“Developmental dyslexia” is a difficulty in reading in children and adults, at the level that would be expected with their home background, educational opportunities, motivation, and intelligence.
Children with this condition, despite being above normal intelligence, may have had difficulties with writing letters and recognizing words since beginning school. They may show poor concentration in the classroom, disruptive behaviour, untidy writing, poor spelling, and they may have fallen significantly behind in reading by the time they are seven or eight. Dyslexia is a very difficult problem for the child, parents, and teachers alike. Since children with dyslexia often have normal or superior intelligence, the teachers and parents often consult an ophthalmologist to look to visual defects that may result to poor reading. The truth is that there is no evidence supporting a relationship between visual disabilities and reading problems.
Studies have consistently shown that normal readers and patients with dyslexia have similar incidences of visual defects. Children with learning disabilities have the same incidence of ocular abnormalities as children who are normal achievers and are reading at grade level. The treatment of visual problems, when present, may lead to some improvement in the reading ability of the child with developmental dyslexia but it is extremely unlikely to lead to a cure.
Even though the majority of children with dyslexia will have normal ophthalmologic examinations, they should have a complete eye examination, including dilating drops for a cycloplegic refraction. Convergence insufficiency and hypermetropia are conditions that may interfere with reading and lead to near fatigue and asthenopia, yet are not easily detected by routine screening examinations performed in school.
The defect in developmental dyslexia lies within the brain and its processing of visual stimuli. The misunderstanding as to the nature of this condition has led to many myths as to its etiology and to controversial therapies.
To summarize, the following are the key features of developmental dyslexia:
The treatment of developmental dyslexia entails a multidisciplinary approach. The following professionals will work as a team in dealing with this condition:
The role of the ophthalmologist is to address any eye problem. The consultation is generally time-consuming because a series of specific ophthalmologic examination shall be performed. A great amount of time shall be spent on explanation of the role of the eyes in reading and developmental dyslexia, and discussion of controversial and non-controversial therapies.
The following are the specific ophthalmological examination that will be undertaken in the clinic:
The eye examination in most children will be normal. If problems are detected relating to ocular muscle imbalance, weakness of convergence or accommodation, or a significant refractive error, these need to be corrected.
Early diagnosis of developmental dyslexia based on a comprehensive evaluation by a skilled educational psychologist will allow the child with developmental dyslexia to gain the maximum benefit from remedial intervention. The diagnosis of developmental dyslexia is reached through an extensive evaluation that involves not only assessment of reading ability, but also assessment of intelligence. Prior to embarking on a remedial program, there is also a need to exclude any sensory deficit involving vision and hearing. The pediatric ophthalmologist will address all the eye-related problems such as visual impairment, refractive errors, abnormal eye movements, and convergence insufficiency. Glasses and eye muscle exercises shall be provided if necessary. A referral to an ENT specialist is advisable to rule out any hearing impairment.
The only form of therapy for developmental dyslexia that has been consistently shown to have results is remediation. To learn to read, all children must discover that spoken words can be broken down into units of sound, phonemes. Children with dyslexia do not easily acquire the basic phonologic skills that serve as a prerequisite to reading. In these children phoneme awareness is taught with systemic and highly structured training exercises.
Parents of children with developmental dyslexia are often on the lookout for any form of therapy that will “cure” or “correct” the problem quickly. The use of these controversial therapiesresults in unwarranted expense and often misplaces resources when they could be better used for reading education and tutors.
A treatment approach can be considered controversial if the approach is proposed to the public before any research is available or preliminary research has bot been replicated; the proposed approach goes beyond what research data support; or the approach is used in isolation when a multimodal approach is needed.
MD, DPBO, FPAO, FPCS
Dr. Barbara Roque is a specialist in pediatric ophthalmology, adult strabismus, and ophthalmic genetics. Her private practice began in 2006, after her post-graduate fellowship training at The Children’s Hospital in Westmead, University of Sydney System, Australia. Her patients are mostly children with ocular disease, refractive errors, cataracts, and eye misalignment.