The majority of children with reading or other learning disorders do not have vision problems, but they should be evaluated by a pediatric ophthalmologist to rule out this possibility. Parents should be advised against optometric vision therapy because there is no evidence of benefit from this expensive and time-consuming treatment.

What Shouldn’t Be Missed

Children with specific reading disorders, such as dyslexia, are usually of normal or above-normal intelligence. They have a specific problem processing written language. Early identification of such problems allows for the development of alternative teaching methods that can maximize the students’ education.

• 1. Dyslexia. Children with dyslexia and other reading problems have specific difficulty processing written information. The disorder does not result from eye or ocular tracking problems, but rather from abnormalities in the portions of the cerebral cortex that process written information. Treatment programs based on “vision therapy” are of no benefit in treating this disorder.1,2
  
• 2. Vision problems. Very few children with reading problems have primary ocular problems. However, they should be screened for these. Occasionally such children will be found to need glasses or have some form of strabismus or other vision abnormality that impedes reading (Table 23–1).
  
• 3. Normal variation in rate of learning. Normal children learn different tasks at different rates. The speed and ease at which children learn to read is quite variable, particularly during kindergarten and first grade. Patients are sometimes referred at this young age for evaluation of possible reading problems. Many of these patients are normal (both visually and cognitively), and will attain normal reading levels as they age.