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Nor is there a unitary deficit that accounts for all of the expressions of the disorder, despite many attempts to identify one. Many individuals have mild or constrained learning problems that are not of sufficient magnitude to be classified formally as learning disabilities; nevertheless, they may have significant learning related vision problems.Learning related vision problems are the manifestation of deficits in visual efficiency and visual information processing. Visual efficiency problems include uncorrected refractive error, dysfunction of accommodation and vergence control systems and the interaction of these systems, and ocular motility. Accommodative and vergence dysfunctions can be primary deficits or can occur secondary to uncorrected refractive error. Isolated visual efficiency deficits are relatively uncommon; most patients present with multiple deficits. A comprehensive description of accommodative and vergence dysfunctions can be found in the Optometric Clinical Practice Guideline for Care of the Patient with Accommodative and Vergence Dysfunction.21 Visual information processing problems include delays or deficits in visual spatial orientation, visual analysis (which encompasses non-motor visual perception), and visual integration skills.4. DiagnosisA learning disability is usually first suspected by a classroom teacher who observes persistent difficulty in some area of academic achievement. Formal diagnosis of learning disabilities is determined locally and has traditionally been made when a significant discrepancy exists between the potential for learning, as defined by a test of intelligence, and actual academic achievement. However, some are questioning the validity of the IQ-discrepancy classification model. 22-25 Diagnostic tests include quantitative achievement tests in academic areas (e.g., reading, spelling), evaluation of expressive and receptive language function, and evaluation of sensory systems.26,27 Vision should be evaluated to rule out potentially consequential deficits. Statement of the Problem 5The definition of learning related vision problems is not universal among educators and other health professionals. Too often it is interpreted narrowly as distance visual acuity. Although distance visual acuity is relevant for such tasks as copying from the whiteboard, other aspects of vision involving efficiency and information processing are fundamental to such near-point activities as reading, writing, and other classroom and learning activities. Proper diagnosis of learning related vision problems therefore requires comprehensive evaluation of visual efficiency and visual information processing skills.5. Reading Disabilities and DyslexiaFor the majority of individuals with learning disabilities, reading disability is their primary deficit.28,29 The role of phonological processing deficits in the understanding of reading disability is significant.30-33 These deficits are manifested in the failure to use or properly understand phonological information when processing written or oral language. This is seen in the inadequacy of phonemic awareness (synthesis, analysis, segmentation), the poor understanding of sound-symbol (or later grapheme-phoneme) correspondence rules, and the improper storage and retrieval of phonological information. There can also be difficulties with short-term and long-term memory that affect comprehension. The use of the term “dyslexia” to describe some form of reading disability has been the subject of much discourse.34 Its application has ranged from the description of reading difficulties only associated with traumatic brain injury to a general synonym for all developmental reading disabilities. It is best understood as a cognitive deficit that is specifically related to the reading and spelling processes.
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