1. Undetected Visual Anomalies in Adult Literacy
Nadia Northway, Gordon Dutton, Janice Waterson Wilson 1 Glasgow Caledonian University
INTRODUCTION
Visual symptoms associated with reading are common in struggling readers however are not diagnostic indicators of dyslexia. Research has shown that vision may be less than optimal in many children with poor reading 1,2. This study examined the binocular visual (BV) status of adult learners seeking literacy support in order to determine if visual anomalies could be contributing to their problems with reading. Assessing the effects of BV treatment was also undertaken to see if the results in adults emulate those of 8 year old children in a similar study3
AIMS AND METHOD
108 adults who were making slow or no progress with reading (age range 16-65) were selected by literacy tutors in 12 centres across Scotland . Visual Acuity (VA), Refraction, Cover Test, Convergence and Accommodation Near Point, Dynamic Retinoscopy, Fusional Reserves were assessed along with reading level (TOWRE, WRAT) and speed (Wilkins RRT). Symptoms such as headache, asthenopia, blur, movement and distortion of text were all noted. Reading was assessed before and after visual intervention. All results were compared to 30 age matched able readers in a control group.
RESULTS
More than half of the learners had poor BV (Fig 1) Treatment for poor vision and binocular vision was given to 89 of the symptomatic readers (Table 1). Treatment resulted in a significant improvement in VA, BV, reading level and speed (Fig 3) in the treated (Fig 2), spelling and phonemic decoding was not significantly improved (Paired T-test p>0.05). Similar gains were not seen in an untreated group (Fig 2). A significant trend was found in terms of number of visual symptoms alleviated and reading improvement (Fig 4)
DISCUSSION
Visual difficulties were highly prevalent in adults with literacy difficulties. The visual problems detected are likely to result in inefficient reading due to text clarity being less than optimal due to uncorrected refractive error often in combination with binocular vision problems giving rise to blur and unpleasant symptoms when reading. Removal of the visual problems had a positive impact on reading speed and level in those treated whilst similar gains were not seen in a delayed treatment group. The effects were seen on reading but not spelling and phonetic decoding. These treatments can enhance reading function however are not treatment for dyslexia 3. Visual difficulties however can make reading in those with symptomatic reading more laborious and should be treated. An initial improvement in reading was noted after 3 months of visual correction but a sustained improvement was seen in those evaluated up to 12 months after visual treatment had been instigated. Improvement in literacy was seen even in those who were no longer receiving literacy tuition, implying that visual correction on its own can have a positive impact on literacy.
CONCLUSIONS
Poor Visual Acuity and Binocular Vision Anomalies are common barriers to fluent reading in adult literacy but not causal of the reading difficulty
Removal of the visual barriers and symptoms resulted in improved reading speed and ability
Improvements in reading are attributed to increased comfort , resulting in greater motivation to read and therefore more practice is undertaken
Orthoptists should examine VA and BV status in symptomatic readers paying careful attention to accommodative status in pre-presbyopia
REFERENCES
Abdi, S & Rydberg, A, Asthenopia in Schoolchildren, Orthoptic and Ophthalmological Findings and Treatment Documenta Ophthalmologica 111(2):65-72 · October 2005  DOI: /s
Evans, B.J., et al., A review of the management of 323 consecutive patients seen in a specific learning difficulties clinic. Ophthalmic Physiol Opt, (6): p
Northway, N, Assessing reading and visual processing skills of young struggling readers: a pilot study , International Journal Of Ophthalmic Practice, 2012, Vol 3, 5, pg180
Visual Assessment
Control Group
Literacy Group
Near Visual Acuity Reduced 6%
27%
Cover test ( tropia) 0% 7%
Cover test ( phoria > 10 PD 1% 8%
Fig 1: Percentage of learners (n=108) with convergence and accommodation anomalies compared to control group (n=30)
Visual Deficit
Treatment Prescribed
Frequency
No Treated
Accommodation, Convergence and Fusional Reserve training
Exercises- , dot card push up, flippers, dinosaur cards
3 times per day for 12 weeks 53
Accommodation insufficiency/lag
Reading Glasses
All literacy tasks 30
Decompensating heterophoria/ tropia
Prisms in glasses/ surgery
All literacy tasks/ full time wear
6/1
Poor near or distance vision
Glasses
As required
 52
Table 1: Treatment Prescribed
Treated Group
Untreated Group
Fig 2:WRAT reading score for treated and untreated group. Treated group show a significant increase in reading level (Paired T-test p=0.001) , untreated group show no significant increase (Wilcoxon p=0.92)
y=2.504 ±
R2=0.27
Linear Regression P=0.0014
Fig 3 : Mean ± SEM reading speed significantly increases after treatment. (Paired T-test p=0.003)
Fig 4: A significant trend was found for reading improvement in response to visual symptoms reduction.