The Role of an Optometrist in Child's Reading and Learning Problems

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Ideally, every child who has the opportunity to go to school starting from nursery, kindergarten, primary and secondary school should have undergone a vision-screening programme every year. Lack of qualified manpower as well as facilities could not make this possible.


If a child under goes such regular eye check-up any visual problem that arise during this developmental period could be treated in time preventing any condition that would be in such an advanced stage that any amount of treatment would not improve his condition. Suppression amblyopia or even functional myopia could be treated and thus allowing the child to mature into an individual who will enjoy better vision.

Often a parent brings a child to the optometrist with the complaint that the child is not progressing well in school. The ability to read and learn is known to be dependent on a number of factors. In a symposium on learning disorders, the following factors were suggested as contributing to academic under achievement or learning disorders: inadequate preparation for learning, poor school or teaching conditions, health problems, emotional and psychologic disturbances or mixed laterality, traditional  visual anomalies, developmental abnormalities, motor disorders, neurologic disorders, mixed dominance, intellectual deprivation and genetic factors.

Despite the presence of these contributing factors, it is obvious that learning requires seeing. Therefore, many parents think first of the optometrist when a reading or learning problem occurs. The optometrist's first responsibility should be to determine whether a child having a learning disability may have an underlying anomaly of refraction or binocular vision.

There have been enough well designed studies to provide documentation that there are notable relationships between visual acuity anomalies and reading ability. On the basis of this information, the optometrist often can advise a parent that the correction of an anomaly of refraction or binocular vision may well remove an obstacle to improved school achievement.

Most studies relating reading ability to spherical refractive errors indicate that myopes, on the average, tend to be better readers than hyperopes. This is not surprising. Myopic children, whose myopia is usually either under-corrected or uncorrected, have little difficult accommodating for the reading distance; whereas hyperopic children, whose visual acuity often is uncorrected because they always read 20/20 in school visual acuity screening tests, not only have to accommodate excessively for the reading distance, but also this accommodation tends to be associated with excessive amounts of accommodative convergence.

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In a study by Kelly, lateral phoria findings were measured at distance and near. It was found that students who were exophoric at distance or at near had reading scores falling within the normal range, but that students who were esophoric at distance or at near scored significantly lower in both intelligence and reading tests.

Children having "myopic tendency", whether esophoric or exophoric, tended to have above average reading scores. As for children having a "hyperopic tendency", those having esophoria at near had mean reading scores that were significantly low in vocabulary, comprehension, and proficiency and were 8.5 points low in mean intelligence test scores; however, those children having esophoria at near were "almost as good as the myopes" in reading and intelligence test scores.

Studies have shown an association between reading failure and the prevalence of strabismus. However, this relationship in all probability reflects that reading failure tends to be associated with hyperopia, since there is a strong relationship between strabismus and hyperopia in children: most strabismic children have the combination of hyperopia and esotropia.

Color vision screening obviously should be included in the examination of young patients, particularly if the child has been found to have a reading problem. If a color vision anomaly is found, the child's parent and teacher should be told of its presence and should be given some insight into the problems the child would be expected to encounter in everyday life.

When the child's  poor reading or learning ability have been ascertained to be ocular, the optometrist should proceed on the basis that for a child having a reading problem the presence of uncorrected hyperopia, astigmatism or binocular vision anomalies may serve as contributing factors to the reading problem and consequently, corrective measures including the prescribing of lenses or visual acuity training or both should be undertaken.