have suggested that dyslexic subjects process visual information more slowly than normal subjects. Such visual abnormalities were reported to be found in more than 75% of the reading-disabled children tested." A
complete eye exam by a developmental optometrist trained to
diagnose and treat vision-based learning problems can determine for certain if
vision is the basis of a child's struggle to read.
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From
America's Leaders in Eye Care: Vision, Learning, and Dyslexia A
Joint Organizational Policy Statement of the American Academy of Optometry Vision and Learning Many
children and adults continue to struggle with learning in the classroom and the
workplace. Advances in information technology, its expanding necessity, and its
accessibility are placing greater demands on people for efficient learning and
information processing. (1,2) Learning is accomplished through complex and
interrelated processes, one of which is vision. Determining the relationships
between vision and learning involves more than evaluating eye health and visual
acuity (clarity of sight). Problems in identifying and treating people with
learning-related vision problems arise when such a limited definition of vision
is employed. (3) This policy statement addresses these issues, which are
important to individuals who have learning-related vision problems, their
families, their teachers, the educational system and society. Policy Statement People at risk for learning-related vision problems should receive a comprehensive optometric evaluation. This evaluation should be conducted as part of a multidisciplinary approach in which all appropriate areas of function are evaluated and managed. (4) The
role of the optometrist when evaluating people for learning-related vision
problems is to conduct a thorough assessment of eye health and visual functions
and communicate the results and recommendations. (5) The management plan may
include treatment, guidance and appropriate referral. The expected outcome of
optometric intervention is an improvement in visual function with the
alleviation of associated signs and symptoms. Optometric intervention for people
with learning-related vision problems consists of lenses, prisms, and vision
therapy. Vision therapy does not directly treat learning disabilities or
dyslexia. (6,7) Vision therapy is a treatment to improve visual efficiency and
visual processing, thereby allowing the person to be more responsive to
educational instruction. (4,8) It does not preclude any other form of treatment
and should be a part of a multidisciplinary approach to learning disabilities.
(6,7) Pertinent Issues Vision is a fundamental factor in the learning process. The three interrelated areas of visual function are: 1.Visual pathway integrity including eye health, visual acuity and refractive status 2.Visual efficiency including accommodation (focusing), binocular vision (eye teaming) and eye movements 3.Visual information processing including identification and discrimination, spatial awareness, and integration with other senses. To identify learning-related vision problems, each of these interrelated areas must be fully evaluated. Educational, neuropsychological and medical research has suggested distinct subtypes of learning difficulties. (9,10) Current research indicates that some people with reading difficulties have co-existing visual and language processing deficits. (11) For this reason, no single treatment, profession or discipline can be expected to adequately address all of their needs. Unresolved visual deficits can impair the ability to respond fully to educational instruction. (12,13) Management may require optical correction, vision therapy, or a combination of both. Vision therapy, the art and science of developing and enhancing visual abilities and remediating vision dysfunctions, has a firm foundation in vision science, and both its application and efficacy have been established in the scientific literature. (14-17) Some sources have erroneously associated optometric vision therapy with controversial and unfounded therapies, and equate eye defects with visual dysfunctions. (18-21) The eyes, visual pathways and brain comprise the visual system. Therefore, to understand the complexities of visual function, one must look at the total visual system. Recent research has demonstrated that some people with reading disabilities have deficits in the transmission of information to the brain through a defective visual pathway. (22-25) This creates confusion and disrupts the normal visual timing functions in reading. Visual
defects, such as a restriction in the visual field, can have a substantial
impact on reading performance. (26) Eye strain and double vision resulting from
convergence insufficiency can be a significant handicap to learning. (27) There
are more subtle visual defects that influence learning affecting different
people to different degrees. Vision is a multifaceted process and its
relationships to reading and learning are complex. (28,29) Each area of visual
function must be considered in the evaluation of people who are experiencing
reading or other learning problems. Likewise, treatment programs for
learning-related vision problems must be designed individually to meet each
person's unique needs. Summary 1. Vision problems can and often do interfere with learning. 2. People at risk for learning-related vision problems should be evaluated by an optometrist who provides diagnostic and management services in this area. 3. The goal of optometric intervention is to improve visual function and alleviate associated signs and symptoms. 4. Prompt remediation of learning-related vision problems enhances the ability of children and adults to perform to their full potential. 5.
People with learning problems require help from many disciplines to meet the
learning challenges they face. Optometric involvement constitutes one aspect of
the multidisciplinary management approach required to prepare the individual for
lifelong learning.
This Policy Statement was formulated by a Task Force representing the College of Optometrists in Vision Development, the American Optometric Association, and the American Academy of Optometry. The following individuals are acknowledged for their contributions: Ronald Bateman, O.D. M.S., Leonard Press, O.D., Susan Cotter, O.D., Michael Rouse, O.D., Stephen Miller, O.D. M.S.Ed., Kelly Frantz, O.D, Julie Ryan, O.D., Ralph Garzia, O.D., Eric Borsting, O.D., Glen Steele, O.D., Louis Hoffman, O.D.M.S., Gary Williams, O.D Approved by: College of Optometrists in Vision Development, October 1996 American Academy of Optometry, January 1997 American Foundation for Vision Awareness, February 1997 American Optometric Association, March 1997 Optometric Extension Program Foundation, April 1997 References 1.Kozol
J. Illiterate America, 1st edition. Garden City, NY: Anchor Doubleday, 1985.
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Below
is the position statement of the American Academy of Optometry and the American
Optometric Association on the relationship between vision and dyslexia. Children
who have been labeled "dyslexic" need to have a complete eye
examination by a pediatric optometrist to evaluate their learning-related vision
skills to determine to what degree poor visual processing is contributing to the
problem. For a specialist near you, contact the national certifying board
of the College of Optometrists in Vision Development at 1-888-268-3770 or visit
their web site at 
