An ophthalmologist's approach to visual processing/learning differences.

In the past, most ophthalmologists read or were told that treatment of the disorders affecting children with dyslexia and other learning disabilities fell outside the field of ophthalmology because the brain, and not the eyes, is the main organ active in the process of thinking and learning (Hartstein, 1971; Hartstein & Gable, 1984; Miller, 1988). Because dyslexia, for example, implied an inability to understand the written word, the definitive diagnosis and therapy was in the hands of the educators and clinical psychologists, not the ophthalmologist. The role of an ophthalmologist, thus, was to rule out disease as the first step in determining the reason for a learning difference before referring the child back to the pediatrician or family doctor for further evaluation and referral. This limited role for ophthalmologists in treating children with learning disorders is now being displaced by a move toward an interdisciplinary approach. The ophthalmologist is often the first expert to whom the pediatrician refers a child suspected of having a learning disorder. Educating ophthalmologists in the medical and nonmedical conditions and situations that could affect learning in a child or older individual will help ensure that a patient receives appropriate, effective, and timely remedial treatment. The first step in educating ophthalmologists is to introduce psychiatry, educational and neuropsychology, physical and occupational therapy, and educational science in all its forms relating to learning differences in children and adults to the ophthalmology community (Koller & Goldberg, 1999). (An appendix to this chapter outlines briefly what an ophthalmologist in general practice should know about learning disorders.) The second is to make the diagnosis and treatment of children more efficient by developing a system for classifying disorders that is oriented toward ophthalmologists. This chapter describes such a classification system for learning disorders. It then goes on to describe causes and treatment of medically based ophthalmic problems affecting learning, as well as other conditions affecting learning that are not purely ophthalmic but which ophthalmologists can help diagnose (Koller, 1999a).