Reading difficulties and the pediatric ophthalmologist.

Approximately 20% of children have dyslexia, a language-based reading disability. A variation in language processing in the brain leads to a deficit in phonological (auditory) processing, which leads to problems in learning to read, write, and spell. Myths continue to exist regarding dyslexia and vision, and although eye and vision problems may coexist with dyslexia, they are not more prevalent than in the general population. Rarely vision problems may make reading at near very difficult and may masquerade as a learning problem or attention deficit disorder/attention deficit hyperactivity disorder. The pediatric ophthalmologist can play a valuable role in determining whether any eye or vision problems exist that might interfere with learning or reading. Treatments to improve these eye conditions may help make reading more comfortable, but they are not a therapy for coexisting dyslexia. The use of vision therapy has never been shown scientifically to be effective and may prevent the application of effective interventions during the critical period of development when reading disorders can best be remediated. The pediatric ophthalmologist should educate parents about reading and dyslexia and provide prompt referral to professionals who have expertise in evaluating and treating learning disabilities.

Learning disabilities, dyslexia, and vision.

Learning disabilities constitute a diverse group of disorders in which children who generally possess at least average intelligence have problems processing information or generating output. Their etiologies are multifactorial and reflect genetic influences and dysfunction of brain systems. Reading disability, or dyslexia, is the most common learning disability. It is a receptive language-based learning disability that is characterized by difficulties with decoding, fluent word recognition, rapid automatic naming, and/or reading-comprehension skills. These difficulties typically result from a deficit in the phonologic component of language that makes it difficult to use the alphabetic code to decode the written word. Early recognition and referral to qualified professionals for evidence-based evaluations and treatments are necessary to achieve the best possible outcome. Because dyslexia is a language-based disorder, treatment should be directed at this etiology. Remedial programs should include specific instruction in decoding, fluency training, vocabulary, and comprehension. Most programs include daily intensive individualized instruction that explicitly teaches phonemic awareness and the application of phonics. Vision problems can interfere with the process of reading, but children with dyslexia or related learning disabilities have the same visual function and ocular health as children without such conditions. Currently, there is inadequate scientific evidence to support the view that subtle eye or visual problems cause or increase the severity of learning disabilities. Because they are difficult for the public to understand and for educators to treat, learning disabilities have spawned a wide variety of scientifically unsupported vision-based diagnostic and treatment procedures. Scientific evidence does not support the claims that visual training, muscle exercises, ocular pursuit-and-tracking exercises, behavioral/perceptual vision therapy, "training" glasses, prisms, and colored lenses and filters are effective direct or indirect treatments for learning disabilities. There is no valid evidence that children who participate in vision therapy are more responsive to educational instruction than children who do not participate.