PAGE 7

Page 7

Thorough eye and vision examinations during the preschool years, and consistently through the school years continue to be the most effective approach to early detection of visual efficiency and information processing problems. In recent public health acknowledgements of the need for early detection and intervention, some states now require a comprehensive eye examination before school entry.10 Learning Related Vision ProblemsII. CARE PROCESS A. GENERAL CONSIDERATIONSCare of the patient with learning related vision problems involves taking a patient history and examining visual efficiency, visual information processing ability, and visual pathway integrity. The Optometric Clinical Practice Guideline for the Pediatric Eye and Vision Examination should be consulted for additional information.⁸⁹B. PATIENT HISTORYThe patient history is the initial component of the care process and an important part of an appropriate diagnosis.⁹⁰ Collection of demographic data usually precedes and supplements the history taking. A questionnaire completed by the parent or caregiver can facilitate the history process. Special attention should be directed to developmental milestones and academic performance.^91-92 Questions should be constructed to define the specific nature of the learning and vision problems and should be used as a guide for the subsequent testing sequence. Information obtained directly from teachers or therapists can be helpful.Language delays are common in individuals with learning problems. As a result, sufficiently detailed descriptions of learning or visual symptoms obtained directly from the patient may be lacking. This could result in an underestimation of the severity of the symptoms and should not be the exclusive source of such information.C. VISUAL EFFICIENCY EVALUATIONVisual efficiency problems are related to learning achievement. An analysis of the literature on the subject indicates that refractive error -- in particular hyperopia and significant anisometropia, accommodative and vergence dysfunctions, and eye movement disorders -- are associated with learning problems.^93-106 Therefore, a thorough clinical investigation for the presence of these conditions in the individual with learning problems is important.12 Learning Related Vision ProblemsThough they are extremely important functional vision disorders to diagnose and treat early, other binocular vision disorders such as constant strabismus and amblyopia have not been found to be associated with learning problems.Some patients with visual information processing deficiencies, particularly deficiencies of discrimination and memory may have difficulty making reliable responses during subjective testing. The clinician may have to make necessary compensations or use alternative testing procedures to obtain relevant information. Reliance on objective findings for clinical decision-making may be necessary.1. Visual AcuityAssessment of visual acuity in patients with learning related vision problems should be measured monocularly and binocularly at distance and near point.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25