Is it a Learning Disability or Vision Problem?  The Eye M.D.’s role in screening and treating children to support school a...
Financial Disclosure <ul><li>The author acknowledges  no financial interest </li></ul>
Learning Disabilities <ul><li>Are common problems  </li></ul><ul><li>5 – 17.5 % of the U.S. population has a learning disa...
Learning Disabilities <ul><li>Arise from neurological differences in brain structure and function </li></ul><ul><li>Affect...
Learning Disabilities <ul><li>LDs may cause difficulty in learning to:  </li></ul><ul><ul><li>Read </li></ul></ul><ul><ul>...
Dyslexia (Reading Disability)  <ul><li>Most common learning disability </li></ul><ul><li>80% of all learning disabilities ...
Dyslexia - Definition <ul><li>Dyslexia is a specific learning disability that is neurological in origin </li></ul><ul><li>...
Dyslexia – Cognitive Basis <ul><li>Brain processing disorder  </li></ul><ul><li>Language-based learning disorder </li></ul...
Dyslexia – Early Detection  <ul><li>Possible early indications of dyslexia:   </li></ul><ul><ul><li>Speech delay  </li></u...
Dyslexia – Common Signs <ul><li>Significance of signs is age dependent: </li></ul><ul><li>Difficulty remembering the names...
Dyslexia – Visual Function  <ul><li>Difficulties in maintaining proper directionality have been demonstrated to be a sympt...
Dyslexia – Visual Function  <ul><li>Children with dyslexia have the same ocular health, ocular coordination, motility, and...
Vision Therapy <ul><li>No evidence that children who participate in vision therapy are more responsive to educational inst...
Role of Education <ul><li>Early detection - screening </li></ul><ul><li>Evaluation </li></ul><ul><li>Treatment </li></ul><...
Role of Education - Remediation <ul><li>Dyslexic children who receive effective phonological training in  K & 1 st  grade ...
Role of Parents <ul><li>Read to their children </li></ul><ul><li>Children should read to their parents as soon as they are...
Role of the PCP (Medical Home) <ul><li>Determine if medical, neurological, or behavioral problems exist  </li></ul><ul><li...
Role of the PCP (Medical Home)  <ul><li>Referral to appropriate educational evaluation, medical, psychological, and other ...
Role of the Ophthalmologist  <ul><li>Perform comprehensive eye examination  </li></ul><ul><li>Detection & treatment of vis...
Role of the Ophthalmologist  <ul><li>Treatable ocular conditions include:  </li></ul><ul><ul><li>Refractive errors </li></...
Role of the Ophthalmologist  <ul><li>Treatments include: </li></ul><ul><ul><li>Glasses </li></ul></ul><ul><ul><li>Eye patc...
Role of the Ophthalmologist <ul><li>Assist with referral to appropriate educational evaluation, medical, psychological, an...
Recommendations <ul><li>Children who exhibit signs of LDs  should be referred as early in the  process for diagnostic asse...
Recommendations <ul><li>PCPs should perform eye & vision screening  </li></ul><ul><li>Children who fail screening or those...
Recommendations <ul><li>PCPs should only recommend evidence-based treatments & accommodations to school districts </li></u...
Recommendations <ul><li>Ophthalmologists should identify & treat any significant ocular or visual disorder </li></ul><ul><...
Resources: <ul><li>The Policy Statement is available at:   </li></ul><ul><li>http://www.aao.org/about/policy/upload/ Learn...
Resources: <ul><li>International Dyslexia Association:  www.interdys.org </li></ul><ul><li>National Center for Learning Di...
 
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American Academy of Ophthalmology Statement on Dyslexia and Learning Disabilities

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American Academy of Ophthalmology Statement on Dyslexia and Learning Disabilities

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  • As educators, we find behavioral optometrists to be invaluable. Over 70% of our students skip words and lines when reading --- and they do the same with numbers. An ophthalmologist was not convinced until his grandson had the problem. A group of ophthalmolgists hired an orthoptist to do visual skills training after meeting with us. Dyslexia is not the same as a vision problem, but at 3D Learner, we always check for a vision problem
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  • I absolutely agree with you. We, ophthalmologists are professionals dedicated to the EYE not to VISION, reason we cannot relate dyslexia to our care. Ophthalmologists are absolutely right there is no relation between DYSLEXIA and THE EYE. We still think the image is formed on the retina and we compare the eye with a camera. There is enough scientific data showing the complexity of the visual system with different channels working in parallel, independent but is synchrony and fulfilling integrated functions to produce the visual information’s. We still use the 150 years old Snellen visual acuity test to measure static visual function and we do not consider visual cortical areas as being part of the visual system as this statement have not considered the many papers relating dyslexia to the visual brain. There are probabilly other reasons for the AAO to issue this this statement, the future will tell us. It is time for us ophthalmologists to upgrade our knowledge from eye to vision and understand vision is not image formation, it is information processing.
    RG
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  • This statement and its predecessors are all based on little to no research and tends to be motivated more by organized medicine's arrogance and hubris towards all non-allopathic practitioners. Optometry does not say dyslexia is a vision problem, we do say that there are learning related vision problems that optometric vision therapy can treat successfully. There are several National Eye Institute clincal trials that show thiw. Go to http://www.mainosmemos.blogspot.com to see some of the latest research. Dr. Handler, shame on you for posting this ... you should know better.
    Dominick . Maino, OD, MEd, FAAO, FCOVD-A
    Professor of Pediatrics/Binocular Vision Illinois Eye Institute/Illinois College of Optometry
    dmaino@ico.edu
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American Academy of Ophthalmology Statement on Dyslexia and Learning Disabilities

  1. 1. Is it a Learning Disability or Vision Problem? The Eye M.D.’s role in screening and treating children to support school and life success Joint Policy Statement 2009 AAP, AAO, AAPOS, AACO Sheryl Handler, M.D. Pediatric Ophthalmology
  2. 2. Financial Disclosure <ul><li>The author acknowledges no financial interest </li></ul>
  3. 3. Learning Disabilities <ul><li>Are common problems </li></ul><ul><li>5 – 17.5 % of the U.S. population has a learning disability </li></ul><ul><li>2.6 million children aged 6 – 11 years in the U.S. are affected </li></ul>
  4. 4. Learning Disabilities <ul><li>Arise from neurological differences in brain structure and function </li></ul><ul><li>Affect the brain’s ability to store, process or communicate information </li></ul>
  5. 5. Learning Disabilities <ul><li>LDs may cause difficulty in learning to: </li></ul><ul><ul><li>Read </li></ul></ul><ul><ul><li>Listen </li></ul></ul><ul><ul><li>Speak </li></ul></ul><ul><ul><li>Spell </li></ul></ul><ul><ul><li>Write </li></ul></ul><ul><ul><li>Reason </li></ul></ul><ul><ul><li>Solve mathematical calculations </li></ul></ul><ul><ul><li>Organize information </li></ul></ul>
  6. 6. Dyslexia (Reading Disability) <ul><li>Most common learning disability </li></ul><ul><li>80% of all learning disabilities </li></ul><ul><li>Family history </li></ul><ul><ul><li>40% affected sibling </li></ul></ul><ul><ul><li>40% affected parent </li></ul></ul>
  7. 7. Dyslexia - Definition <ul><li>Dyslexia is a specific learning disability that is neurological in origin </li></ul><ul><li>It is characterized by difficulties with decoding, accurate and/or fluent word recognition, and/or comprehension </li></ul>
  8. 8. Dyslexia – Cognitive Basis <ul><li>Brain processing disorder </li></ul><ul><li>Language-based learning disorder </li></ul><ul><ul><li>Phonologic decoding, analysis, and word identification deficit </li></ul></ul><ul><ul><li>Verbal memory deficit </li></ul></ul><ul><li>Not a vision based disorder </li></ul>
  9. 9. Dyslexia – Early Detection <ul><li>Possible early indications of dyslexia: </li></ul><ul><ul><li>Speech delay </li></ul></ul><ul><ul><li>Difficulty with rhymes </li></ul></ul><ul><ul><li>Confusing words that sound alike </li></ul></ul><ul><ul><li>Delay in learning letters </li></ul></ul><ul><ul><li>Delay in learning phonics </li></ul></ul>
  10. 10. Dyslexia – Common Signs <ul><li>Significance of signs is age dependent: </li></ul><ul><li>Difficulty remembering the names of the letters </li></ul><ul><li>Difficulty remembering the sounds of the letters </li></ul><ul><li>Reading words incorrectly – guessing </li></ul><ul><li>Reversing letters and words – (past 3 rd grade) </li></ul><ul><li>Skipping words or lines </li></ul><ul><li>Slow reading in adolescents & adults </li></ul>
  11. 11. Dyslexia – Visual Function <ul><li>Difficulties in maintaining proper directionality have been demonstrated to be a symptom, not a cause, of reading disorders </li></ul><ul><li>Word reversals and skipping words and lines are due to linguistic deficiencies and not visual or perceptual disorders </li></ul>
  12. 12. Dyslexia – Visual Function <ul><li>Children with dyslexia have the same ocular health, ocular coordination, motility, and visual processing as children without dyslexia </li></ul>
  13. 13. Vision Therapy <ul><li>No evidence that children who participate in vision therapy are more responsive to educational instruction </li></ul><ul><li>No evidence that vision training is a necessary primary or adjunctive therapy in learning disabilities </li></ul>
  14. 14. Role of Education <ul><li>Early detection - screening </li></ul><ul><li>Evaluation </li></ul><ul><li>Treatment </li></ul><ul><ul><li>Remediation </li></ul></ul><ul><ul><li>Accommodations & Modifications </li></ul></ul><ul><li>Vision screening </li></ul>
  15. 15. Role of Education - Remediation <ul><li>Dyslexic children who receive effective phonological training in K & 1 st grade will have fewer problems in learning to read than children not identified until 3 rd grade </li></ul>
  16. 16. Role of Parents <ul><li>Read to their children </li></ul><ul><li>Children should read to their parents as soon as they are able </li></ul><ul><li>Monitor children for language difficulties </li></ul><ul><li>Educate themselves on learning disabilities </li></ul><ul><li>Advocate for the child </li></ul>
  17. 17. Role of the PCP (Medical Home) <ul><li>Determine if medical, neurological, or behavioral problems exist </li></ul><ul><li>Perform complete medical history and physical examination </li></ul><ul><li>Perform vision and hearing screening </li></ul><ul><li>Refer to ophthalmologist if vision screening is failed or vision problem is suspected </li></ul><ul><li>PCP’s do not diagnose learning disabilities </li></ul>
  18. 18. Role of the PCP (Medical Home) <ul><li>Referral to appropriate educational evaluation, medical, psychological, and other services </li></ul><ul><li>Coordinate care between the family and other health care services </li></ul><ul><li>Dispel myths surrounding learning disabilities </li></ul><ul><li>Encourage family to become the child’s advocate </li></ul>
  19. 19. Role of the Ophthalmologist <ul><li>Perform comprehensive eye examination </li></ul><ul><li>Detection & treatment of vision problems as some children may also have a treatable visual problem along with their primary reading or learning dysfunction </li></ul><ul><li>Ophthalmologists do not diagnose learning disabilities </li></ul>
  20. 20. Role of the Ophthalmologist <ul><li>Treatable ocular conditions include: </li></ul><ul><ul><li>Refractive errors </li></ul></ul><ul><ul><ul><li>Hyperopia </li></ul></ul></ul><ul><ul><ul><li>Myopia </li></ul></ul></ul><ul><ul><ul><li>Astigmatism </li></ul></ul></ul><ul><ul><li>Amblyopia </li></ul></ul><ul><ul><li>Strabismus </li></ul></ul><ul><ul><li>Convergence and/or focusing deficiencies </li></ul></ul>
  21. 21. Role of the Ophthalmologist <ul><li>Treatments include: </li></ul><ul><ul><li>Glasses </li></ul></ul><ul><ul><li>Eye patching </li></ul></ul><ul><ul><li>Eye drops </li></ul></ul><ul><ul><li>Prisms </li></ul></ul><ul><ul><li>Eye muscle surgery </li></ul></ul><ul><ul><li>Convergence training </li></ul></ul>
  22. 22. Role of the Ophthalmologist <ul><li>Assist with referral to appropriate educational evaluation, medical, psychological, and other services </li></ul><ul><li>Distribute information on learning disabilities </li></ul><ul><li>Discuss the lack of efficacy of vision therapy and other alternative treatments </li></ul>
  23. 23. Recommendations <ul><li>Children who exhibit signs of LDs should be referred as early in the process for diagnostic assessment </li></ul><ul><li>Children with LDs should receive individualized evidence-based educational interventions combined with psychological and medical treatments as needed </li></ul>
  24. 24. Recommendations <ul><li>PCPs should perform eye & vision screening </li></ul><ul><li>Children who fail screening or those with suspected visual problems should be referred to an ophthalmologist experienced in children’s care </li></ul>
  25. 25. Recommendations <ul><li>PCPs should only recommend evidence-based treatments & accommodations to school districts </li></ul><ul><li>Families of children with suspected LDs should receive information about state & local parent support programs </li></ul>
  26. 26. Recommendations <ul><li>Ophthalmologists should identify & treat any significant ocular or visual disorder </li></ul><ul><li>Diagnostic & treatment approaches for dyslexia that lack scientific evidence of efficacy such as behavioral vision therapy, eye muscle exercises, or colored filters & lenses are not endorsed or recommended </li></ul>
  27. 27. Resources: <ul><li>The Policy Statement is available at: </li></ul><ul><li>http://www.aao.org/about/policy/upload/ Learning-Disabilities-Dyslexia-Vision-2009.pdf </li></ul><ul><li>More information about vision therapy for learning disabilities is available at: </li></ul><ul><li>http://www.aao.org/eyecare/treatment/ alternative-therapies/vision-therapies-learning-disabilities.cfm </li></ul>
  28. 28. Resources: <ul><li>International Dyslexia Association: www.interdys.org </li></ul><ul><li>National Center for Learning Disabilities: www.ncld.org </li></ul><ul><li>Learning Disabilities On Line: http://www.ldonline.org </li></ul><ul><li>Interdisciplinary Council on Developmental and Learning Disorders: www.icdl.com </li></ul><ul><li>Great Schools Inc/Schwab Learning: www.schwablearning.org </li></ul><ul><li>All Kinds of Minds: www.allkindsofminds.org </li></ul>

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