This blog post earned its author a $500 Travel Grant for the COVD 2018 Annual Meeting! Students and residents–the application period for 2019 is open thru November 30th, 2018! Apply now and see your COVD Family in Kansas City next April 9-13!

by Dr. Sloan Rajadhyksha (SUNY ’17)

Dr. Marc B. Taub is the 2017 recipient of the A.M Skeffington Award . Historically, this
award is presented to the COVD Fellow “who has made outstanding contributions to the
optometric literature in the areas of vision therapy and development.” Dr. Taub’s
commitment to evidence-based practice has been demonstrated by his involvement in
numerous optometric publications: Journal of Behavioral Optometry , Review of
Optometry and Optometry Times to name a few. He has authored books about
optometric care for patients with special needs, complied vision therapy success stories
from around the world and is the Editor in Chief for the highly accredited Optometry and Visual Performance journal. To say that Dr. Taub is active in the vision rehabilitation
community is an understatement. He plays an exemplary role for students at Southern
College of Optometry where he serves as the Chief of vision therapy and rehabilitation.
Dr. Taub is an honored COVD member and Fellow; we continue to be thankful for his
contributions.

In clinical studies, the Hawthorne effect has been described as a modification in
behavior of patients upon realizing that they are being observed. Often times, studies
that measure subjective outcomes expose themselves to the bias of this very effect.
When browsing the literature, it is important for us as clinicians to look at the design of
each study, objective outcome measures and reproducibility so we can create an
appropriate treatment plan for our patients.

Irlen Syndrome , also known as Meares-Irlen Syndrome or Scotopic Sensitivity Syndrome has been categorized as a reading efficiency disorder. Patients who suffer from symptoms consistent with this syndrome are theorized to have “excessive retinal sensitivity” to particular wavelengths of light. This heightened sensitivity causes patients to exert more effort during reading related tasks. The current treatment for Irlen Syndrome is color filter overlays that are proposed to reduce light sensitivity thus improving the overall experience of reading.

In 2009, Taub et al investigated the efficacy of color filters to treat patients with
symptoms of Irlen Syndrome. Prior to this study, authors had demonstrated subjective
improvement in reading comprehension and speed with Irlen filters without consistent
evidence in improvement of objective outcomes. By analyzing objective changes with a
visagraph (an instrument that tracks eye movements), Taub et al aimed to identify the
underlying cause of reading inefficiency in patients diagnosed with Irlen Syndrome.

A comprehensive vision exam plays a pivotal role in the optometric evaluation.
While each practitioner utilizes a different battery of tests to form a diagnosis, it is
important to report objective findings that support their diagnosis. Previous studies
about Irlen Syndrome have provided limited insight into the nature of entrance testing
performed prior to diagnosing patients with this condition. Overlooking important clinical findings poses a threat of misdiagnosing patients. To rule out visual anomalies, Taub et al screened for visual acuity, binocularity (eye teaming) and accommodation (eye
focusing) prior to testing with color filters for both symptomatic and asymptomatic
patients.

Visagraph analysis revealed that Irlen filter overlays did not significantly improve
the eye movement efficiency of symptomatic patients, leaving the diagnosis of Irlen
syndrome open to interpretation. In fact, 83% of patients categorized as symptomatic
based on the Irlen Syndrome questionnaire had an objective vision problem that was
able to be identified by the initial screening tests. These findings support evidence from
another study by Scheiman et al who found that 95% of patients who qualified for Irlen
tinted overlays also had an underlying visual anomaly such as vergence dysfunction
(eye teaming) or accommodative insufficiency (eye focusing).

As an emerging optometrist, this study was especially valuable in reminding me
to use evidence-based research when treating patients. Recently, a patient diagnosed
with Irlen Syndrome presented for a visual skills evaluation. While the interpretation of
the syndrome remained open ended, one thing was for certain: the patient had eye
teaming and eye tracking issues which could be improved with vision therapy.
Therefore, as the study emphasizes, it is important to perform a visual skills
examination on any patient who has been diagnosed with Irlen Syndrome. In our
careers, patient from all walks of life will present with variable symptoms, but it is our
jobs as optometrists to use a comprehensive, evidence based approach to best treat
them.

Earn a $500 Travel Grant by writing a post like this one!

 

header

Advertisements