Visual Stress and Reading – Part 3

In Part 1 and Part 2 we talked about the work of Dr. Arnold Wilkins in the U.K. and its relationship to Helen Irlen’s theories about light and color, then subequently the concept of ChromaGen lenses now making their way into the U.S. market.

Although I had read Helen Irlen’s Reading by the Colors, I hadn’t yet read her more recent book, which came out last year, detailing how she got into the application of filters in the first place.  I discovered (p.19) that what led Irlen to her theories about filters changing perception during reading was pure serendipity.  Here’s how it happened.  It was in the early 1980s that she was asked to set up a program at a California State University to investigate why adult readers were having persistent problems with reading.

During that time, Stein and Fowler in England were publishing about the influence of binocular instability on reading disorders and investigated treating some of these dyslexic children simply by occluding one eye to establish a stronger eye dominance.  Irlen decided to investigate that approach but suspected that many children would be uncomfortable with the idea of reading with one eye covered. So instead of covering one eye, she decided to have her subject wear red and green (anaglyphic) glasses, with a red filter over the page of print.

Essentially Irlen was setting up a condition that vision therapy optometrists will recognize as monocular fixation in a binocular field (MFBF).  As she reports, the group of struggling readers noted that it was now easier to read.  However, some reported that it was just as easy reading with only the red overlay without the red/green glasses on.

Irlen then made another critical observation.  For some, the color eliminated their distortions so that the words were clear and remained still.  But for others, the red overlay only made a slight difference.  At this point Irlen decided to pursue the angle of investigating whether different color combinations would have a more individualized effect.  Optometrists, meanwhile, continued to work on decreasing binocular instability to improve visual function while reading, principally through expanding vision therapy procedures rather than trying to establish a strong eye dominance through blocking the print from one eye.  And now, as Paul Harvey would say, you know the rest of the story.

– Leonard J. Press, O.D., FCOVD, FAAO

11 thoughts on “Visual Stress and Reading – Part 3

  1. Evans and Wilkins ruled out and treated vergence instability before confirming a diagnosis of visual stress and the need for precision tinted lenses. Their assessment of accommodation was poor. My experience is that a thorough assessment of both vergence and accommodation needs to be done as many of those who present with the potential need for colour have funcitonal vision issues. Once treated the number who still need or benefit from colour is quite low. The major advantage of treating them first with VT is that the visual system is free to work in any light setting. The effect of coloured filters can vary depending on the light source. It is interesting to read that Irlen’s work was kick started from a binocular vision assessment……… Thanks Len. Paul

    • You’re welcome, Paul. Yes – Scheiman’s group made that clear in their work that many Irlen clients had a bare bones eye exam prior to receiving their filters, and Ciuffreda’s group showed that accommodation in essentially unaffected by filters. Work by Chase and colleagues and Wilkins and colleagues makes me feel at present that the jury is not quite out on how many people can uniquely be helped by color as opposed to good visual care independent of color. Naturally if one is a Syntonics practitioner or dispensing colored filters or glasses, you’ll make that professional judgment after weighing what the research shows. Beyond that, a strong argument by Irlen proponents has been that the cost of the filters is far less than VT, and what does it hurt to try that first? In a way I support that, as long as it doesn’t provide a false sense of security that “we tried a visual approach and it didn’t work”. After all, if one did try filters first and symptoms persisted — any placebo effect of visual intervention has already been ruled out.

  2. Greetings Dr. Press and All,

    Juanita Collier, O.D., and Mark Rosenfield, Ph.D., reported in the July 2011 Journal of the American Optometric Association that symptoms result from the patient not having sufficient visual performance to perform the computer task comfortably. If we use their methods to research print reading and get similar results then would we agree to treat only those patients with symptoms. Yes. The reported symptoms in order of prevalence were burning/irritated
    eyes, blurred vision, tearing or itching, and red eyes. Well then, why not place these patients on premium dry eye drops and Omega 3 or Temporary Punctal Plugs, if examination results show dry eyes? Of course we want to eliminate other medical conditions as well, then proceed with our specialty testing, i.e. accommodation, convergence, oculomotor, and the rest of the visual system.

    Further research might find Dyslexics do better when we disrupt binocular function by using, let’s say a different tinted soft lens in each eye or by using a Helen Irlen filter? I have found some kids read better when
    blocking down the line they are reading with a book marker, or using a high lighter as they read, or underlining as they read or reading out loud, or using their reading finger while reading and some read better with tinted eyeglass lenses. No one vision therapy works for everybody.
    The book “Left Neglected” by Lisa Genova is an excellent read for Optometrists and shows us what works for two people in the book. It shows the brain re-wires itself. Certainly for mathematics, the spirit of perseverance, concentration, smaller class room size, stable emotion, mental poise and motor center development is needed. Certainly for reading visual perception games are needed.
    Finally, what to do with the results of the above referenced research. The paper suggests that symptoms associated with computer use and I propose all near work, is related to an increased vergence response, and not likely due to a change in accommodative response. So my question is: A little plus goes a long way so why not prescribe +.50 O.U. as it affects convergence via the ACA ratio if the effect by MEM and subjective testing improves reading performance? The OEP system of case analysis regards exophoria at near as desirable because it provides a “buffer” to over convergence. (Birnbaum MH. Optometric management of near point vision disorders)

    • I’m all for trying anything that works to reduce visual stress, August. What I’ve tried to show is that the source of nearpoint visual stress is rich and varied. It should therefore not be surprising that there are many different possible ways to approach it. As you noted, Birnbaum wrote an entire book on the subject. A lens or filter modifies incoming light by wavelength changes. A prism modified it by spatial displacement. It’s important to bear in mind that it does it differentially over a relatively narrow range of nanometer or diopter. For a system that is in flux, it would not be surprising if this were beyond the range of what a singular filter, lens, or prism could stabilize. It is the instability that is the principal source of visual stress. But hey — if a simple approach works, go for it! My point is that if it does not, or if its effect is fleeting, optometric vision therapy has its greatest utility in helping the individual acquire sufficient flexibility to absorb the visual stress without having to rely on a lens. prism or filter as a buffer.

      • Dr. Press,
        I agree and I love vision therapy. I was taught at ICO and still do a lot of home VT, hart charts, oculomotor, visual perception, Brock String, chalk board, flash cards, shadow walking, simon says, and lots of other developmental training.
        I never had the expertise needed with Esotropia and with Autistic Kids, and with CI, so I try to get these and other difficult cases to see my friend, Dr. Fortenbacher. I am in Kalamazoo, Michigan but patients are told he is worth the drive. I sincerely appreciate your expertise as well. You are good at what you do. We are all doing what we can for each and every patient.

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