La Jolla, CA-Screening for problems that affect school performance can be a challenge, according to David B. Granet, MD, who posed the question: "Who evaluates whether patients understand what they see?" Dr. Granet explained the task of pediatric ophthalmologists.
"It is the job of pediatric ophthalmologists to understand the important visual tasks of reading, to explain it to parents, and to educate them about where to find the most help," said Dr. Granet, the Anne F. Ratner professor of ophthalmology and pediatrics, and director, pediatric ophthalmology and adult re-alignment services, Anne F. and Abraham Ratner Children's Eye Center, University of California-San Diego (UCSD), La Jolla.
"To do this, we have to understand how we read," he added. However, it is not the job of a pediatric ophthalmologist to identify a learning disorder.
A complicated process
"Reading is complicated, yet we expect children ages 4, 5, and 6 to become fluent at these tasks," he said, and illustrated the difficulties associated with reading for young children.
He explained the concept of object permanence. For example, if a picture of a car is turned upside down, the object remains a car. However, problems arise with reading, for example, because of the concept of object permanence; when the letter d is turned upside down, it becomes the letter p.
"Developmentally, that makes no sense to children, because they have learned that when objects turn over their names do not change," Dr. Granet said. "Yet, in order to read, individuals must identify this concept and understand that directionality and orientation change the sound and the meaning of a letter.
"Reading requires identification of the text, decoding of the concept of the text, identifying words using global intelligence, vocabulary, reasoning, and concept formation to determine the meaning," he said. "Reading is not just visual identification of words; there is a huge amount of processing that takes place to read."
In addition to those tasks, skilled readers also jump from word to word while reading.
"We saccade when we read; we make forward saccades and then backward saccades continuously according to a staircase method to put the words in context," Dr. Granet said. "Smooth pursuit or 'tracking' is not involved in reading. Thus, reading requires decoding and understanding language for comprehension. Without all these elements, we cannot read."
Problems of underachievement
"Parents should be able to turn to their pediatric ophthalmologist for information about a disorder such as dyslexia," he explained.
"Dyslexia is an unexpected reading difficulty in children and adults who otherwise possess the intelligence, motivation, and education necessary to read," he said. "Children with dyslexia are not reading up to their intelligence level as expected."