Reading, Dyslexia, and Vision Therapy

Abstract

Learning to read and write may be challenging for many children. In the USA, approximately 65% of children experience difficulty learning to read. Good literacy is an important social determinant of both physical and psychological health and is a large factor in final educational attainment, employment, income, and other socioeconomic outcomes. The causes of reading difficulty are multifactorial. Dyslexia is a neurobiological language-based reading disability that is typically due to a deficit in phonological processing leading to trouble sounding out and recognizing words. Though it is often underrecognized, dyslexia affects up to 15-20% of children in the USA, to some degree. Treatment of dyslexia is educational in nature. The International Dyslexia Association recommends that the "structured literacy" approach be implemented by well-trained educators. Because dyslexia and other learning disabilities are chronic conditions with no quick simple cure, they have spawned a wide variety of scientifically unsupported evaluations and treatments. When parents are anxious to find solutions, friends, teachers, other health providers, or the media may suggest expensive and unproven treatments such as vision therapy or colored lenses or colored overlays. Early identification is crucial for these children, and ophthalmologists may be the first professional asked to evaluate the child who is experiencing challenges learning to read. Sometimes, parents are seeking a second opinion regarding contemplated or ongoing vision treatments and dealing with their own concerns over late diagnoses. This puts ophthalmologists in a unique position to detect and treat ocular problems that might contribute to difficulty reading; educate parents regarding reading, reading disability, evidence-based "structured literacy" approach, and nonevidence-based vision treatments; and provide referrals to specialists for further evidence-based evaluation and treatment. This chapter explores how we read, visual function and reading, dyslexia, current recommended educational evaluation and treatment of dyslexia, colored lenses or overlays, vision therapy, and the role of the ophthalmologist.