Section on Ophthalmology and Council on Children with Disabilities, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Association of Certified Orthoptists

Learning disabilities constitute a diverse group of disorders in which children who generally possess at least average intelligence have problems processing information or generating output. Their etiologies are multifactorial and reflect genetic influences and dysfunction of brain systems. Reading disability, or dyslexia, is the most common learning disability. It is a receptive language-based learningdisability that is characterized by difficulties with decoding, fluent word recognition, rapid automatic naming, and/or reading-comprehension skills. These difficulties typically result from a deficit in the phonologic component of language that makes it difficult to use the alphabetic code to decode the written word. Early recognition and referral to qualified professionals for evidence-based evaluations and treatments are necessary to achieve the best possible outcome. Because dyslexia is a language-based disorder, treatment should be directed at this etiology. Remedial programs should include specific instruction in decoding, fluency training, vocabulary, and comprehension. Most programs include daily intensive individualized instruction that explicitly teaches phonemic awareness and the application of phonics. Vision problems can interfere with the process of reading, but childrenwith dyslexia or related learning disabilities have the same visual function and ocular health as children without such conditions. Currently, there is inadequate scientific evidence to support the view that subtle eye or visual problems cause or increase the severity of learning disabilities. Because theyaredifficult for thepublic tounderstandand for educators to treat, learning disabilities have spawned a wide variety of scientifically unsupported vision-based diagnostic and treatment procedures. Scientific evidence does not support the claims that visual training, muscle exercises, ocular pursuit-and-tracking exercises, behavioral/perceptual vision therapy, “training” glasses, prisms, and colored lenses and filters are effective direct or indirect treatments for learningdisabilities. There is no valid evidence that children who participate in vision therapy aremore responsive to educational instruction than children who do not participate. Pediatrics 2011;127:e818–e856 INTRODUCTION Reading is the complex process of extracting meaning from abstract written symbols. In modern societies, reading is the most important way to access information, and in today’s Western society, literacy is a prerequisite for success. In elementary school, a large amount of time and effort is devoted to the complicated process of learning to read. Because of the difficulties encountered in teaching some children to read, Congress mandated that the Eunice Kennedy Shriver National Sheryl M. Handler, MD, Walter M. Fierson, MD, and the SECTION ON OPHTHALMOLOGY AND COUNCIL ON CHILDREN WITH DISABILITIES, AMERICAN ACADEMY OF OPHTHALMOLOGY, AMERICAN ASSOCIATION FOR PEDIATRIC OPHTHALMOLOGY AND STRABISMUS, AND AMERICAN ASSOCIATION OF CERTIFIED ORTHOPTISTS