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The distinctive vertical heterophoria of dyslexics

Authors Quercia P, Quercia M, Feiss L, Allaert F

Received 13 May 2015

Accepted for publication 25 July 2015

Published 25 September 2015 Volume 2015:9 Pages 1785—1797

DOI https://doi.org/10.2147/OPTH.S88497

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Yang Liu

Peer reviewer comments 5

Editor who approved publication: Dr Scott Fraser


Patrick Quercia,1,2 Madeleine Quercia,3 Léonard J Feiss,3 François Allaert4

1Department of Ophthalmology, University Hospital, 2INSERM U1093, University Bourgogne Franche-Comté, Dijon, 3Office of Ophthalmology, Beaune, 4CEN Biotech, Dijon, France

Abstract: In this study, we looked for the presence of vertical heterophoria (VH) in 42 dyslexic children (22 males and 20 females) aged 118.5±12.9 months who were compared with a control group of 22 nondyslexic children (eleven males and eleven females) aged 112±9.8 months. Dyslexics presented a low-level (always <1 prism diopter) VH combined with torsion. This oculomotor feature clearly separates the dyslexic group from the normal readers group. It is independent of the type of dyslexia. The essential feature of this VH is a lability that appears during specific stimulation of sensory receptors involved in postural regulation. This lability is demonstrated using a vertical Maddox test conducted under very specific conditions in which postural sensors are successively stimulated in a predetermined order. A quantitative variation in this VH may be seen during the Bielchowsky Head Tilt Test, which reveals hypertonia of the lower or upper oblique muscles. Vertical orthophoria can be achieved by placing low-power prisms asymmetrically within the direction of action of the superior or inferior oblique muscles. The selection of power and axis is not only guided by elements of the eye examination but also from observation of postural muscle tone. All these elements suggest that the VH could be of postural origin and somehow related to the vertical action of the oblique muscles. VH and torsion are not harmful per se. There is no statistical relationship between their level and the various parameters used to assess the reading skills of dyslexic children. VH and torsion could be a clinical marker of global proprioceptive dysfunction responsible for high-level multisensory disturbances secondary to poor spatial localization of visual and auditory information. This dysfunction might also explain the motor disorders concomitant to dyslexia.

Keywords: dyslexia, proprioception, ocular torsion, postural control, oblique muscles, prism

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