This review explores the literacy difficulties experienced by prelingual, profoundly deaf, sign-dominant adults. A critical overview of the existing literature identifies the importance of understanding their language experiences and word-coding preferences. Findings challenge the notion that a permanent lack of audition from birth prevents individuals from developing efficient strategies for the lexical processing of words and raises the possibility that sign-based word coding could play a central role in proficient word reading for those adults who cannot learn to read by way of the auditory perceptual route. The unique resources needed to assist in the development of the literacy skills of this minority group are discussed.