When students with at least average intelligence have unexpected problems performing at expected levels in reading, writing or math, that can suggest the possibility of a Specific Learning Disability.
As noted in the AAP paper linked below, 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. Specific learning disabilities in reading (dyslexia) are associated with weaknesses in one or more reading-related language processing skills. Decades of research (most notably a series of studies funded by the NIH/NICHHD) have clearly demonstrated this, as well as the kinds of interventions that are most successful in remediating reading disabilities.
Despite this consistent body of research over time, alternate explanations continue to flourish. One of the most common unproven alternatives involves vision therapy for eye-tracking problems. Yes, we rely on vision and smooth tracking to “track” the written word on the page. And, children who struggle to read and work very hard to do so, will sometimes say that the strain of it can make their eyes “hurt.” They may, in fact, have documentable oculomotor difficulties (for example, as related to smooth tracking (pursuits), convergence, saccades, or binocular vision), but difficulties in these areas do not cause dyslexia or reading difficulties!
The paper below, an updated joint statement by the American Academy of Pediatrics, American Academy of Ophthalmology, American Academy of Pediatric Ophthalmology and Strabismus, and American Association of Certified Orthoptists explains the relationship between learning disabilities, dyslexia and vision, and debunks some of the folklore surrounding the use of vision therapy to treat reading problems. If you want to cut to the chase, see the Summary of Research Findings on Vision Therapy, beginning on page e846.
The take-home message:
(1) Vision problems do not cause reading problems, particularly in isolation.
(2) When academic learning or performance difficulties are demonstrated, seek comprehensive testing – a thorough evaluation of all skills and contributing factors that can impact learning and performance. This would include a thorough review of development, educational context, social-emotional functioning, AND the skills that are considered the building blocks of learning – reasoning skills, language, attention, memory, visual-perceptual skills, and self-regulation, to name a few. Eye exams should be part of that, too, and vision therapy may be indicated, but that alone won’t cure the reading problem.
P.S. For whatever it’s worth, my own personal history includes strabismus, convergence insufficiency, poor eye-tracking and monocular vision since infancy…and fluent, strong reading skills since my early school years.