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LEARNING DISABILITIES AND DYSLEXIA
Subnormal reading and learning skills may be the reason for an ophthalmic
evaluation for a child or even an {*filter*}. The determination of subnormal
educational performance is best left to the professionals in this
discipline, the educators. The role of the ophthalmologist is to
determine if there is a visual abnormality contributing to poor
performance. The standard ophthalmic examination should be performed with
special attention to visual function at near. If the ophthalmic
examination is normal, the patient should be directed to the pediatrician
or primary care physician for assistance in continuing the
multidisciplinary approach to diagnosis and treatment.
There is little evidence that reading disabilities result from problems in
the visual system. The American Academy of Ophthalmology, the American
Association for Pediatric Ophthalmology and Strabismus, and the American
Academy of Pediatrics have issued a joint policy statement which is
printed here in its entirety.
POLICY STATEMENT: AMERICAN ACADEMY OF OPHTHALMOLOGY ON
LEARNING DISABILITIES, DYSLEXIA AND VISION
The American Academy of Ophthalmology and the American Association for
Pediatric Ophthalmology and Strabismus support the position that a child
or {*filter*} with dyslexia or a related learning disability should receive:
1)early medical, educational or psychological evaluation and diagnosis,
and 2)treatment with educational procedures of proven value, demonstrated
by scientifically valid research.
The problems of dyslexia and related learning disabilities have become
matters of increasing public attention. A child1s or {*filter*}1s inability to
read with understanding, as a result of defects in processing visual
symbols, is a major obstacle to school learning and may have far-reaching
social and economic implications. The normal and appropriate concern of
parents for the welfare of their children and of society for its
disadvantaged has fostered a proliferation of purportedly diagnostic and
remedial procedures, many of which are controversial. Therefore, the
diagnosis and treatment of dyslexia and associated learning disabilities
have recently been reviewed with the following conclusions endorsed by the
American Academy of Ophthalmology and the American Association for
Pediatric Ophthalmology and Strabismus.
Dyslexia and related learning disabilities, as well as other forms of
learning underachievement, require a multidisciplinary approach from
medicine, education, and psychology in evaluation, diagnosis and
treatment. Certain symptoms may be detected during infancy and early
childhood through the use of screening techniques by educational
specialists. Children with potential problems include those with speech
defects, emotional problems, or family history of learning disability.
These individuals should be assessed by educational and psychological
specialists as early as possible to identify individuals who may exhibit
indications of learning disabilities.
Eye care should never be instituted in isolation when a person does have
dyslexia or a related learning disability. Children identified to have
such problems should be evaluated for general medical, neurologic,
psychologic, visual and hearing defects. If any problems of this nature
are found, they should be corrected as early as possible.
Since clues in word recognition are transmitted through the eyes to the
brain, it has, unfortunately, become common practice to attribute reading
difficulties to subtle ocular abnormalities, presumed to cause the faulty
perception. Although eyes are necessary for vision, the brain encodes
visual information resulting in 3visual perception.2 Attention directed
to the eyes would not be expected to have any effect on the brain1s
processing of visual stimuli. Indeed, children with dyslexia or related
learning disability have the same incidence of ocular abnormalities, e.g.,
refractive errors and muscle imbalance (including near point of
convergence and binocular fusion deficiencies), as children without.1-3
There is no peripheral eye defect that produces dyslexia and associated
learning disabilities.4 Eye defects do not cause reversal of letters,
words, or numbers. Instead, recent studies suggest dyslexia and
associated learning disabilities may be related to genetic,5
biochemical,6 and/or structural brain changes. Further controlled
research is warranted.
No known scientific evidence supports claims for improving the academic
abilities of dyslexic or learning disabled children, or modification of
delinquent or criminal behavior, with treatment based on: 1) visual
training, including muscle exercises, ocular pursuit or tracking
exercises, or glasses (with or without bifocals or prisms); and
2)neurologic organizational training (laterally training, balance board,
perceptual training).2-4,8-14,15
Furthermore, such training frequently yields deleterious effects. A false
sense of security is created which may delay or prevent proper instruction
of remedial therapy. The expense of such procedures is unwarranted, and
appropriate remedial educational techniques may be omitted. Improvements
claimed for visual training or neurologic organizational training
typically result from those remedial education techniques with which they
are combined.
Excluding correctable ocular defects, glasses (with or without bifocals or
prisms) have no value in the specific treatment of dyslexia or a related
learning disability. In fact, unnecessarily prescribed glasses may create
a false sense of security, delaying needed treatment.
The teaching of dyslexic and learning disabled children and {*filter*}s is a
problem of educational science. Proper, proven, expert educational and
psychological testing should be performed to identify the type of learning
disability. Since remediation may be more effective during early years,10
especially prior to the development of a pattern of failure, early
diagnosis is paramount. As mental and psychological factors contribute to
a child1s success or failure, no single educational approach is applicable
to all children. A change in any variable may result in improved
performance and reduced frustration (including placebo benefits).
The American Academy of Ophthalmology and the American Association for
Pediatric Ophthalmology and Strabismus strongly support the early
diagnosis and appropriate treatment of persons with dyslexic and related
learning disabilities. The Academy and Association commit themselves to
these efforts and to scientifically verified research on the cause,
diagnosis, and remediation of these conditions or defects.
ACKNOWLEDGMENT
This policy statement was developed by the Ad Hoc Working Group of the
American Association for Pediatric Ophthalmology and Strabismus and the
American Academy of Ophthalmology.
1. Flax N: Visual function in learning disabilities. J Learning
Disabil 1: 551,1968.
2. Bettman JW, Jr, Stern EL, Whitesell LJ, et al: Cerebral {*filter*}
in developmental dyslexia: Role of ophthalmology. Arch
Ophthalmol 78: 722- 730, 1967.
3. Norn MS, Rindziunski E, Skydsgaard H: Ophthalmologic and
orthoptic examinations of dyslectics. Acta Ophthalmol 47: 147,
1969.
4. Goldberg HK, Drash PW: The disabled reader. J Pediatr Ophthalmol
5: 11-24, 1968.
5. University of Miami: Chromosome 15 may cause dyslexia. Med World
News, p 24, Dec 22, 1980.
6. Shaywitz SE, Cohen DJ, Shaywitz BA: The biochemical basis of
minimal brain dysfunction. J Pediatr 92: 179-187, 1978.
7. Galaburda AM, Kemper TL: Cytoarchitectonic abnormalities
in developmental dyslexia. Ann Neurol 6: 94-100, 1979.
8. Cohen HJ, Birch HG, Taft LT: Some considerations for evaluating the
Doman- Delacato patterning method. Pediatrics 45: 302-314, 1970.
9. Committee on Handicapped Child: Doman-Delacato treatment of
neurologically handicapped children. American Academy of
Pediatrics Newsletter, June 1, 1968.
10. Goldberg HK, Arnott W: Ocular motility in learning disabilities,
J Learning Disabil 3: 160, 1968.
11. Cygan WF: Research in visual-perceptual-motor activities related
to reading achievement. Optometric Weekly, pp 796-803, August 29,
1974.
12. Keough B: Optometric vision training programs for learning
disability children: Review of issues and research, presented in
part at the 10th annual meeting of the Association for Children with
Learning Disabilities, March 15, 1973, Detroit, Michigan.
13. Kavanagh JF, Yeni-Komshian G: Developmental dyslexia and related
reading disorders, Bethesda, MD, NIH publication No. 80-92, January,
1980.
14. GAO Report: Perceptual and visual Training as a CHAMPUS benefit,
Report to Congress, May 31, 1979.
15. Smith HM: Motor activity and perceptual development. J
Health-Physician- Recreation, Feb, 1968.
16. Metzger RL, Werner DB: Use of visual training for reading
disabilities: A review. Pediatrics 73: 824-829, 1984.
I hope all enjoyed this-
David
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David B. Granet, M.D.
Director
Pediatric Ophthalmology & Ocular Motility Services
University of California, San Diego
*Keeping an Eye on Our Future ;-) *
Reading Disorders - AAO Policy Statement