The Truth About Visually-Based Reading Disability (Part 1)

There is a growing body of scientific evidence pointing to the existence of what can best be categorized as “Visually-based Reading Disability” or VBRD. (Visually Based Reading Disability)

What is a VBRD?   It can best be described as a reading disorder where visual signs and symptoms predominate.  Here are some examples:

  • Letters/words become blurry or turn double
  • Letters/words seem to float all over the page
  • —Loss of place when reading/ re-reading
  • The page gets “glary” and hurts eyes
  • —There are frequent small word errors (both omissions and substitutions)
  • Words move or shimmer on the page
  • —Can read well when words presented individually, but not when the same words are in a paragraph

Charles Fortenbacher has done a marvelous job depicting what written text might look like for a child with VBRD 

This can be contrasted to the more typical symptoms of a phonologic or “language-based reading disability” whose signs and symptoms include:

  • Difficulty learning the alphabet or letter order
  • Associating sounds with the letters that represent them
  • Identifying or generating rhyming words, or counting syllables
  • Segmenting words into individual sounds, or blending sounds
  • With word retrieval or naming problems
  • Learning to decode written words
  • Distinguishing between similar sounds in words; mixing up sounds in   polysyllabic words (auditory discrimination) (for example, “aminal” for   animal, “bisghetti” for spaghetti)
Of course, the possibility exists that a child will have both “visual” and “language” components to their reading disability.
Visually-based reading disability can be insidious in nature, as children who have these visual symptoms often are “good” readers.  They may have good reading comprehension, and their independent reading level is often at grade level, or one to two years behind at most.  But they are often visually uncomfortable, inefficient, and rarely read for pleasure.  Many times they are labeled  “lazy” or are underachieving compared to their potential.
How can you find out if your child has VBRD?  The best way is through a comprehensive examination by a developmental optometrist.  You can find one through the College of Optometrists in Vision Development Locate a doctor
In part 2, I will discuss some current theories about the underlying basis of visually-based reading disability and what some potential treatment options are.

17 thoughts on “The Truth About Visually-Based Reading Disability (Part 1)

  1. Dr. Tannen, thanks for the excellent summary of research that accompanies this post. Very timely as I am undertaking much research and writing in this area currently.

    Just some thoughts re: use of the term VBRD:

    > Disability is a difficult word as it has legal implications. Perhaps ‘disorder’ or ‘dysfunction’ would better suit the purpose. Further, we would expect that a disability may not be as responsive to Tx as would a disorder or dysfunction.

    > As visual impediments often impact upon other classroom behaviour including attentiveness, ability to sit still, tolerance for near tasks, and many quasi-medical concerns such as headache and diplopia, the term VBRD would best be included as a subset of VIL – Visual Impediments to Learning. LRVD / VRLD would be somewhat synonymous with VIL.

    Again, thanks for the post.

    • Dr. Boulet, thank you very much for your thoughtful response. I can see your point with regards to the word disability; however the term reading disability has had so many definitions and variations over the years that I didn’t think of the legal aspect of disability. I could certainly live with visually based reading disorder as well. Thank you also for your insight on visual impediments to learning.

      • Agree that there is great variability in how ‘disability’ is used. As non-MDs, we do not have the option of diagnosing an apple as an orange and getting away with it. Whether it is an apple or orange, the child and parents will still have to deal with the outcome of additional costs and possibly toxic psych and medical interventions, even if there are in fact NO fruit involved at all… My preference is for MDs to apply the ‘disability’ label when referring to LD/RD, but eventually when the ‘flatlanders’ of the world recognize there is some variance in visual function that impacts upon behaviour, I will be happy to provide the same legal tag.

  2. Excellent discussion. I believe we have wiggle room here because the term “disability” isn’t necessarily a legal one. There is considerable overlap with education. While under ADA guidelines phyical disability is something accommodated more often than remediated, the learning aspect of disability can certainliy be remediated. That is, after all, what many educational programs set out to do. The learning community uses the term disability so widely that it would introduce confusion to talk about reading disorders rather than disabilites. As usual, we are talking about a hybrid factor here, part physical (“health”) and part educational (“learning”).

    • Great point Len. In fact, my intent was to try avoid confusion by keeping consistency in terminology. By using the reading disability parallel (with the classification of a visually based subtype), I hope to bring recognition to a category of patients who many of us are all too familar with clinically.

      • What I’m looking for in particular are examples of vision dysfunction that lead to accommodations in the classroom (other than field loss, blindness, and other medical Dx). What about saccadic problems, or CI, intermittent exo, accom disorders, amblyopia, etc.? At this point, I’ve not heard of schools accommodating for this in Alberta/Canada, let alone insurance providing coverage for Tx. What do school divisions and insurance provide for these conditions in the context of LD/RD? Hope this is somewhat clearer.


  3. … Gents, in the end, I look forward to the day where visual dysfunction will be recognized as the basis for disability and open the door to OVT coverage. Soon upon us? Research is moving this way – I’ve recently come across some intriguing pieces from edpsych that point strongly to a role for vision in learning. It’s that ‘d’uh’ moment that I’m seeing more and more of when I speak to developmental pros. Difficult vision as disability, however, has many battles to fight before the health insurance lobby in the US relents – research is needed to support it, but it will take law suits before anything moves. We’ll see. Again, education and research are key. Our best steps forward are indeed to find points of fusion between behavioural domains, esp: teachers, OTs, PTs, and psychology, edpsych.

  4. That day IS coming. In the face of interdisciplinary research, the need to address vision early will become an obvious imperative where all stakeholders will benefit, and this in spite of what the ‘other’ eye care profession has to say about the relative lack of disease. More to come…

  5. I hope so too. Its hard when people dont understand how difficult it has been for me to earn a college degree with diplopy. The tast of learning anything by heart was and still is for me enormous. I sometimes look to people as dumb as the memory is necessary for intelligence processes as it allows for ordering ideas etc. I have always had the issue of decission making since not remembering things like names , numbers, etc, made it more difficult to establish a logical connection. It is interesting to note that in my case I can rememeber better when using no correction and not focusing my eyes on nothing, but the decission making process gets harder when not focusing too.

    Its an ordeal.

    I need to get people to realize this IS a Dissability and should be recognized as such.

    Ramon Puig

  6. I have had this problem since childhood.
    apparently I was born with Strabismus and I had surgery at a very early age without receiving eye therapy which is what would have made my brain regain the necesssary binocularity before the surgery, according to what an eye therapist told me some years ago.

    i am 33 now, and I have realised that all my learning difficulties where derived from this. It has been and stil is hard when you see that this creates memory problems and learning problems. Many people dont understand this , specially those who only believe in what doctors say or newspapers . Most people will look at you and tell you that you are looking for an excuse to backup your stupidity. The reality is that you get more stupid when you have this problem. Excuse my words but I am pretty annoyed at this social problem.

    If this problem was recognized as a disability then people would have to respect the ones suffering more.

    There is truly a lack of understanding towards this problem and this has to end .

    Thank you Doctor Barry for wrting this book and I hope it helps us others who are still trying to get the 3D back.

    • You are welcome. I think that awareness of the problem is the first step to getting it accepted. If you’d like you can email me privately and I can try to help you find a developmental optometrist in your geographic area.

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