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Irlen syndrome: expensive lenses for this ill defined syndrome exploit patients

BMJ 2014; 349 doi: (Published 29 July 2014) Cite this as: BMJ 2014;349:g4872

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From its discovery 35 years ago, Irlen has been the subject of scrutiny and criticism from a number of groups, particularly optometrists, who have sometimes suggested that the Irlen Method is not supported by scientific research and that the problems associated with Irlen Syndrome can be corrected through standard optometric interventions. Research has shown that binocular and accommodative anomalies may occur in conjunction with the syndrome, but are not considered to be the underlying physiological basis of the condition (Evans, Patel, Wilkins, Lightstone, Eperjesi, Speedwell et al., 1999; Evans, Wilkins, Brown, Busby, Wignfield, Jeanes, & Bald, 1996; Evans, Wilkins, Busby, & Jeanes, 1996; Scott, McWhinnie, Taylor, Stevenson, Irons, Lewis et al., 2002). Irlen has also been reviewed by various USA Boards of Optometry and the USA Medical Board and was found not to be either the practice of optometry or medicine. As a perceptual problem, it is similar to other processing problems (both visual and auditory) that are diagnosed by psycho-educational testing and treated within the educational system.

When it comes to research, often individuals who say Irlen is not supported by research are uninformed, citing second-hand positions based on research that is more than 20 years old. Specifically, early critics of the research have said that it does not control for placebo effects or experimenter bias, and that it lacks validity and reliability. However, there are more than 100 scientific research studies on the topic of Irlen Syndrome that are published in peer-reviewed scientific journals. These studies have most often been conducted by independent researchers with no financial investment in the method. This research has established a hereditary component of the disorder (Loew & Watson, 2012; Robinson, Foreman, & Dear, 2000; Robinson, Foreman, Dear & Sparkes, 2004), a number of biochemical markers for problems associated with Irlen Syndrome (Robinson, Roberts, McGregor, Dunstan, & Butt, 1999; Robinson, McGregor, Roberts, Dunstan & Butt, 2001; Sparkes, Robinson, Dunstan, & Roberts, 2003), and differences between both the anatomy and functioning of brains of individuals with Irlen Syndrome (Chouinard, Zhou, Hrybousky, Kim, & Commine, 2012; Huang, Zong, Wilkins, Jenkins, Bozoki, & Cao, 2011; Lewine, Davis, Provencal, Edgar, & Orrison, 1997; Riddell, Wilkins, & Hainline, 2006; Yellen & Schweller, 2009). The research has repeatedly documented efficacy of both colored overlays and spectral filters, as measured by improvements in a variety of reading skills (Bouldoukian, Wilkins, & Evans, 2002; Nobel, Orton, Irlen & Robinson, 2004; Park, Kim, Cho, Joo, 2012; Robinson & Foreman, 1999; Tyrrell, Holland, Dennis, & Wilkins, 1995; Williams, LeCluyse, & Rock Faucheux, 1992; Wilkins, Evans, Brown, Busby, Wingfield, Jeanes & Bald, 1994), reduction in physical symptoms that include headaches, migraines, eye strain, fatigue, and light sensitivity (Barbolini, Lazzerini, Pini, Steiner, Del Cecchio, Migaldi, & Cavallini, 2009; Bulmer, 1994; Chronicle & Wilkins, 1991; Huang et al., 2011; Wilkins & Wilkinson, 1991), and improved functioning and success in both academia and the workplace (Bulmer, 1994; Irlen & Robinson, 1996; Robinson & Conway, 1994; Robinson & Conway, 2000; Whiting & Robinson, 1988; Whiting, Robinson, & Parrot, 1994).

Over the years, there have also been a few studies that offered negative results, and these limited studies have often been cited as the support for dismissing the validity of Irlen. However, these negative studies have been critiqued in the literature for their methodological flaws (Robinson, 1994; Robinson, Foreman, & Dear, 2000), which include not controlling for uncorrected optometric problems, utilizing inappropriate outcome measures, and, the most egregious error, not screening for Irlen Syndrome to ensure they have selected an appropriate sample for the study. In addition, most of the researchers who published negative findings in the early days of research on the topic have subsequently published positive research and have become some of the strongest proponents of colored filters and colored overlays. These individuals have, in many cases, begun prescribing colored filters and overlays in their own practices.

While admittedly frustrated by the controversy that seeks to prevent a research-based, non-invasive, and easily implementable intervention from reaching individuals who need it most, we find that with controversy comes the drive to continue to advance our technology and document its validity. We continue to push forward in the face of adversity because of the millions of individuals we have helped and for the millions of children and adults who have yet to be helped.

Sandra I. Tosta, Ph.D.
Irlen Institute International Headquarters

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Competing interests: I am employed by the Irlen Institute.

29 July 2014
Sandra I. Tosta
VP Business Development and Research Operations
Irlen Institute International Headquarters
5380 Village Road, Long Beach, CA 90808 USA