Identifying the cause

Optometrists can help children with dyslexia by eliminating visual symptoms, according to Professor Bruce Evans.

Speaking at 100% Optical (27–29 January, ExCeL London), Professor Evans explored what optometrists can do to help children with reading and spelling problems.

During his presentation, The role of the optometrist in dyslexia, Professor Evans said that the idea that dyslexia is caused by visual factors is “almost certainly wrong.” However, he noted that visual problems can co-occur with dyslexia.

He explained that most people with dyslexia do not have visual symptoms and therefore, optometrists are not in the business of treating or diagnosing the learning difficulty. “I would be a bit suspicious of an optometrist who saw lots of dyslexics and gave them all visual therapy…because the evidence just doesn’t support that.”

However, Professor Evans said that if a patient has dyslexia as well as visual symptoms then “eliminating those visual symptoms is going to be of some help to that child. It’s going to take away a visual element of their difficulties,” he explained, adding: “We have a role but we need to be modest and precise when stating what that role is.”

When explaining what the visual problems are that can co-occur with dyslexia, Professor Evans said that binocular instability can cause symptoms of blurring, visual distortions, eye strain and headaches, but added that these symptoms can be caused by other co-occurring conditions, such as visual stress. “The patient needs an optometrist that can tell them, if they’ve got these symptoms, what the main cause or causes of those symptoms are for that child.” He added that 85% of people with dyslexia do not have binocular instability. 

Professor Evans said that the holistic approach taken by behavioural optometrists is good practice and something all optometrists should do as it takes account of a dyslexic child’s home and school life. However, he did not recommend prescribing visual therapy to train a patient’s saccades as the evidence in favour of it is weak. 

Digital devices are a potential solution for treating visual stress and often work successfully, he explained. Professor Evans said that the grey screen on a Kindle and use of the latest iOS software, which has a coloured background function, are often all a child needs instead of coloured filters.  

Professor Evans works in a community optometric practice and is director of research at the Institute of Optometry, as well as a visiting professor at City, University of London and London South Bank University.