Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls

Abstract

Background

Approximately one in ten students aged 6 to 16 in Ontario (Canada) school boards have an individual education plan (IEP) in place due to various learning disabilities, many of which are specific to reading difficulties. The relationship between reading (specifically objectively determined reading speed and eye movement data), refractive error, and binocular vision related clinical measurements remain elusive.

Methods

One hundred patients were examined in this study (50 IEP and 50 controls, age range 6 to 16 years). IEP patients were referred by three local school boards, with controls being recruited from the routine clinic population (non-IEP patients in the same age group). A comprehensive eye examination was performed on all subjects, in addition to a full binocular vision work-up and cycloplegic refraction. In addition to the cycloplegic refractive error, the following binocular vision related data was also acquired: vergence facility, vergence amplitudes, accommodative facility, accommodative amplitudes, near point of convergence, stereopsis, and a standardized symptom scoring scale. Both the IEP and control groups were also examined using the Visagraph III system, which permits recording of the following reading parameters objectively: (i) reading speed, both raw values and values compared to grade normative data, and (ii) the number of eye movements made per 100 words read. Comprehension was assessed via a questionnaire administered at the end of the reading task, with each subject requiring 80% or greater comprehension.

Results

The IEP group had significantly greater hyperopia compared to the control group on cycloplegic examination. Vergence facility was significantly correlated to (i) reading speed, (ii) number of eye movements made when reading, and (iii) a standardized symptom scoring system. Vergence facility was also significantly reduced in the IEP group versus controls. Significant differences in several other binocular vision related scores were also found.

Conclusion

This research indicates there are significant associations between reading speed, refractive error, and in particular vergence facility. It appears sensible that students being considered for reading specific IEP status should have a full eye examination (including cycloplegia), in addition to a comprehensive binocular vision evaluation.

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References

  1. 1.

    Sheedy JE (1988) Binocular versus monocular task performance. Am J Optom Phys Opt 63:839

    Article  Google Scholar 

  2. 2.

    Jones RK, Lee DN (1981) Why two eyes are better than one: the two views of binocular vision. J Exp Psychol Hum Percept Perform 7:30

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Kulp MT, Schmidt PP (1996) Effect of oculomotor and other visual skills on reading performance. A literature review. Optom Vis Sci 73(4):283–292

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Kulp MT, Schmidt PP (1996) Visual predictors of reading performance in kindergarten & first grade children. Optom Vis Sci 73(4):255–262

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Young B, Collier-Gary K, Schwing S (1994) Visual factors: a primary cause of failure in beginning reading. J Optom Vis Dev 32(1):58–71

    Google Scholar 

  6. 6.

    Grisham D, Powers M, Riles P (2007) Visual skills of poor readers in high school. Optometry 78(10):542–549

    PubMed  Article  Google Scholar 

  7. 7.

    Fulk G, Goss D (2001) Relation between refractive status and teacher evaluation of school achievement. J Optom Vis Dev 32:80–82

    Google Scholar 

  8. 8.

    Rosner J, Rosner J (1997) The relationship between moderate hyperopia and academic achievement. How much plus is enough? J Am Optom Assoc 68:648–650

    PubMed  CAS  Google Scholar 

  9. 9.

    Eames T (1955) The influence of hypermetropia and myopia on reading achievement. Am J Ophthalmol 39:375–377

    PubMed  CAS  Google Scholar 

  10. 10.

    Grisham J, Simons H (1986) Refractive error the reading process: a literature analysis. J Am Optom Assoc 57:44–55

    PubMed  CAS  Google Scholar 

  11. 11.

    Simons H, Grisham J (1987) Binocular anomalies and reading problems. J Am Optom Assoc 58:578–587

    PubMed  CAS  Google Scholar 

  12. 12.

    Granet DB, Gomi CF, Ventura R, Miller-Scholte A (2005) The relationship between convergence insufficiency and ADHD. Strabismus 13:163–168

    PubMed  Article  Google Scholar 

  13. 13.

    Scheimann M, Blaskey P, Ciner EB, Gallaway M, Parisi M, Pollack K, Selznick R (1990) Vision characteristics of individuals indentified as Irlen filter candidates. J Am Optom Assoc 61:600–605

    Google Scholar 

  14. 14.

    Clinical Practice Guideline (2011) ADHD: clinical practice guidelines for the diagnosis, evaluation and treatment of ADHD disorder in children and adolescents. J Pediatrics 128(5):1007–1021

    Article  Google Scholar 

  15. 15.

    Borsting E, Rouse M, Chu R (2005) Measuring ADHD behaviours in children with symptomatic accommodative dysfunction or convergence insufficiency: a preliminary study. Optometry 76(10):588–592

    PubMed  Article  Google Scholar 

  16. 16.

    Colby D, Laukkanen HR, Yolton RL (1998) Use of the Taylor visagraph system to evaluate eye movements made during reading. J Am Optom Assoc 69(1):22–32

    PubMed  CAS  Google Scholar 

  17. 17.

    Webber A, Wood J, Gole G, Brown B (2011) DEM test, Visagraph eye movement recordings and reading ability in children. Optom Vis Sci 88(2):295–302

    PubMed  Article  Google Scholar 

  18. 18.

    Crawford C (2002) Learning Disabilities in Canada: Economic Costs to Individuals, Families and Society. Prepared for the Learning Disabilities Association of Canada by the Roeher Institute

  19. 19.

    Quaid PT, Hamilton-Wright A (2010) Diagnosing extraocular muscle dysfunction in clinic: comparing computerized hess analysis, Park’s 3-step test and a novel 3-step test. J Optom Vis Dev 41(3):143–157

    Google Scholar 

  20. 20.

    Gall R, Wick B, Bedell H (1998) Vergence facility: establishing clinical utility. Optom Vis Sci 75(10):731–742

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Sassanov O, Sassonov Y, Koslowe CK, Shneor E (2010) The effect of test sequence on measurement of positive and negative fusional vergence. J Optom Vis Dev 41(1):24–27

    Google Scholar 

  22. 22.

    CITT Investigator Group (2008) A randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol 126(10):1336–1349

    Article  Google Scholar 

  23. 23.

    Marran LF, DeLand PN, Nguyen AL (2006) Accommodative insufficiency is the primary source of symptoms in children diagnosed with convergence insufficiency. Optom Vis Sci 83(5):281–289

    PubMed  Article  Google Scholar 

  24. 24.

    Kleinstein RN, Jones LA, Hullett S, Kwon S, Lee RJ, Friedman NE, Manny RE, Mutti DO, Yu JA, Zadnik K (2003) Refractive error and ethnicity in children. Arch Ophthalmol 121:1141–1147

    PubMed  Article  Google Scholar 

  25. 25.

    Zadnik K (1997) Myopia development in childhood. Optom Vis Sci 74:603–608

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Borsting E, Rouse MW, Deland PN, Hovett S, Kimura D, Park M, Stephens B (2003) Association of symptoms and convergence and accommodative insufficiency in school-aged children. Optometry 74(1):25–34

    PubMed  Google Scholar 

  27. 27.

    Simons HD, Gassler PA (1988) Vision anomalies and reading skill: a meta analysis of the literature. Am J Optom Physiol Opt 65(11):893–904

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Grisham JD, Simons HD (1986) Refractive error and the reading process: a literature analysis. J Am Optom Assoc 57(1):44–55

    PubMed  CAS  Google Scholar 

  29. 29.

    Palomo-Alvarez C, Puell MC (2010) Binocular function in school children with reading difficulties. Graefes Arch Clin Exp Ophthalmol 248:885–892

    PubMed  Article  Google Scholar 

  30. 30.

    O’Donaghue L, Rudnicka A, McClelland J, Logan N, Saunders K (2012) Visual acuity measures do not reliably detect childhood refractive error: an epidemiological study. PLoS ONE 7(3):1–7

    Google Scholar 

  31. 31.

    Aziz S, Cleary M, Stewart HK, Weir CR (2006) Are orthoptic exercises an effective treatment for convergence and fusion deficiencies? Strabismus 14:183–189

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Gallaway M, Boas M (2007) The impact of vergence and accommodative therapy on reading eye movements and reading speed. J Optom Vis Dev 38(3):115–120

    Google Scholar 

  33. 33.

    Maples WC (2003) Visual factors that significantly impact academic performance. Optometry 74(1):35–39

    PubMed  CAS  Google Scholar 

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Acknowledgements / Disclosures

The authors have no financial interests in any of the products or testing procedures discussed in this paper. No conflicts of interest or conflicting affiliations are reported as of the date of submission of this paper. The authors have full control of all primary data, and agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review any data if requested. The authors wish to thank two anonymous reviewers for helpful comments in the preparation of this manuscript. The authors would also like to thank Dr. Patricia Hyrnchak (Faculty, University of Waterloo) for valuable comments on the manuscript prior to submission.

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Correspondence to Patrick Quaid.

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Quaid, P., Simpson, T. Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls. Graefes Arch Clin Exp Ophthalmol 251, 169–187 (2013). https://doi.org/10.1007/s00417-012-2135-0

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Keywords

  • Binocular vision
  • Reading
  • Visagraph
  • Vergence
  • Accommodation