“My daughter was diagnosed with Dyslexia. We had her eyes tested and they said it’s fine. Could tracking be a problem?”
This mom writes in with a really common question. Can vision be part of the dyslexia puzzle? Well, the answer is yes… and no. Probably not what you want to hear, is it? As we break down how vision and dyslexia are related, you’ll understand just what I mean.
First, a reminder of vision. Unfortunately many professionals still consider vision just as seeing clearly, a glasses prescription and the health of the eye. What is now understood by the leaders in the field is that vision is much more than that. It’s about how well the eyes and the brain work together. The TedX talk here: https://youtu.be/L0pljgXZ_GA covers a lot of this.
- Eye teaming (binocularity)
- Focusing (accommodation)
- Visual processing (visualization for spelling etc)
- Visual-motor integration (writing and fine motor coordination)
- Visual-vestibular integration (how the eyes and inner ear talk to each other.
The International Dyslexia Association defines dyslexia as:
“Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.”
So how does vision relate to dyslexia?
Picture yourself listening to an audiobook on headphones, and the CD or track was skipping and jumping around. Understandably you would have difficulty recognizing the words, and making sense of what was said. So the language areas in your brain would not be given accurate input to work with. Of course you would show difficulties.
Now imagine if you were reading a paragraph of text. While reading, the letters all split in random ways, and then floated around to reorganize themselves every couple of seconds. You would be able to see the page, but the language centers would not be getting accurate input about what was actually on the page. This is like the skipping CD, expect you may not even know it’s skipping, and nobody around you would know either.
If a child’s eyes do not track accurately, their eyes can often jump to the wrong place when reading, or jump forwards then backwards without them understanding this is what happened. The eyes can also deviate from each other so that each eye is actually pointing at a different part of a word, confusing the information that is ‘seen’.
How could you expect someone to recognize a word, or decode a phoneme (part of a word), if it looks different every time they see it? This is often why vision problems can mean that you will teach your child a word on one line, and three lines later they won’t recognize the same word. Because to them, it looks like an entirely new word!
If a child was struggling while listening to an audiobook, you would want to check to make sure they are getting the proper input in their headphones. Vision is the same thing. Problems with eye tracking and teaming can mess up the input like the skipping CD.
When diagnosing dyslexia, the DSM-V clearly states:
“The individual’s difficulties must not be better explained by developmental, neurological, sensory (vision or hearing), or motor disorders… “
Ironically, vision is developed, neurological in origin, sensory, and vision is an important part of motor ability (coordination requires coordinates). So this means that all areas of vision should technically be ruled out before dyslexia testing is done or a diagnosis is made. This is now the standard in the UK.
The reason for this, as you can imagine, is that most of the testing done requires vision, or visualization in order to do the testing.
Dyslexia and Vision confusion
The confusing part about the DSM-V statement on dyslexia is that many people understand it to mean that dyslexia has nothing to do with vision. This is 100% true, if vision (including tracking, binocularity, and processing) was completely ruled out before the dyslexia was diagnosed. Unfortunately, most dyslexia diagnoses are made when only seeing clearly and eye health have been checked. This means that most children who are tested for, and diagnosed with dyslexia, have not had had the visual functions properly tested and ruled out. This means that if they have vision problems (80% do), these problems will have interfered with the testing.
What can you do?
If your child or someone you love is struggling with reading, suspected of dyslexia, or has a dyslexia diagnosis, it’s is important to have their full visual function evaluated. Find a neurological or developmental optometrist who will test: binocular function, accommodative function, tracking, visual processing, and often more. Make sure the optometrist is experienced in this area, as most optometry and ophthalmology schools still teach the old understanding of vision. Many routine eye exams, or even exams with the best surgeons, will not test the actual tracking function. So don’t stop until you find someone who will.
The exam may rule out vision entirely, and then you know that it’s not part of the problem. Or it may find that vision is part of the issue, or with treatment you may find that vision was the entire part of the problem. Either way, it’s an 80% chance that vision is involved in the struggle, so the odds are in favour of an exam.