Australian Journal of Ophthalmology. 1981, 9. 179- 180

EDITORIAL LEARNING DISABILITIES AND THE OPHTHALMOLOGIST

Australian ophthalmological writers have largely ignored the subject of learning disabilities. This may be because they considered it to be a problem fa the schools and remedial teachers. This hiatus in the literature has been filled by authors of other disciplines. Many claims have been made concerning the efficiency of forms of therapy ( e g visual training exercises, spectacles, occlusion) without any true scientific evidence. Few rebuttals have appeared concerning various claims to correct this problem. No requests for controlled trials have been made. This has given an air of respectability to authors whose theories have been published as proven fact.

In this journal are three papers previously presented at the Neuro-ophthalmology Sym- posium in Brisbane.

The failure of previous authors to classify fully the problem of learning disabilities has led to confusion on a grand scale. A simple practical classification is necessary. Cassin’s Classification which is quoted by Brown fills this need. The use of this classification should prevent the use of the terms “Dyslexia” and “learning disabilities” as synonyms. The role of the higher visual centres in visual perception is explained. Electrophysiological examination has confirmed the presence of brain damage in the area of the parietal region in patients with Specific Developmental Dyslexia proving that this group of patients has brain damage.

These papers support the view that there is no definite evidence of relationship between

peripheral visual ability and reading problems. Nor does the presence of a visual problem mean that visual inefficiency has resulted in the learning disability. Poor vision may give slow reading but it will not give reversals or retarded reading and correction will not improve perception.

It is shown that there can be an increased incidence of convergence insufficiency in children with learning disabilities but it is seen that this is frequeqtly secondary to the reading disability.

Much has appeared previously claiming the importance of crossed laterality as a cause of learning disability. Brain states “It is probably that the failure to establish a dominant hemisphere is the result of and not the cause of congenital abnormalities of brain function which express themselves in disabilities of speech, reading and writing.” Many forms of therapy for dyslexia have gained a semblance of respectability by being repeatedly presented in journals. This respecta- bility is historical and unfortunately not chically justified.

It has been previously suggested that if this symptom of brain damage is treated then learning disabilities can be improved. Most series involving this therapy deal with children from 6-14 years of age. Yet all neurological evidence shows the plas- ticity of the developing visual system is lost by the age of 6 years. Most series have been uncontrolled. They have stated that “occlusion plus remedial teaching plus support gives improved reading.” Claims of this nature must be supported by controlled trials before they can be accepted.

Reyririt rqrwsts : D. J. Stark, 40 Annerley Road. Woolloongabba. 4102. Brisbane.

LEARNING DISABILITIES AND THE OPHTHALMOLOGIST 179

The problem of learning disabilities is an emotional one for parents, children and teachers. It is therefore fertile soil for the charlatan. It is not surprising therefore that peripheral elements have become involved.

Ophthalmologists should be aware of the Com- bined Statement of the American Academy of Paediatrics, American Academy of Ophthalmology and Otolaryngology and American Association of Ophthalmology' which is summarised:

1. Learning difficulty requires a multidisciplinary approach

2. No peiipheral eye defect will produce dyslexia and associated learning difficulties.

3. Visual training or neurological organisational training including laterality and perceptual training is not supported with scientific evidence

4. Glasses (except where normally clinically

5. Dyslexia and learning difficulties is a problem

The ophthalmologist must therefore tread cautiously concerning claimed results. All claims of beneficial therapy must be delivered for close statistical analysis and the scrutiny of controlled trial. The role of the ophthalmologist must therefore be a "watching brief" in the treatment of learning disabilities ~ to protect the public ~ the child, the parent and the teacher.

indicated) will not assist

of Educational Science.

References 1. The Eye and Learning Disabilities. Joint Statement of

the American Academy of Paediatrics, the American Academy of Ophthalmology and Otolaryngology. and the American Association of Ophthaimology. Sight Sav Review 41:183-184. 1971.

180 A U S T R A L l A N J O U R N A L OF O P H T H A L M O L O G Y