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Parents and school systems often prefer the expression of performance as an age or grade equivalent, or as a percentile rank, to enable direct comparison with expected performance levels. It is important to relate visual information processing test results to the current level of cognitive function as measured by IQ tests (such as the Weschler Intelligence Scale for Children – IV or Stanford -Binet Intelligence Scales, Fifth Edition). In the case of individuals with low average IQ scores, overall performance in visual information processing in the same range may not be indicative of a problem, but rather the expected level of performance.G. MANAGEMENTThe goal of the management of learning related vision problems is to prepare the individual to take full advantage of the opportunities for learning. Optometric intervention directed toward improving visualfunction to its appropriate level183 has been shown to be efficacious.21,75,184-191 It does not replace conventional educationalprogramming but is a necessary complementary intervention to maximize the learning environment and the effectiveness of pedagogy. In most situations, optometric intervention for learning related vision problems is delivered in conjunction with other professionals involved in the management of the learning problem from an educational or medical perspective. Interdisciplinary communication, consultation, and referral are vital for the most effective management of the individual with learning problems.The management of learning related vision problems should be directed at the identification and treatment of specific visual deficits. The expectation for intervention should be the reduction or elimination of the signs and symptoms associated with particular visual deficits. The goals of optometric intervention should be specific and problem oriented, rather than indefinite such as “to improve school performance.” To the34 Learning Related Vision Problemsextent that visual deficits influence school performance, improvement can result from optometric intervention.Learning related vision problems are usually managed in a progressive sequence. Treatment should begin with consideration of refractive status. Careful attention should be paid to the correction of hyperopia and anisometropia because of their known association with learning problems. Sometimes even slight degrees of hyperopia or anisometropia can be problematic.Next, visual efficiency deficits should be treated aggressively, using lenses, prisms, and vision therapy. The Optometric Clinical Practice Guideline for Care of the Patient with Accommodative and Vergence Dysfunction offers more detailed management recommendations.21
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