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 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 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 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

Coloured filters may reduce symptoms of dyslexia in those with visual stress

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Communication: part 2 - delivering findings and advice to the patient

The outcome and consequences of results from examination tests need to be communicated in a way that can be easily understood by the patient, encouraging them to follow the advice that has been given by the practitioner. For a number of reasons, the delivery of findings and advice to the patient is a highly complex communicative activity. The content of information given can vary widely in length and seriousness. In addition, patients can vary in their capacity to understand information delivered and in their ability to cope with ‘bad news’. Finally, the ways in which findings and advice are communicated can have a significant impact on patient adherence and compliance with management recommendations

Communication: part 1 - soliciting information from the patient

Soliciting information from the patient is a key part of the consultation. Successful clinical outcomes are reliant on the practitioner asking questions to gather relevant information regarding, for instance, the patient’s history and symptoms and their responses to examination tests. This information needs to be gathered in a time efficient manner and in a way that encourages the patient to feel relaxed and fully engage with the eye examination. Practitioners often report that soliciting relevant information can be made difficult by over-talkative patients who take up valuable time giving lengthy, perhaps irrelevant, answers. Alternatively, patients may provide insufficient detail due to discomfort, anxiety or a lack of understanding. Finally, patients can at times appear overly concerned with providing the ‘correct’ answer to certain questions. This article describes some ways to optimise the complex process of soliciting information from the patient focusing on selection of question type, question wording and the role of eye contact. Examples given are based upon research analysis of video-recorded optometric consultations

A Delphi study to develop practical diagnostic guidelines for visual stress (pattern-related visual stress)

Purpose: Visual stress (VS) is characterised by symptoms of visual perceptual distortions and eyestrain when viewing text, symptoms that are alleviated by individually prescribed coloured filters. A recent review supports the existence of VS and its treatment, but noted that controversy remains, in part due to inconsistencies in the diagnosis of the condition. The present paper reviews the diagnostic criteria for VS in the literature and reports a Delphi analysis of the criteria currently used in clinical practice. Methods: Twenty-six eyecare practitioners were invited to participate in a Delphi study. They were selected because they were frequent prescribers of precision tinted lenses. In the first round they were sent a list of the indicators for which there is literature to suggest a relevance in the diagnosis of VS. The practitioners were invited to rank the indicators and add any additional criteria they use in diagnosis. In the second round a revised list was circulated, including item added from the responses in the first Round. Results: The respondents included optometrists, orthoptists and opticians. In the first round the response rate was 85%. Ninety-one percent of those who participated in the first round also responded in the second round. Strong indicators in the second round included the symptom of words moving when reading, voluntary use of an overlay for a prolonged period, improved performance of ≥15% with an overlay on the Wilkins Rate of Reading test, and an abnormally high score on the Pattern Glare Test. Conclusions: The strongest diagnostic criteria are combined in a diagnostic tool. This is proposed as a guide for clinical practice and further research

New Italian version of the Wilkins Rate of Reading Test: Materials for repeated‐measure designs in optometry and neuropsychological research

Purpose: To develop a series of equivalent passages of text in Italian, according to the principles of the Wilkins Rate of Reading Test (WRRT), suitable for both clinical examination and scientific research when equivalent stimuli are needed to compare performance in repeated‐measure designs. Method: Fifteen high‐frequency Italian words (matched for grammatical class and length to the English WRRT) were used to generate 15 different 10‐line meaningless passages, according to the design principles of the English WRRT. Thirty‐two healthy Italian‐speaking higher education students read the passages aloud according to a fixed randomisation schedule. Performance was recorded digitally to measure reading speed and accuracy offline. Equivalence between the passages and the practice and fatigue effects for both reading speed and accuracy were examined as well as test–retest reliability. Results: No significant difference in reading speed and accuracy was found between the passages. There was a significant practice effect on reading speed but not accuracy, with the first presented passage read significantly slower than the others. There was no evidence of a fatigue effect. Reading speed, the reference metric for the WRRT, showed good test–retest reliability. Conclusions: The passages of the Italian version of the WRRT were equivalent to each other. The practice effect suggests that familiarisation with the test (i.e., reading at least one matrix of words) should be carried out before consecutive/repeated reading of different passages for experimental or clinical purposes