The use of a distance letter chart test for school screening would be very unlikely to detect any of the visual correlates of dyslexia described in this chapter. Some schools use screening instruments that include binocular vision tests, but these tests are generally coarse and create conditions very different from normal reading. This is in direct contrast with optometric binocular vision tests which have, in recent years, evolved so as more closely to resemble the normal situation when reading (Evans, 2002).

Not all the children who require optometric intervention have symptoms. It therefore seems most appropriate for all children with suspected learning difficulties to receive optometric investigation.

The largest eye care profession in the United Kingdom is optometry. There are approximately 7,000 optometrists who are trained to diagnose diseases, diagnose and treat refractive and orthoptic (binocular vision) anomalies, and to dispense spectacles and contact lenses. There are about 1,500 ophthalmologists who are medical specialists trained in eye examination, and medical and surgical treatment of eye diseases. There are about 1,000 orthoptists, most of whom work with ophthalmologists. Orthoptists are principally concerned with detecting and treating binocular vision anomalies. About 3,500 registered dispensing opticians supply and fit glasses and sometimes, with additional qualifications, contact lenses.

The vast majority of optometrists work in primary care, usually in city center locations, and patients do not need a referral from a GP to see an optometrist. Few ophthalmologists work in primary care and most of the patients seeing ophthalmologists have been referred by GPs or optometrists. Most orthoptists work in hospital practice and receive the majority of their patients via an ophthalmologist.

Optometrists receive a fixed fee for a child's eye examination. The value of this fee has reduced in real terms since its introduction and only the basic eye examination is usually covered by the NHS fee. Because of the various visual anomalies that need to be looked for in a person with (suspected) dyslexia, an eye examination of such a person usually takes two to three times as long as a normal eye examination. Therefore, practitioners who have specialized in investigating children with reading difficulties almost always charge a private fee for these additional tests.

Unfortunately, there are no specific qualifications that eye care practitioners can take to indicate specialist expertise in the assessment of people with dyslexia. It is the hope of this author that the College of Optometrists will create a specialist diploma to indicate expertise in this area. A code of conduct for such practitioners is currently being prepared and it is hoped that a list of practitioners who have undertaken to adhere to this will be available, which will be held on or linked to the following website: In the meantime, the best method of finding eye care practitioners who have specialized in this area is by personal recommendation.

When, under the 1996 Education Act, a statement of special education needs is prepared, this frequently includes, under appended "medical advice," a description of vision as being "normal." In some cases, the only vision test to have been performed is distance visual acuity, which is virtually irrelevant to reading performance. This is certainly not good practice and the opinion of appropriately specialized eye care practitioners really should be sought long before the stage of drawing up a statement of special educational needs.

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Adult Dyslexia

Adult Dyslexia

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