The following editorial appeared in Visions, which is COVD’s newsletter. It was written by Dr. David Damari who is presently serving as COVD’s President.
There has been some interest in the Kelley King Heyworth article in the December article in Parents magazine, “Outsmarting Dyslexia.” Your patients or their parents may be asking some hard questions based on this statement in the article—“Because dyslexia is a language disorder and not a visual problem, experts say there is no evidence that doing vision exercises or wearing special training lenses with colored lenses can benefit kids – even though there are companies that sell them.” This statement is fraught with errors (I discuss them one by one below), as is the American Academy of Pediatrics political statement on “Dyslexia and Vision” from 2009, but it may raise questions. Here are my suggestions for a reasoned, literature-based response. These suggestions are based on my opinions formed from keeping up on the extensive literature in vision disorders and learning problems; they are not to be taken as official COVD policy.
As is my wont, I will start with my most controversial suggestion. Our profession should stop using the term dyslexia: I would strongly recommend that we stopusing this term immediately. Why? Because here is how Shaywitz defines the word dyslexia in the December article in Parents: “the learning disability that prevents children from reading and spelling with ease and accuracy.” As everyone (and I do mean everyone) knows, there are a host of disabilities and disorders – learning, visual, auditory, mental, or emotional – that could cause difficulties with reading. The term therefore has no useful meaning; that is, labeling a child as dyslexic does nothingtoward improving that child’s life. For evidence, look no further than the article’s suggestions for treatment of children labeled as dyslexic. None of the recommended “treatments” have been shown to improve reading to average levels in well-designed, long-term studies, and the remaining suggestions are accommodations, not solutions. Note that the article describes these measures as “methods that have been scientifically studied,” NOT as scientifically proven effective. As an added irony, the Rave-O and Orton-Gillingham systems mentioned as possible management have elements of vision therapy included to improve the orthographic processing aspects of reading acquisition.
Dyslexia is a word that has been used against our profession time after time. It can be used this way because almost every writer who uses the term uses it broadly to meanany problem with reading but then conflates “dyslexia” with phonological processing disorder. The logic of their argument then runs like this — dyslexia is any problemwith reading, the reading problems we have studied are phonological processing disorders, phonological processing disorders are language disorders, therefore vision has nothing to do with reading problems. When we use the term dyslexia, we only aid this flawed syllogism. Let’s not. But if you do use the word dyslexia, please be very clear about what you mean by it, and contrast your definition with how others misuse that term.
Continue to aid patients toward a useful diagnosis: If the patient has a binocular, accommodative, or other ocular motor dysfunction, find it and call it what it is. If he has a visual information processing disorder, find it and call it what it is. If she has a fine- or gross-motor delay, find it and call it what it is. If it becomes apparent that the problem is more of an auditory information processing or emotional or psychological disorder, refer appropriately. The management suggested by the Parents article and most other allopathic medicine-based articles on reading problems are usually just variations on the “try harder and take longer” theme. We offer so much more, including good multidisciplinary approaches to care of complex developmental challenges. Don’t be afraid to demonstrate our capabilities. Educate, and provide references: One of my favorite resources on reading is Beginning to Read: Thinking and Learning about Print by Marilyn Jager Adams. This classic book clearly demonstrates the complexity of the reading process, including how visual the act of reading actually is, and how the interplay between visual and verbal abilities is critical to reading acquisition and reading fluency. This is demonstrated in study after study described in the book.
In fact, there is some good in the Heyworth article. As I mentioned, some of the approaches suggested actually include visual interventions, once you investigate them. What I have found in my review of these suggestions, though, is that they are all far less efficient than vision therapy. The study on Rave-O included 70 hours of interventional instruction! And ophthalmology says that our interventions are expensive! My suggestion would be to review the article point by point with your patients, or train your staff to do this. Use what is good to reinforce the education you have already given your patient, and point out the flaws in the other aspects of the article. During the review, start with the offensive sentence quoted above, which is made easy by these major mistakes: Heyworth uses the term dyslexia to mean phonological processing disorder, she therefore implies that there is no visual process involved in reading even though every study indicates that is incorrect; she does not offer any references or state which experts make the contention that visual exercises don’t help, she ignores the myriad of studies – some of which were funded by the National Eye Institute – that demonstrate that vision therapy does help reading in certain people with reading problems, and she expands the population supposedly not helped to all kids.
The best places to look for good resources on vision and reading are the COVD andOEP websites. These sites offer a host of good, scientific articles on the subject of reading and the impact visual and other disorders can have on the process. Have your patients write to the magazine: If your patients or their parents would like to respond to the article they can do so at email@example.com. Please ask them to send a cc to our Executive Director, Pam Happ at firstname.lastname@example.org.
The CITT and brain injury literature have already had a great impact on reducing these types of articles, but as long as optometry remains an independent profession organized medicine will continue to distort what we do, or distort the science on reading, in order to attack vision therapy. A reasoned, patient-centered response will always serve us well when these attacks occur. Count on COVD to help you with useful resources when discussing these issues with your patients and referral sources.