Abstract
Aim: To provide an insight into the current issues in assessing visually symptomatic readers and the role of the orthoptist in the management of these patients. Methods: A literature-based review was undertaken to investigate the assessment of patients presenting with visual symptoms associated with reading. Areas related to binocular vision and visual stress, visual discomfort and illusions are covered. The importance of differentiating between the correction of visual discomfort and the correction of dyslexia is also highlighted. Results: Visual symptoms associated with reading are common, particularly in struggling readers, and the incidence of binocular vision anomalies in these patients is high. An evidence base spanning more than 40 years has demonstrated that binocular vision anomalies are common in those who complain of symptoms when reading and that correction of these anomalies is associated with improvement in reading function. The production of visual distortions and discomfort and links with reading have been noted in the literature. The use of colour has also been advocated to reduce visual discomfort associated with reading, and theories of pattern glare, noise exclusion and hyperexcitability are still being pursued to try to improve our understanding of how colour affects visual processing and can reduce symptoms of headache and visual discomfort. In addition binocular vision anomalies and distortion of text known as visual stress can coexist, and differential diagnosis is required when trying to improve visual comfort when reading, thus providing a role for the orthoptist in such cases. Conclusions: Orthoptists can play a vital role in the assessment of visually symptomatic readers and should modify their assessment, as well as considering a range of treatments when assessing visually symptomatic readers. They should, however, be clear that treating visual symptoms is not treatment for dyslexia per se but that alleviation of visual symptoms associated with reading can be beneficial to those with reading discomfort and can help those with dyslexia and those without known reading difficulties.
Highlights
The cause of reading difficulty is complex and most would agree principally phonological[1] in nature; correcting visual functions used for near work may be critical in those with other neurophysiological barriers to reading such as dyslexia, and making the reading process physically more comfortable can be a considerable step towards more successful and comfortable reading
The results showed that visually symptomatic dyslexics, who otherwise had elevated contrast thresholds for discriminating symbols in visual noise, had thresholds similar to non-dyslexics when wearing coloured filters
Separating out the possible causal factors of visual symptoms is key to any clinician assessing visually symptomatic readers or those who suffer from frequent headaches
Summary
The cause of reading difficulty is complex and most would agree principally phonological[1] in nature; correcting visual functions used for near work may be critical in those with other neurophysiological barriers to reading such as dyslexia, and making the reading process physically more comfortable can be a considerable step towards more successful and comfortable reading. Determining whether the symptoms described by the patients are attributable to poor binocular vision relies on history taking and comparing the results of clinical tests with known normative values. For those with poor binocular vision, such as convergence insufficiency, treatment with orthoptic exercises can be beneficial and successful in alleviating symptoms.[2,3] in recent times the use of a range of interventions has been suggested to alleviate headaches and visual symptoms associated with reading. This review will look at the assessment of visually symptomatic readers and the evidence available to clinicians when determining the aetiology of symptoms associated with reading
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