Vision and Reading Difficulties Part 5: Clinical protocol and the role of the eye-care practitioner

This series of articles has described various aspects of visual characteristics of reading difficulties and the background behind techniques such as the use of coloured filters in helping to reduce the difficulties that are experienced. The present article, which is the last in series, aims to describe a clinical protocol that can be used by the busy eye care practitioner for the investigation and management of such patients. It also describes the testing techniques that can be used for the various assessments. Warning: DO NOT LOOK AT FIGURE 7 IF YOU HAVE MIGRAINE OR EPILEPSY

Vision and Reading Difficulties Part 4: Coloured filters - how do they work?

This article is the fourth in a series of five about vision and reading difficulties. The first article provided a general overview and the second covered conventional optometric correlates of reading difficulties (e.g. binocular vision problems). The present article continues on from the third article by describing the use of coloured filters in treating a condition now known as visual stress. Visual stress is often associated with reading difficulties, but also a variety of other neurological conditions. This article concentrates on the possible mechanisms for the benefit from coloured filters, beginning with obvious peripheral factors. The terminology for this condition has changed over the years (e.g. Scotopic Sensitivity Syndrome, and Meares-Irlen Syndrome) and the issue of terminology is discussed at the end of this article. Warning: DO NOT LOOK AT FIGURE 6 ON PAGE 33 IF YOU HAVE A MIGRAINE OR EPILEPSY

Vision and Reading Difficulties Part 3: Coloured filters - do they work?

This is the third article in a series of five on Vision and Reading Difficulties. The first article provided a general overview of learning disabilities and specific learning difficulties (SpLD). It outlined the role of the optometrist in helping people with SpLD. The second article covered conventional optometric correlates of reading difficulties (e.g. binocular vision problems) This article and the next will describe the use of coloured filters to treat a condition now know as "visual stress", which is often associated with reading difficulties; the symptoms of visual stress were described in Part 1. The terminology for this condition has changed over the years (e.g. Scotopic Sensitivity syndrome, Meares-Irlen syndrome). Terminology is discussed more in Part 4

Vision and Reading Difficulties Part 1: Specific learning difficulties and vision

This article is the first in a series of five about vision and reading difficulties, and provides an introduction and an overview of learning disabilities and specific learning difficulties. It outlines the role of the optometrist in helping people with such problems; it describes the symptoms that optometrists should look for and it provides an introduction of the evidence-based approach. The second article in this series will cover the optometric and orthoptic correlates of reading difficulties. Articles three and four will describe the use of coloured filters, including background, techniques, evidence, and mechanism. The final article will draw together the themes in the series of articles and discuss the clinical protocol and the role of the eye care practitioner in managing visual factors associated with reading difficulties

Vision and Reading Difficulties Part 2: Optometric correlates of reading difficulties

In this second article of the series on vision and reading difficulties, the optometric factors (for example refractive error and orthoptic function) that may be associated with reading problems are discussed in detail. The first article of this series introduced the correlates of, and interventions for, reading difficulties that have been supported by evidence-based research. This present article describes the optometric correlates more specifically, providing details of the aspects of visual function that ought to be considered for further investigation

Pattern-Related Visual Stress, Chromaticity, and Accommodation

PURPOSE. To investigate the impact of colored overlays on the accommodative response of individuals, with and without pattern- related visual stress (PRVS), a condition in which individuals manifest symptoms of perceptual distortion and discomfort when viewing a 3-cyc/deg square-wave grating. METHODS. Under double-masked conditions, 11 individuals who reported PRVS selected an overlay with a color individually chosen to reduce perceptual distortion of text and maximize comfort (PRVS group). Two groups of control subjects individually matched for age, sex, and refractive error were recruited. Control group 1 similarly chose an overlay to maximize comfort. Control group 2 used the same overlays as the paired PRVS participant. The overlay improved reading speed by 10% (P < 0.001), but only in the PRVS group. A remote eccentric photorefractor was used to record accommodative lag while participants viewed a cross on a background. The background was uniform or contained a grating and was either gray or had a chromaticity identical with that of the chosen overlay. There were therefore four backgrounds in all. RESULTS. Overall, the accommodative lag was 0.44 D greater in the participants with PRVS. When the background had the chosen chromaticity, the accommodative lag was reduced by an average of 0.16 D (P = 0.03) in the PRVS group, but not in the symptom-free groups: in control group 2 the colored background slightly increased the accommodative lag. CONCLUSIONS. Accommodative lag was greater in individuals susceptible to pattern-related visual stress and was reduced by a colored background. © Association for Research in Vision and Ophthalmology

Visual stress, its treatment with spectral filters, and its relationship to visually induced motion sickness

We review the concept of visual stress and its relation to neurological disease. Visual stress can occur from the observation of images with unnatural spatial structure and an excess of contrast energy at spatial frequencies to which the visual system is generally most sensitive. Visual stress can often be reduced using spectral filters, provided the colour is selected with precision to suit each individual. The use of such filters and their effects on reading speed are reviewed. The filters have been shown to benefit patients with a variety of neurological conditions other than reading difficulty, all associated with an increased risk of seizures. © 2009 Elsevier Ltd

Case Report: Color as a Therapeutic Intervention

Peer reviewedFinal Accepted Versio

fMRI evidence that precision ophthalmic tints reduce cortical hyperactivation in migraine

Background: Certain patterns can induce perceptual illusions/distortions and visual discomfort in most people, headaches in patients with migraine, and seizures in patients with photosensitive epilepsy. Visual stimuli are common triggers for migraine attacks, possibly because of a hyperexcitability of the visual cortex shown in patients with migraine. Precision ophthalmic tints (POTs) are claimed to reduce perceptual distortions and visual discomfort and to prevent migraine headaches in some patients. We report an fMRI visual cortical activation study designed to investigate neurological mechanisms for the beneficial effects of POTs in migraine. Methods: Eleven migraineurs and 11 age- and sex-matched non-headache controls participated in the study using non-stressful and stressful striped patterns viewed through gray, POT, and control coloured lenses. Results: For all lenses, controls and migraineurs did not differ in their response to the non-stressful patterns. When the migraineurs wore gray lenses or control coloured lenses, the stressful pattern resulted in activation that was greater than in the controls. There was also an absence of the characteristic low-pass spatial frequency (SF) tuning in extrastriate visual areas. When POTs were worn, however, both cortical activation and SF tuning were normalized. Both when observing the stressful pattern and under more typical viewing conditions, the POTs reduced visual discomfort more than either of the other two lenses. Conclusion: The normalization of cortical activation and SF tuning in the migraineurs by POTs suggests a neurological basis for the therapeutic effect of these lenses in reducing visual cortical hyperactivation in migraine. </jats:p

Fear of Holes

Phobias are usually described as irrational and persistent fears of certain objects or situations, and causes of such fears are difficult to identify. We describe an unusual but common phobia (trypophobia), hitherto unreported in the scientific literature, in which sufferers are averse to images of holes. We performed a spectral analysis on a variety of images that induce trypophobia and found that the stimuli had a spectral composition typically associated with uncomfortable visual images, namely, high-contrast energy at midrange spatial frequencies. Critically, we found that a range of potentially dangerous animals also possess this spectral characteristic. We argue that although sufferers are not conscious of the association, the phobia arises in part because the inducing stimuli share basic visual characteristics with dangerous organisms, characteristics that are low level and easily computed, and therefore facilitate a rapid nonconscious response. </jats:p