I am enormously pleased to share with you a guest post by Pediatric Ophtalmologist, William O. Young, MD. This post, in two parts, offers Dr. Young’s candid observations about treatments that claim to be effective for dyslexia. Bill Young is a member of the Lexercise Board of Advisors.
The remediation that we know works for dyslexia—multisensory phonics-based structured literacy instruction with daily practice—takes a lot of work and a lot of time. Parents of struggling readers are willing to do the work and spend the time (and the money) because they’ll do anything to help their child learn to read. Wouldn’t it be great, though, if there were an easier way? Like if your child could just put on a pair of special glasses, or do eye exercises, or take a pill that would treat her dyslexia?
Based on this hope for a quicker, easier, or better way, a whole industry of quick fixes and other alternative therapies for dyslexia has arisen. Many are based on the false belief that dyslexia is the result of a problem with the visual system, and that’s where I as a practicing pediatric ophthalmologist may be of some help in guiding you.
In some cases the people who suggest that you try these unvalidated treatments, or who try to sell them to you, are well-intentioned (though misguided); in other cases, they may just be preying on your willingness to do anything and to pay whatever they’re charging if you believe it will help your child. To try to help you navigate these waters, here are
1. Eye exercises/”vision therapy”
Vision therapy (VT) is practiced by optometrists (not ophthalmologists), particularly “behavioral” or “developmental” optometrists. It is, according to the optometrists who promote it, “a progressive program of eye exercises,” together with some or all of the following: lenses (sometimes with prisms), “optical filters, occluder/eye patch, electronic targets with timing mechanisms, computer software, balance board (vestibular device), and visual-motor-sensory integration training devices” (from www.visiontherapy.org).
Optometrists believe vision therapy, which costs several thousand dollars, is helpful for all sorts of things, but it is most widely used with children who are struggling with reading and/or learning. In its carefully worded policy statement on the subject, the American Optometric Association says that VT does not treat dyslexia directly, but that it treats visual problems that interfere with reading or learning, and in that way improves reading and learning. That seems reasonable enough at first glance, but the problem is that in fact reading/learning problems are very, very seldom due to vision disorders, whereas the vision therapists say that most (if not all) reading and learning issues are due to eye/vision disorders, and thus most (if not all) kids who struggle with reading or learning need vision therapy.
Vision therapy causes no known harm (except to the bank account!); the problem is that it wastes not only money but time: by spending months on eye-related treatments for a problem (dyslexia) that is unrelated to the eyes, you’re delaying your child getting the language-based diagnosis and remediation he needs.
2. Irlen lenses/filters
Tinted lenses and overlays are promoted by over 7,000 educators trained by the Irlen Institute, which is why they’re called Irlen lenses/filters. In 1983 Helen Irlen proposed (without publication) the existence of “scotopic sensitivity syndrome,” which supposedly causes affected people to have visual distortions when reading. “60 Minutes” and other news programs immediately did stories on this “breakthrough,” and word spread like wildfire. The Irlen Institute estimates that almost half of people with dyslexia have scotopic sensitivity syndrome—a syndrome for the existence of which there still is no credible published evidence. Irlen lenses/filters are the supposed treatment for this “syndrome.”
On the contrary, carefully controlled studies have been done demonstrating that these filters have no beneficial effect on dyslexia or other reading disorders, including Irlen Colored Overlays Do Not Alleviate Reading Difficulties, by Ritchie et al, in Pediatrics Vol. 128 No. 4, October 2011. The best, most objective evidence currently indicates that any “benefit” to struggling readers from Irlen lenses/filters is a placebo effect.
Dr. Young has no financial interest in any dyslexia evaluation or remediation program, method, or company, including Lexercise.
For a referral to a qualified clinician, or for more information, contact us and schedule a free consultation with one of our expert dyslexia therapists.
The study you referred to which was published in Pediatrics was significantly flawed in terms of methodology, interpretation, and presentation of results. The title is inaccurate. The authors state they were only studying the immediate effect of color in changing reading ability of young students with reading difficulties and who, therefore, had not yet developed reading skills. It is highly unlikely that they would have mastered or even acquired many of the basic skills required for reading. Irlen Colored Overlays/Filters remove the barrier preventing these skills from being acquired but are not a replacement for instruction and practice which develop the necessary foundation required to read. For those without adequately developed reading skills, Irlen Colored Overlays/Filters remove the barrier preventing them from acquiring these skills at a normal rate but they skill need instruction to learn how to read. There are 25 years of research showing positive effects involving Irlen Colored Overlays/Filters to improve reading in young children generally involve an intervention period, thus allowing children to use their overlays while acquiring their reading skills. These studies compare children who were allowed to use their overlays during the intervention period with a similar group of children who were not provided with colored overlays/filters to use during the same period of instruction. Specifically, in a study by Jeanne Noble, Michelle Orton, Sandra Irlen PhD, and Greg Robinson PhD (2004), those who needed colored overlays made significant progress in all aspects of reading; whereas, those who needed overlays and were not allowed to use them made no progress. Importantly, after the intervention period, the control group was also given overlays; and they made the same significant progress as their counterparts in all aspects of reading. We would never have expected to see immediate effects with this population of young children who were identified as poor readers.
A second issue with the recently published Pediatrics article is that visual problems were identified but not corrected prior to testing. Fifty-four percent (54%) of the small number of subjects in this study were identified as having uncorrected visual problems which were not corrected prior to participating in the study, nor were these students eliminated from the research. This would have had a significant affect on the test results as uncorrected visual problems will continue to stand in the way of reading improvement, even if issues related to Irlen Syndrome are eliminated through the use of color.
In conclusion, this was a poorly designed and limited study of the Irlen Method, especially when dealing with such a complex issue as visual processing problems related to reading problems. We do find it unfortunate that you are using this study to caution parents, educators, and professionals against the use of colored overlays altogether, when there are numerous controlled studies confirming the improvements in reading with Irlen Overlays and Spectral Filters (Kyd, Sutherland & McGettrick, 1992; O’Connor, Sofo, Kendall & Olsen, 1990; Robinson & Miles, 1987; Williams, Le Cluyse & Rock-Faucheux, 1992; Jeanes, Busby, Martin, Lewis, Stevenson, Pointon et al., 1997; Northway, 2003; Scott et al., 2002; Tyrrell, Holland, Dennis & Wilkins, 1995; Wilkins & Lewis, 1999; Williams, Le Cluyse & Littell, 1996; Robinson & Conway, 2000; Bouldoukian et al., 2002; Jeanes et al., 1997; Robinson & Foreman, 1999) and ongoing medical research looking at physiological changes in both body and brain through fMRI, SPECT scans, VER, and biochemical analysis.
Stuart J. Ritchie, PhD Student
Sergio Della Sala, Robert D. McIntosh
Human Cognitive Neuroscience, University of Edinburgh
Ms. Irlen takes issue with the design of our study on colored overlays for reading. We are perplexed and saddened by this. Even a casual reader would notice that our study relied on extensive co-operation and collaboration of an Irlen Institute diagnostician, who modified her normal practice to facilitate our double-blind design. More than this, we involved the Irlen Institute in our design from the outset, as this was essential to mounting a fair test of Irlen practice. We sent our draft design to Ms. Irlen, and received a reply on 9 October 2009 from Sandra Irlen, who described our study as ‘ very exciting’ and ‘well-designed’, and made several recommendations. One was that we should include a measure of reading comprehension as well as speed, which we accordingly did (we are happy to provide copies of this correspondence on request). It is, to say the least, inconsistent for Ms. Irlen to now describe our study as ‘significantly flawed in terms of methodology’, and it is hard not to view this as an opportunistic response to the negative outcome of the study.
Ms. Irlen identifies two factors that may have accounted for our negative results: the fact that we focused on immediate effects, and the presence of uncorrected vision problems in our sample. On the first issue, she states that ‘we would never have expected to see immediate effects’ of the overlays. This is contrary to the Irlen Institute’s core diagnostic procedures, which are based upon an evaluation of a person’s immediate response to colored overlays. It is also contrary to numerous published statements of Ms. Irlen’s. For example, in her book, ‘The Irlen Revolution’ , she describes her original discovery of the treatment: ‘For the first time, all the struggling readers were able to see words on the paper that were not jumping, swirling, dancing, or all jumbled together’ (p. 20). Of one adult reader, Ms. Irlen states ‘she had struggled to read for so long, and was suddenly able to without such a great effort’ (p. 20).
Ms. Irlen suggests that the lack of developed reading skills in our sample would preclude immediate effects of the overlays. It was precisely to avoid this problem that we used a test of reading speed consisting only of very simple words. All of the children in our sample knew all of these words, and this was verified before testing. It is illogical to suggest that, if colored filters improve text clarity, they should not lead to faster reading of such text that is within the reader’s competence. In any case, we are also interested in long-term outcomes, and have completed a one-year follow-up study of the original cohort, which is now under review at another journal.
Ms. Irlen then suggests that the visual problems identified in 54% of our sample ‘would have had a significant affect [sic] on the test results’. This point does not reflect well on Irlen Institute practice, as the children received an orthoptic assessment only due to their involvement in our study (the assessment was paid for by us). Had our study not been taking place, the children would have had the Irlen assessment, but not the orthoptic assessment. Moreover, there was no overlay benefit even in the sub-sample without orthoptic problems. Ms Irlen has been able to verify this personally, since we provided our raw data to the Irlen Institute on study completion.
Ms. Irlen ends her rebuttal by stating that we made ‘strong recommendations… against the use of colored overlays altogether’. This is false; in the conclusion of our article, we merely urge interested parties to ‘carefully consider the totality of the evidence’ (p. e937). She then provides a list of studies showing positive effects of colored filters (one of which she cites twice). Given that she does not predict immediate overlay effects, it is curious that several of these studies looked only at immediate effects. Moreover, several concerned methods of colored filter provision other than the Irlen Method. In any case, citing only those studies that support a treatment, when several negative studies exist, gives a biased impression. In our article, we cited four recent reviews, all of which identified significant methodological problems in many studies in this area. A constructive approach for people interested in this treatment would be to address these problems by carrying out research designed to avoid them. This was our objective in carrying out our study, and we consulted with the Irlen Institute to ensure that the assessment was fair to them. We stand by our design, and the results that it produced, even if Ms. Irlen does not.
 Irlen H. The Irlen Revolution: A Guide to Changing Your Perception and Your Life. New York, NY: Square One Publishers; 2010
The above was Dr. Ritchie’s reply to Ms. Irlen’s criticisms. Here also is Dr. Ritchie’s 1 year follow up to the study in question which directly addresses Ms. Irlen’s assertion that her lenses make any difference in the long term to children with reading difficulties.
Again, there is no evidence that these glasses do anything to improve reading performance in children with reading difficulties.
I only found 2, not 5. then an arguement about 2. where are 3-5.
Sandie is a speech-language pathologist with more than 30 years of experience in the private practice sector. She is Visiting Assistant Professor of Communication Sciences & Disorders at University of North Carolina Greensboro, and founder/owner of the Language & Learning Clinic, PLLC, a private practice in Elkin, NC, and Greensboro, NC, specializing in communication disorders, including disorders of reading and written language.
Your information about what doesn’t work with dyslexia is right on target.