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Is your child's vision to blame? Dispelling myths about reading disorders like dyslexia, vision problems, and the use of vision therapy.

drkristagreenfield
 



As a pediatric neuropsychologist and school psychologist, I often receive questions about vision therapy and its role in helping children with reading and learning challenges. Today, I want to clear up some common misconceptions and provide you with the facts.


Let's dive in!


First Things First...

A common MYTH is that dyslexia, a specific learning disorder in reading, is related to vision problems. In fact, dyslexia is a language-based disorder and not caused by visual issues. Children with dyslexia have difficulties with phonological processing, which affects their ability to decode words, rather than problems with their eyesight.

[Source: International Dyslexia Association]


Jump straight to the Myths Set Straight section below for more myths about reading, vision, and vision therapy



Vision Difficulties vs. Reading Disorders

It's crucial to differentiate between the symptoms of vision difficulties vs. the errors and challenges common in a reading disorder like dyslexia. Identifying your child's specific reading challenges and complaints can help you determine whether a trip to an optician or a psychologist is your next best move:


  • Vision Difficulties (e.g., Convergence Insufficiency): Children may experience symptoms like skipping lines, losing their place while reading, or seeing double. Their eyes may fatigued faster when reading. These issues are related to how the eyes work together and can sometimes be improved with vision therapy.


  • Specific Learning Disorder in Reading (Dyslexia): Children with dyslexia typically struggle with phonemic awareness, decoding, and spelling. A child with a reading disorder may occasionally skip small words, mispronounce bigger words, substitute words entirely, or lose track of where they are when reading. Many also dislike/avoid reading, which can impede the growth of their vocabulary and general knowledge. These challenges are not due to how your child's eyes function but rather how their brain processes language. No vision testing can diagnose Dyslexia, or any specific learning disorder for that matter.



Limitations of Optometric Eye Movement Testing

As a part of a vision assessment, your provider may have measured your child's saccades (rapid, ballistic eye movements that quickly redirect your eyes to a target of interest) and pursuits (slower, tracking eye movements that keep a moving target on the central point of acuity). According to validated research, there are a few things you should know when understanding your child's results:


  1. There is no valid reason in grading saccades and pursuits in dyslexia/reading problems; multiple studies have shown increased saccades and pursuits are due to poor comprehension. Thus, issues in these areas are due to dyslexia/a reading disorder, not a cause. Weakness in this area should not be interpreted as tracking problems.

  2. Many eye movement tests do not accurately assess eye movements, both due to test design and due to lack of a normative comparison (i.e., there is no "normal" baseline to compare your child's results to). A few tests have been named specifically as being poor measures due to inconsistent procedures, poor reliability, low inter-observer agreement, generally poor validity (i.e., it does not test what it is meant to test), anecdotal validity only, and/or lack of normative comparison. Examples cited in research include:

    • NSUCO test—patients asked to glance back and forth at colored balls on sticks

    • Developmental Eye Movement Test (DEM)

    • Visagraph I & II—computer monitored eye movement (Other similar device is the ReadAlyzer)

    • and others...



What is Vision Therapy?

Vision therapy is a series of exercises designed to improve visual skills and processing. It's often recommended for children with specific visual problems, but it's essential to understand when it is and isn't effective.



When is Vision Therapy Helpful?

Scientific research has shown that vision therapy can help make reading more comfortable for certain conditions, and perhaps allow children to read for longer periods of time. Some research has found that vision therapy works in improving these certain deficits:


  1. Convergence Insufficiency (CI): This is a condition where the eyes do not work together properly when focusing on a close object. Vision therapy has been shown to be effective in treating CI, improving symptoms like eye strain, headaches, and double vision. Most of these exercises can be performed at home, and extensive in-office vision therapy is usually not required. [Sources: American Academy of Pediatrics; Convergence Insufficiency Treatment Trial (CITT)]

  2. Amblyopia (Lazy Eye): Vision therapy can help improve visual acuity in children with amblyopia, especially when combined with other treatments like patching the stronger eye. [Source: American Academy of Ophthalmology]


*A caveat * When treating these conditions, benefits from vision therapy or other vision-based treatments don't necessarily translate to a better performance in the classroom...

It may be that vision efficiency interventions (for example treatment of CI) make a person more comfortable with reading. However, there is little evaluation of whether even the experience of more comfort carries over to the classroom or is a sustained practice. Referral for color overlays, tinted lenses, eye tracking, and visual information processing interventions are not supported by research. (Fletcher & Currie, 2011)

In other words, the headaches and double-vision may improve after vision therapy...but your child's actual reading, writing, and math skills will not improve as a result of vision therapy. (more on this below)



When Vision Therapy is NOT Helpful

According to the American Academy of Ophthalmology and the American Academy of Pediatrics, vision therapy should not be used to treat learning disorders like dyslexia. These respected organizations emphasize that there is no scientific evidence supporting the use of vision therapy for improving academic performance in children with learning disabilities.

[Source: Joint Policy Statement from the American Academy of Pediatrics, American Academy of Ophthalmology, and American Association for Pediatric Ophthalmology and Strabismus]



Myths Set Straight

Let's debunk some common myths linking learning disorders like Dyslexia, vision problems, and vision treatments:


  • Myth: All reading difficulties are due to vision problems.

    • Fact: Some vision issues can have secondary symptoms that impact reading (e.g., an acuity issue that requires glasses or the double vision/headaches that can arise from convergence insufficiency causing reading fatigue), but difficulties with fundamental reading skills (like phonological awareness, decoding, spelling, etc.) are due to a specific learning disorder that require diagnosis and intervention by specialists. See the Vision Difficulties vs. Reading Disorders section above to learn how to spot the difference


  • Myth: Vision therapy can cure dyslexia.

    • Fact: Dyslexia is a language-based disorder, and vision therapy does not address the underlying phonological processing issues. Historically, theories about the cause of dyslexia have pointed to vision issues, but we now know this to be untrue. Many respected medical and psychological organiztations agree that vision therapy should never be offered as a viable treatment for a learning disorder.


  • Myth: Treating convergence insufficiency will improve my child's decoding and reading comprehension skills

    • Fact: Even if your child has convergence insufficiency, treatment of this condition will NOT directly improve decoding or reading comprehension skills...or any academic skill deficit.

      .

  • Myth: A vision specialist can diagnose dyslexia or other specific learning disorders.

    • Fact: Specific learning disorders are not related to vision, and diagnosis requires a psychologist or educational specialist with specific expertise in the area.


  • Myth: Vision issues are to blame for reading errors like skipping words, reversing/flipping words, and poor reading directionality.

    • Fact: Research has shown that these errors can be symptoms of an underlying reading disorder; they stem from linguistic deficiencies, not vision or visual-perceptual deficiencies.


  • Myth: Vision therapy is a quick fix for academic struggles.

    • Fact: Vision therapy can be time-consuming and is only effective for specific visual conditions (see above), not for general academic improvement.


  • Myth: Tinted lenses and filters can help improve reading difficulties.

    • Fact: Research does not support the effectiveness of tinted lenses and tinted filters in treating reading difficulties.


Understanding the facts about vision therapy can help you make informed decisions for your child's health and education.

  • If you suspect your child has a vision problem, consult with a qualified eye care professional.

  • For reading and learning challenges, a comprehensive evaluation by a neuropsychologist, school psychologist, or educational specialist is essential. Most students with dyslexia will need to participate in a highly structured, intensive, individualized instruction by a teacher, educational therapist , or reading specialist who was specially trained in teaching the application of phonics


Stay informed, and keep advocating for your child's well-being!





 


Dr. Greenfield is an expert in the assessment, diagnosis, and treatment planning for neurodevelopmental disorders, including specific learning disorders like dyslexia. Contact our office (info@drgreenfield.com) for more details about our evaluation processes, or to receive a trusted referral for treatment of a specific learning disorder. If you have any questions about this blog, please leave us a comment or send us an email.


For more information, see the following scientific papers and position statements:



References:

  1. Convergence Insufficiency Treatment Trial (CITT)

  2. American Academy of Ophthalmology

  3. International Dyslexia Association

  4. Joint Policy Statement from the American Academy of Pediatrics, American Academy of Ophthalmology, and American Association for Pediatric Ophthalmology and Strabismus


Feel free to share this post with other parents, educators, and service providers who might find it helpful!


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