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Behavioural Optometry, Dyslexia and Autism – Let’s Get It Straight

Every now and then an article of paper is published which claims to prove that Behavioural optometry is of no value in treating dyslexia or autism, or both.

Here’s the thing – behavioural optometrists don’t treat dyslexia or autism.

What they do try to improve, through the application of proven scientific principles and therapeutic modalities, is the underlying and concurrent vision problems that are not helping the child or person with these conditions to achieve their potential.

A useful model to illustrate this has was published by the Griffin in 1997[i]. The UK College of Optometry explains, “A general reading problem due mainly to vision problems, such as high, uncorrected hyperopic astigmatism would fall into circle 1. An individual with dyslexia and a concurrent vision problem would fall into area 4. From the diagram, it can be seen that optometric evaluation would be useful for those people who fall into circle1 and in particular areas indicated by and in particular areas indicated in Figure 1 by 4, 5 and 7.”

It may be that there is an apparent improvement in the dyslexia or autism, and people who do not understand what is going on may interpret the changes as improvement in the primary condition, but quite simply it is an improvement in vision effectiveness. This is no different to any other person with a vision problem. It just happens that this child or person also has dyslexia and the vision deficiency is not helping at all!

A recent press release and study issued by the University of Bristol is a classic piece of misinterpretation and selective use of statistics to support a particular perspective rather than the facts.

Dyslexics Don’t Have Vision Problems – Not True

The Bristol University press release is authored by Dr Cathy Williams, a paediatric ophthalmologist, who says “These population-based results give the 'bigger picture' and show us that vision problems are rare in dyslexic children.” [ii]

Let’s look at the facts as the study[iii] itself presents them........... One has to wonder what Dr Williams means by “rare”. The article says that 2 in 10 (or 16%) of dyslexic kids have proven vision problems. That’s a bit vague for an academic study but that’s between 16% and 20% of kids with a problem. That’s not rare either! White rhinos are rare. About 1.5% of the population has red hair. We don’t think they are rare? To suggest that 20% incidence of anything in a population is rare, is to mislead.

The article says, “The few vision impairments we did see in the dyslexic children also occurred in their non-dyslexic classmates.”

Who would have thought? Nobody claimed that dyslexic kids had “exclusive” vision problems and why would you expect that? Dyslexic kids also get influenza and get bitten by the neighbour’s dog, just like everyone else.

Dr Creavin continues, “Some practitioners feel that vision impairments may be associated with dyslexia and should be treated. However, our study results show that the majority of dyslexic children have entirely normal vision on the tests we used.”

These two logically unrelated statements seem to imply that dyslexic kids are being treated unnecessarily. The first sentence is confirmed by the study. Dyslexic kids do have vision problems. Nearly twenty percent of them do. Depends what you mean by the term “associated”. If she means “connected” that would have to be demonstrated, and the article itself does raise a question about this.

It is clear though that a significant number of dyslexic kids have vision problems concurrent or coincidental to their dyslexia, and that cannot be helping the situation. Surely vision problems that co-exist with dyslexia should be treated?

The two previous statements from Dr Williams are combined to imply that unnamed practitioners are treating kids with normal vision. This has not been demonstrated and is a significant comment to make about another profession.

“The researchers found that the majority of the dyslexic children had perfect vision on each of the tests.”

Nobody would be particularly surprised by that.

“For example, more than 8 in 10 (84%) of the dyslexic children fused (combined) information from each eye perfectly whilst 16% did not, but importantly one in 10 (11%) of non-dyslexic children didn’t fuse either.”

The study demonstrates that dyslexic kids have vision problems that occur at a much greater frequency than in the general it appears that we have reason to be concerned about these children. If the vision problems are not associated with dyslexia, how is it that they have so many more problems? There could be several explanations. What is certain is that they have more vision problems than is usual.

Dr Alexandra Creavin, a trainee ophthalmologist says “Our findings may reassure families that their child’s sight is very unlikely to be affecting their reading ability (assuming the need for glasses has been ruled out) and so they can pursue other options for supporting their child.”

Is twenty percent very unlikely Dr Creavin? I’d like a twenty percent chance of winning the lottery! That assurance cannot be obtained from the data in this study at all.

Naturally if you rule out vision problems as she suggests, the need to treat vision problems is low. If you exclude car crashes, the need for car insurance is low. Assuming we rule out heroin addiction, the need for rehab programs is overstated.

Dr Creavin also seems to be of the opinion that if glasses are not needed, there is no problem. She probably means myopia or hyperopia. That’s a pretty short-sighted view in itself. There are plenty of other vision problems.

She goes on, “Similarly, 3-D vision was excellent in more than 8 in 10 (83%) of the dyslexic children and was only seriously reduced in two dyslexic children and in another 13 children who were not dyslexic.”

We’ve been here before, but twenty percent (20%) of dyslexic kids had 3-D vision problems presumably not helping their dyslexia. The use of the actual numbers “2 dyslexic children” and “13 children who were not dyslexic”, is at best a careless use of data which understates that real issue.

In fact, there are 375,000 kids in the UK with dyslexia. 60,000 kids with dyslexia have problems “fusing” according to the study. Also according to the study, around 60,000 dyslexic kids have 3-D vision problems. The article did not say whether these were the same kids. We would have to assume there would not be perfect correlation between these two different problems and so the actual problem is very much understated by the article.

Just as a further point of interest, there are 1.2 million kids in the UK with vision problems if the article is correct. To put this in perspective, about 1,200 kids are diagnosed with cancer each year in the UK. About 35,000 kids have Type 1 diabetes. To suggest that vision problems are insignificant is to seriously understate the actual position.

Clearly we have to be careful when reading and interpreting what is written in published articles. It is obvious that there is a significant incidence of vision problems in dyslexic and normal kids that requires intervention. There may be some practitioners who make overly optimistic claims to be able to improve learning disabilities like dyslexia, but the vast majority of behavioural and general optometrists understand that they are looking to improve concurrent vision problems.

Just So there is No Doubt…

The official position of the College of Behavioural Optometrists and Optometry Australia is that optometrists do not diagnose or treat Autism or Dyslexia. They do however have the proven professional capability, and evidence based practices for management and treatment of concurrent vision problems in kids with learning disabilities. And it’s now becoming more clear that these children have a greater incidence of problems than the rest of the population

Children with dyslexia and autism should see a qualified and experienced optometrist. Every child should. That has to be better for the kids?

[i] Griffin et al. (1997). Optometric Management of Reading Dysfunction. Butterworth Heinemann, Newton


[iii] Alexandra L. Creavin, Raghu Lingam, Colin Steer, Cathy Williams. Ophthalmic Abnormalities and Reading Impairment. Pediatrics, May 2015

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