Diagnosis of oculomotor anomalies in children with learning disorders

Abstract

This systematic review presents the existing scientific evidence for oculomotor anomalies in children with three different types of learning disorders – namely, dyslexia, dyspraxia and attention deficit‐hyperactivity disorder (ADHD). This review was registered in the PROSPERO database (registration number: 139317). The QUADAS‐2 tool was used to systematically evaluate the quality of the diagnostic tests used in the evaluated studies and to confirm whether the oculomotor alterations observed in the different groups of children with various learning disorders had a consistent diagnostic basis. Using this tool, the design of the articles was well elaborated, although concerns exist regarding the selection of patients and the diagnostic criteria for the binocular conditions. All the studies reviewed conclude that a pattern of oculomotor anomalies exist in the groups of children with these three types of learning disorders compared to healthy children. However, there is a concern regarding the diagnostic methodology, as no clear range of normality for the parameters used to characterise ocular motility was identified and no gold standard or reference test has been defined. In future studies, this range of normality must be developed for different oculomotor skills, and a reference test (possibly video‐oculography) for the measurement of these skills must be established.

Clinical Characterization of Oculomotricity in Children with and without Specific Learning Disorders

“…Eye movements and binocular function have been studied for many years in groups of children with learning disorders, reporting oculomotor abnormalities in this population [17][18][19][20]34]. Considering the relevance of saccades for reading activities [7], it has been hypothesized about the potential contribution of oculomotor abnormalities in specific learning disorders to reading difficulties, especially in dyslexia [16]. Likewise, visual exercises to promote oculomotor functionality have been suggested to be useful for improving reading performance in children with specific learning disorders [35,36].…”

“…Although videoculography has been used in several studies as an objective mode of characterizing oculomotor anomalies, no clear and validated diagnostic criteria have been defined for the different oculomotor aspects explored with this advanced technology [16]. For this reason, the DEM test was used to detect and classify oculomotor anomalies, which has good intra-subject test-retest reliability for all four of its scores when it is administered in an office setting, as well as good consistency in classifying patients as passes or fails [30,39].…”

“…Future studies should be conducted to confirm the outcomes of the current study with this advanced eye tracking technologies. However, consistent diagnostic criteria for normality should be defined for the eye tracking outcomes, as the presence of significant differences between some groups compared to healthy control individuals only confirmed the presence of a difference but not the presence of an abnormality [16].…”

“…Indeed, several studies have reported some specific differences in oculomotor patterns in these children compared to others with no learning disorders, even concluding that these differences may be a potential ocular biomarker of specific learning disorders [17][18][19][20]. However, the diagnosis of oculomotor analysis in this type of patients is still controversial, as no clear range of normality for the parameters used to characterize ocular motility has been clearly defined, and no gold standard or reference test has been established [16]. Furthermore, the real impact of this potential oculomotor anomaly on daily activities has not been clearly determined.…”

“…One group of patients that have been normally associated to oculomotor abnormalities are children with learning disorders [16]. Indeed, several studies have reported some specific differences in oculomotor patterns in these children compared to others with no learning disorders, even concluding that these differences may be a potential ocular biomarker of specific learning disorders [17][18][19][20].…”