Visual issues - frequently asked questions

Answers to the most frequently asked questions about dyslexia and visual issues

What are the roles of professionals in eye care?

Optometrist:

• usually based in optical practices
• undertake the NHS primary eye examination and prescription for corrective treatment
• will correct sight errors with glasses and contact lenses, as well as treating a range of eye diseases
• trained to detect certain general health conditions which show themselves in eye examinations
• may refer on to other professionals.

Optician (or dispensing optician):

• experts in different types of lenses and the fitting of glasses
• provide glasses (and sometimes contact lenses) based on a prescription supplied by an optometrist or ophthalmologist.

Ophthalmologist:

• diagnose and treat disorders both medically and surgically
• usually employed in hospital eye departments
• conduct eye operations as well as prescribing medication and treating eye disease.

Orthoptist:

• usually based within the NHS, specialists in visual development and binocular vision
• part of multidisciplinary teams alongside optometrists, ophthalmologists and other health care professionals such as paediatricians
• diagnose and provide therapy for eye muscle problems which can impair how the eyes work together causing difficulties with seeing and doing close work
• specialise in how the brain uses vision during reading and in paediatrics and neurological visual issues after strokes, neurological disorders, glaucoma and brain injury
• many assess for visual problems associated with reading and have undertaken additional training to do this.

Behavioural Optometrist:

• concerned with both eye care and with how vision is processed into meaning
• use lens treatment and vision therapy (exercises) to treat visual and visual perceptual difficulties.

Do all people with dyslexia have visual stress?

No. It’s important to understand that visual stress and dyslexia are different things, but some people have both. Visual and visual perceptual issues can affect our reading and writing, which is why it is sometimes confused with dyslexia. Visual issues don’t cause dyslexia but can affect how you see text and make reading difficult and uncomfortable, affecting how you learn to read.

What should I do if I suspect someone has visual stress?

Ask – what does it feel like when you read?

Pay particular attention to the way they describe how it feels physically. For example they might say it makes their eyes feel scratchy or makes their head hurt.

Ask – what does it look like when you read?

For example, they might say they have to ‘catch the words with their eyes’ to stop the words moving, or that it looks like the text is dissolving.

Ask – what seems to make it easier or more difficult?

Use different examples of text in different font typefaces, sizes and background colours and discuss the ‘pros’ and ‘cons’ of them.

Observe – do you notice any of these things?

• They seem to get watery eyes
• They rub their eyes
• They yawn a lot (this is a result of the brain needing more oxygen to process and control the visual system)
• They move their head or the page around
• They follow text with their finger
• They seem to squint
• They need to move the page further away or have their head close to the page
• They need additional lighting or need the lights low.

Observe – when reading out loud do they do any of these things?

• Skip or omit words
• Transpose letter in words (for example they read ‘spilt’ instead of ‘split)
• Miss the beginning or end of words or punctuation marks
• Run words together and miss the gaps between them
• Use a finger to follow the text
• Seem to find it more difficult or make more mistakes the longer they read
• Are unable to comprehend what they are reading
• Mix up lines of text or columns of numbers, such as in a table.

What should I do next?

When you have gathered information about all of the symptoms, go to your Optometrist.

It is important that all of the information is passed onto the person carrying out any eye test. Make sure that you describe all the symptoms and difficulties that have been observed.

Specialist tests are needed to detect all the possible motor and perceptual difficulties and not all practices do this.

Many of the difficulties might not show up in a standard eye test. For example you might be able to read the line of text shown to you but you might not be able to sustain this over a full page of text without difficulties.

The person you go to must be a fully qualified Optometrist/Orthoptist. They must be able to assess for a number of difficulties, many of which will give similar symptoms. If they are not a specialist in reading difficulties they will be able to suggest someone who has done additional training in dyslexia and reading difficulties.

Following the eye test, an Optometrist might carry out additional tests, prescribe lenses and if necessary refer you for further tests or treatment with an Orthoptist or other professional.

See our Dyslexia and Visual Issues leaflet