In an initial discussion the examiner must determine whether a child has a specific reading problem or a more generalized learning disorder. 

It is important to look at school papers and to review any prior psychometric testing.  If psychometric testing has not been done, it should be.  These tests of verbal performance capabilities comprise the IQ or intelligence quotient.

 Uncorrected hypermetropia or astigmatism may contribute to poor reading performance.  In such cases, the appropriate correction should be prescribed.

 A rare cause of reading difficulties is premature presbyopia.  The near point of accommodation is reduced and prescription of reading glasses or bifocals remedy this problem.

 Convergence insufficiency causes asthenopia at near vision and may contribute to poor reading performance.  Orthoptic exercises are indicated.

Efforts to maintain fusion in the presence of a large heterophoria may decrease reading performance; this may require surgery or orthoptic exercises.

  V pattern esotropia or esophoria - as seen in this child - may cause diplopia or asthenopia in downward gaze and must be ruled out as a cause for poor reading performance.  This is a rare cause of reading difficulty and may require surgery to correct esotropia on looking down.

Surgery needed for this child is OU MR &  downshift of the insertion without recession or resection .