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vision & Dyslexia

Most (about eight out of ten) bright children practically teach themselves to read.  It doesn't matter which reading program is used, the child rapidly masters the reading skills.  Dyslexia is a term used when a child does not respond to a standard reading program and needs to be guided one tiny step at a time.  The term is a catch-all used to describe any condition that makes it difficult for an otherwise bright child to learn to read. Different children have different reasons or combinations of reasons for not learning to read.  These are a few of the more common:  

  • Language problems:  The child may not understand the meaning of the words or be familiar with language.  If when you read to the child, he does not understand an age-appropriate story, a language problem is very likely tied to the reading problem.  If a child easily understands when being read to, then the most serious obstacle to reading comprehension is probably not present. 

  • Phonemic Awareness: The child cannot hear a stream of sound and break it down into its parts.  For instance, the child might not hear that the word doghouse is made up of the sounds dog and house.  Or the child might not hear that the word coat is made up of the "k" sound and the word oat.  Children who do not hear the sounds in words have difficulty with typical phonics programs because they cannot hear the sounds they are trying to match with the letters.

  • Automatic Naming:  The child is very slow at looking at a symbol, remembering what to call it, and getting the sound out.   Poor automatic naming makes a child very slow at sounding out words.  The better that child's ability to recognize whole words, the quicker he will be able to read.   

  • Visualization:  The child either cannot picture words in his mind or has not been taught to picture words.  Thus, when the child sounds out a word in one line he does not recognize the same word in the next line.   On the other hand, a  child who pictures words easily may have a good sight vocabulary but still not be able to "sound out" words seen for the first time.  When it comes to reading comprehension rather than decoding, the child who has not learned to picture the story being read is at a disadvantage.

  • Spatial Perception/Eye-Teaming:  The child is confused by symbols when they are crowded together.  He can recognize a word with the letters well-spaced and large on a flashcard, but cannot recognize the same word when the letters are small and crowded together in a line of print.  Such spatial perception problems can be due to print doubling and running together because of eye-teaming problems like convergence insufficiency.  This confusion is also described in our Reading webpage. 

  • Directionality: the ability to understand the concepts of right and left in space.  A young child has two directions: "toward me" and "away from me."  A b and d is a line with a half circle and the circle goes "outward" or "away from me".  Such a child will not understand how a b is different than a d.  This is a different problem than merely not remembering which letter is which.  To such a child the b and d look "the same."  The various "tricks" for teaching the difference between b's and d's may not work without first addressing the directionality problem. 

The purpose of our Developmental Vision Evaluation is to get to the heart of what is causing the reading problem.  It could be any or all of the above.  Only a reading specialist is trained to work around the reasons children do not learn to read.  If we eliminate the reasons themselves, however, there is far less to work around.  Once a child can comfortably look at the parts of a word, picture the parts of a word in his mind, and hear the parts of the word, the learning rate should increase dramatically.  This makes it relatively easy to go back to the beginning and fill in the missing reading skills.  The review process remains necessary because our vision therapy programs do not teach missing phonics skills.  The difference is that the review can now generally be done by a good tutor, a home educator, or a reading specialist because the child no longer has to sound out the same word in a line he sounded out in the previous line.            

Dyslexia and vision image

Learn more about the PHONETIC AND

Learning to read requires phonetic and eidetic processes, which are cognitive ways to decode and encode words. Visual skill deficits can interfere with both encoding and decoding words, in a host of different ways. Vision problems can cause problems with sight recognition, reading comprehension, memorization, recall, fluency, speed, rhythm and the length of time spent reading or writing.


To explain how a behavioral optometrist can help diagnose and manage vision related learning difficulties in dyslexic individuals, it may be helpful to briefly explain some of the categories of dyslexia.


The following terms are for your information, but the bottom line is the label is not what matters (though sometimes it is necessary to begin correct treatment and management). What IS important is what can be done about the difficulties the child is experiencing to make it easier for them to learn. Don't let the labels and terms make you forget the child.


The three most common types of dyslexia and how developmental optometrists can help:

  • Dysphonesia - A dysfunction where the primary problem is letter-sound integration. They are unable to identify words or letters with their accompanying phonetic sounds. They cannot attack unfamiliar words using skills such as phonics, syllabication and/or structural analysis. This is a decoding problem. Dysphonetics rely on eidetic coding (word attack skills). You can think of eidetic coding as memorizing words instead of sounding them out. Words like "pneumonia" and "mnemonics" are eidetically coded. Dysphonetics may recognize familiar words, but are incapable of efficiently decoding unfamiliar and multisyllabic words because they have difficulty sounding out and blending sounds together. For example, if they were taught the word "deal" they may still have difficulties with the word "seal" or not know how to read the word "dealing." These children tend to need more educational help rather than optometric remediation, though remediating any vision problems that could be causing some of the difficulty is always helpful.

  • Dyseidesia - A dysfunction that involves whole word decoding, a more global process in which words are recognized based upon their shape and configuration. This is the opposite of dysphonesia. People that are considered dyseidetic lack the ability to take whole words or configurations and perceive them as a unit symbol (or gestalt), but can use skills such as phonetics (sounding out words), syllabication and structural analysis. This means they don't have good word attack skills. It is more of an encoding problem. They have problems storing information, which involves sequential memory (knowing the right order of things). Consequently, retrieval of information is difficult. People who experience this dysfunction rely on phonetic coding instead, which can lead to incorrect spelling. Some researchers have found that these individuals have deficient short-term visual memory (the ability to recall previously presented visual experiences), visual discrimination (the differentiation between visual patterns), visual figure ground (differentiating a particular part of a visual field, e.g. Where's Waldo), and visual sequential memory (visualizing in a particular order). These problems are often remediated by visual perception training. Visual perceptual therapy can improve a person's reading skills and comprehension, assuming they are still provided the proper educational instruction.

  • Dysnemkinesia - A dysfunction that involves memory and motor movement. Individuals with this dysfunction tend to be distinguished by their abnormally high frequency of letter reversals. It is the dysfunction most people think about when they hear the word dyslexia. This is actually a developmental issue. It occurs due to poor development of the visual spatial skills known as laterality and directionality. They have problems with things like symbol orientation. For example, "p" "b" "q" and "d" are all the same symbol oriented in different ways. Dysnemkinesics will not see this symbol as being different letters when oriented differently and will confuse them. Consequently, Dysnemkinesics tend to transpose letters and syllables, exhibit faulty eye movements, demonstrate excessive reversals, and have spatial difficulties. They often have poor sight recognition and tend to have trouble building up a sight vocabulary. Reading tends to be slow and difficult, since they often read and spell phonetically. Dysnemkinesia is the easiest type of dyslexia to identify and treat by an optometrist skilled in vision training.

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