Visual and Oculomotor Function in Developmental Dyslexia: A Systematic Review and Meta-Analysis

Abstract

Topic To determine whether individuals with developmental dyslexia present differences in visual and oculomotor functions compared with age-matched controls.

Clinical Relevance Developmental dyslexia affects a substantial proportion of school-aged children, with prevalence estimates ranging between 3% and 6%, depending on diagnostic criteria. It is characterised by persistent reading difficulties despite normal intelligence and education. Although phonological deficits are well established, the contribution of visual and oculomotor anomalies remains debated. Identifying consistent visual differences may support more comprehensive assessments and targeted interventions alongside educational strategies.

Methods This systematic review and meta-analysis, registered in PROSPERO (CRD420251119429), included observational case-control studies comparing visual and oculomotor functions in individuals with developmental dyslexia and age-matched controls. Searches were conducted in PubMed, Web of Science, and Scopus. Outcomes included binocular vision, oculomotor performance, accommodation, visual acuity, refractive error and contrast sensitivity. Methodological quality was assessed using the MINORS tool and certainty of evidence using GRADE.

Results Twenty-six studies with 8 to 124 participants per group were included. Dyslexic individuals showed significantly greater near exophoria (mean difference 0.84 prism diopters, 95% CI: 0.22 to 1.46) and reduced near fusional vergence ranges, including negative (–6.42 prism diopters, 95% CI: –8.65 to –4.19) and positive fusional vergence (–6.72 prism diopters, 95% CI: –8.66 to –4.77), all p < 0.01. Oculomotor differences included a higher number of fixations, longer fixation duration, more regressions and reduced saccade amplitude. No significant group differences were found for refractive error or visual acuity.

Conclusions Children with developmental dyslexia exhibit consistent binocular and oculomotor anomalies that may increase visual effort during reading. Incorporating targeted assessment of these functions into vision care may complement multidisciplinary management. Further research is needed to clarify their clinical relevance.