Dyslexia and Vision Therapy

Dr. Burke is one of Cincinnati's most trusted resources concerning dyslexia and vision therapy in children.

What is a learning disability?

The term learning disability refers to difficulty understanding and using spoken or written language. Individuals with learning disabilities may have problems with reading, writing, listening, speaking, concentration or doing mathematical calculations. Approximately 80% of people with learning disabilities have dyslexia. Dyslexia is a major cause of learning disability occurring in almost one out of five children worldwide.

What is dyslexia?

The definition of dyslexia is “difficulty in learning to read despite normal intelligence, strong motivation, and adequate instruction.” It is characterized by difficulties with accurate and/or fluent sight word recognition and decoding abilities. Dyslexia may affect not only how a person reads but, surprisingly, a range of other important functions as well, including the ability to spell words, to retrieve words, to articulate words, and to remember certain facts. These difficulties are unexpected in relation to the child’s other cognitive skills. This disability may also damage a child’s developing self-image and cause emotional problems such as withdrawal, anxiety, depression, or aggression. Dyslexia has been identified as having a strong genetic basis with up to 40% having extended family individuals demonstrating dyslexic tendencies.

Do children with dyslexia have more eye problems than average?

Children with learning disabilities and dyslexia have no greater incidence of eye problems than the rest of the population.

What is the most up-to-date information on dyslexia?

The scientific and education communities know that dyslexia is common (up to 20% of all humans), persistent, and chronic. It is now known that this complex reading problem has its roots in the very basic brain systems that allow humans to understand and express language. The accepted model of dyslexia is based upon phonological processing – processing the distinctive sound elements of language. In dyslexic children, it is this glitch within the language that impairs the child’s phonemic awareness. As a result of this weakness, children have difficulty breaking the reading code. Reading represents a code, specifically, an alphabetic code. Seventy to 80% of children (American and those all over the world) learn how to transform printed symbols into a phonetic code without much difficulty. For the remainder, however, written symbols remain a mystery. These children are dyslexics. Although vision is fundamental for reading, the brain must interpret the incoming visual images. Historically, many theories have implicated defects in the visual system as a cause of dyslexia. We now know these theories to be untrue.

National Center for Learning Disabilities
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Is there any treatment for dyslexia?

The greatest stumbling block preventing a dyslexic child from realizing his/her potential and following his/her dreams is the widespread ignorance about the true nature of dyslexia.

Dyslexia and learning disabilities are complex problems that have no simple solutions. A prestigious national panel of scientists and educators have agreed upon what we now believe are the optimal methods of teaching children to read. Their report was released April 13, 2000, and is titled “Report of the National Reading Panel, Teaching Children to Read: An Evidence–Based Assessment of the Scientific Research Literature on Reading and Its Implications for Reading Instruction.” Much of that report has been synthesized by one of the panel participants, Sally Shaywitz, M.D., into a wonderfully understandable book titled Overcoming Dyslexia, Random House, New York, 2003. In this book, Dr. Shaywitz explains how to help a child become a reader and what methods accomplish the task of turning struggling readers into proficient readers -- namely, “overcoming dyslexia.”

The American Academy of Pediatrics, the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, and the American Association of Certified Orthoptists all strongly support these recommendations for early diagnosis and educational intervention. With early recognition and individualized, interdisciplinary management strategies, children with learning disabilities can enjoy successful academic experiences.

What about other treatments?

The new science of reading has direct application to identifying and treating reading difficulties. The treatment must be educationally directed. There is no credible evidence to show that simple solutions, such as visual training, eye muscle exercises, perceptual or hand-eye coordination exercises, weak magnifying glasses, colored overlays, diet, megavitamins, or sugar restriction, can significantly affect a child’s learning disability. These approaches can give parents a false sense of security and may delay proper educational assistance.

There appears to be much controversy about vision therapy, why is that? Because learning disabilities and dyslexia are difficult for the public to understand and for educators to treat (that was in the past before the newer scientific evidence was available), the attempt to help these struggling learners gave rise to a wide variety of controversial and scientifically unsupported alternative treatments, including one that is now called “vision therapy”, also referred to as vision training or eye exercises.

Optometrists who advocate vision therapy persist in claiming that many problem learners have undiagnosed vision problems contributing to their difficulties. However, optometrists concede vision therapy does not directly treat learning disability or dyslexia. Advocates claim vision therapy is a treatment to improve visual efficiency and visual processing which thereby allows the child to be more responsive to educational instruction. Despite the significant lack of corroborating research findings with statistical validity, vision therapy is popular and persuasive.

As advocates for their patients, physicians use scientific evidence of effectiveness as the basis for treatment recommendations. Treatments that have inadequate scientific proof of efficacy should be and are discouraged. Ineffective, controversial methods of treatment such as vision therapy may give parents and teachers a false sense of security that a child’s learning difficulties are being addressed, may waste family and/or school resources, and may delay proper educational instruction or remediation.

What major organizations are against vision therapy in the treatment of dyslexia?

Given that the most widely accepted scientific view that dyslexia is a language-based disorder, the American Academy of Pediatrics, the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, the Council on Child and Adolescent Health, and the National Education Association all agree with the evidence that vision therapy does not benefit children with learning disabilities or dyslexia. And all are united in discouraging parents from having their children participate in such unsubstantiated and expensive vision training programs, saving the parents’ valuable time and family resources and allowing the child to use their time and effort utilizing proper educational intervention.

What resources are available?

Locally and nationally, information and support can be obtained from:

The Attention Deficit Disorder
Council of Greater Cincinnati
6941 Jerry Dr
West Chester, OH 45069-4040

International Dyslexia Association
Ohio Valley Branch
Cincinnati, Ohio 45208
(513) 651-4747
http://www.cincinnatidyslexia.org/

International Dyslexia Association
40 York Rd., 4th Floor

Baltimore, MD 21204

Voice: (410) 296-0232

Fax: (410) 321-5069
http://www.interdys.org/

Learning Disabilities Association of America
4156 Library Rd., Pittsburgh, PA 15234-1349
Voice: (412) 341-1515
Fax: (412) 344-0224
http://www.ldanatl.org/

National Center for Learning Disabilities
381 Park Ave. South, Suite 1401
New York, NY 10016 Voice: (212) 545-7510
Fax: (212) 545-9665
Toll-free: (888) 575-7373
http://www.ncld.org/

The national reading information website is:
http://www.nichd.nih.gov/publications/pubs.cfm?from=reading_new

Overcoming Dyslexia, Sally Shaywitz, M.D.,
Random House, New York, 2003.
(I have borrowed freely from this book to help answer some of these questions and this is my acknowledgement thereto.)

The following are scientific references discouraging the use of vision therapy:

Evidence shows vision therapy does not benefit children with dyslexia, Sheryl M. Handler, M.D., AAP News, volume 31 (number 5): 19, May 2010.
(I have borrowed freely from this article to help answer some of these questions and this is my acknowledgement thereto.)

http://aapnews.aappublications.org/cgi/content/full/31/5/19

A critical evaluation of the evidence supporting the practice of behavioural vision therapy, by Brendan T. Barrett, Ophthalmic and Physiological Optics. 2009, 29: 4–25.

Learning disabilities, dyslexia and vision: Policy statement, jointly supported by the American Academy of Pediatrics, Section on Ophthalmology, Council on Children with Disabilities, the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, and the American Association of Certified Orthoptists
http://pediatrics.aappublications.org/cgi/content/full/124/2/837
http://www.aapos.org/terms/conditions/65
http://www.aapos.org/terms/conditions/108
http://www.aao.org/about/policy/upload/Learning-Disabilities-Dyslexia-Vision-2009.pdf

Complementary Therapy Assessment: Vision therapy for learning disabilities, American Academy of Ophthalmology, September 2001.
http://onetext.aao.org/CE/PracticeGuidelines/Therapy_Content.aspx?cid=d7238b2b-a59f-49f6-9f30-64d1e84efc3b

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  • Dr Burke examined my son’s eyes and spoke with him. You told me,"Andrew’s eyes are fine. Andrew is dyslexic." My response was: “What do we do?” You suggested the book ‘Overcoming Dyslexia,’ by Sally Shaywitz. My husband and I read the book and began practicing the principles advised. I will not lie, it was a struggle and an enormous amount of work. Within a year, Andrew’s Reading and self-esteem improved tremendously. Thank You.
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