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Full participation in science, technology, business, and the professions requires increasing levels of learning, particularly reading.⁷ Therefore, learning problems are a public health issue of widening significance.⁸ They can decrease the quality of life for the affected individual, delay academic achievement,and reduce employment and earnings opportunities.^9,10 Self-esteem and peer relationships can be negatively influenced.^11,12 There is also thepossibility of lasting effects on family function, with stresses placed on the community and family for financial and service resources.¹³The emphasis on reading achievement reached national prominence with the sweeping No Child Left Behind Act of 2001, Public Law 107-110 (NCLB) that reauthorized the Elementary and Secondary Education Act -- the main federal law affecting education from kindergarten through high school. NCLB is built on four principles: accountability for results, more choices for parents, greater local control and flexibility, and an emphasis on doing what works based on scientific research. Reading First is the academic cornerstone of the No Child Left Behind Act. Reading First provides grants to states to help schools and school districts improve children's reading achievement through scientifically proven methods of instruction. The program funds instructional programs, materials and strategies, screening, and diagnostic and classroom assessments.Undetected and untreated vision problems are of great concern because they can interfere with the ability to perform to one's full learning potential. ⁶ When these vision problems have an adverse effect on learning, they are referred to as learning related vision problems.Statement of the Problem 32. DefinitionLearning related vision problems represent deficits in two broad visual system components: visual efficiency and visual information processing.¹⁴ Visual efficiency comprises the basic visual physiological processes of visual acuity (and refractive error), accommodation, vergence, and ocular motility. Visual information processing involves higher brain functions including the non-motor aspects of visual perception and cognition, and their integration with motor, auditory, language, and attention systems.3. Problems Encountere Many different forms of learning problems are encountered in optometric practice; the most severe involve learning disabilities. In 1975 the Education for All Handicapped Children Act, Public Law 94- 142, defined learning disability as a disorder in one or more of the basic psychological processes involved in understanding or in using spoken or written language, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations. This basic definition has been incorporated into the Individuals with Disabilities Education Act (IDEA), Public Law 101-476 (1990).Learning disabilities are a heterogeneous group of disorders that result in significant difficulties in academic achievement. Learning problems in spoken language can be represented as delays, disorders, or discrepancies in listening and speaking (vocabulary/articulation); in written language, as difficulties with reading, writing, or spelling; in mathematics, as difficulties in performing math functions or comprehending basic concepts; and in reasoning, as difficulties in organizing and integrating thoughts and turning them into effective actions.¹⁵ Attention deficits with hyperactivity disorder (ADHD) or without it frequently are co-morbid with learning disabilities.^16-18 Other associated traits, such as impulsiveness, low frustration tolerance, and difficulties with social interactions and situations, are also common.^19,204 Learning Related Vision ProblemsThere is no single ideal clinical profile of an individual with learning disabilities. The definition of learning disabilities does not identify or describe a specific individual with a specific problem.

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