Sunday 16 December 2018

Finding reason between the extremes - Optometry Today - May 2018

This curious article that reports an interview with Bruce Evans and Arnold Wilkins appeared in Optometry Today in May 2018. Although the piece contains arguments that are not really scientifically based, it is a step forward because it acknowledges that a multicentred randomised controlled trial is required. Not so long ago one of the interviewees was claiming that the Intuitive and Irlen systems were 'validated by RCTs'. Now it seems that is not the case. It is also a small step forward compared to a previous article in Optometry Today because the interviewees refrain from describing opponents who do not share their views as 'deviants' or 'deniers' (with the awful connotations that word has). See my blog post of June 2017.


I will focus on Arnold Wilkins' (AW) response to one question

Q Visual stress and the intuitive colorimeter have attracted some controversy. Why is that?

According to AW, 'the recent controversy seems to have been orchestrated by one two individuals'
No justification is given for this assertion. However, if look at where recent papers and reports, critical of this treatment, have come from - the statement is manifestly wrong.
1) Coloured overlays and precision‐tinted lenses: poor repeatability in a sample of adults and children diagnosed with visual stress. Paper from City University London published in Ophthalmic and physiological optics showing that people with the putative disorder visual stress are unlikely to find the same colour beneficial on different occasions.  You can access the paper here and it is reviewed in my blog post of August 2017.
2) The effect of coloured overlays and lenses on reading: a systematic review of the literature.
Review commisioned by the editor of Ophthalmic and Physiological Optics which is the house journal of the College of Optometrists. The review commented on the methodological problems with most of the trials and did not support the use of Intuitive Overlays and Precision tinted lenses. 
3) Effectiveness of Treatment Approaches for Children and Adolescents with Reading Disabilities: A Meta-Analysis of Randomized Controlled Trials  Review originating from the University of Munich and the University of Cologne in Germany, published in the Journal Plos One. As is the case with pretty much every independent review it concluded that the evidence did not support the use of coloured lenses and noted that studies with a placebo control condition tended not to find meaningful effects. 
4) Diagnosis and  Treatment of Reading and/or Spelling disorders in Children and Adolescents - a clinical practice guideline published in Germany that does recommend the use of (Irlen) coloured lens to ameliorate reading difficulties. Accessible here.
5) The use of Coloured Filters and Lenses in the Management of Children with Reading Difficulties. A report prepared by Christine Malins for the New Zealand Ministry of Health. Reviews many of the Intuitive overlay and Precision Tinted lenses and concludes that 'coloured overlays and filters are not an empirically supported treatment'
6) Coloured Filters and Dyslexia: A quick Gliding over myth and (possible reality).  review from an Italian neuro-ophthalmologist that takes a sceptical but open-minded view of the subject.
7) Learning Disabilities Dyslexia and Vision A statement from the  American Academy of Pediatrics, Council on Children with Disabilities, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus and the American Association of Certified Orthoptists.
States that Science does not support the use of tinted filters or lenses to support long-term educational performance.
8) The effectiveness and cost-effectiveness of coloured filters for reading disability: A systematic review. This study came from a respected group at Birmingham with a record of conducting systematic reviews. Like all the reviews listed above, it commented on the methodological shortcoming of the studies and concluded that the evidence was not strong enough to justify the use of coloured lenses and overlays for the remediation of reading difficulties.
9) No scientific evidence that Irlen Syndrome exists, say ophthalmologists. Statement from the Royal Australian and New Zealand College of Ophthalmologists
10) Report prepared by the Royal College of Ophthalmologists in the UK concluded that 'manipulation of the visual system using colour to facilitate reading lacks scientific support'
11)Neuroscience in Education: The Good Bad and the Ugly. Sergio Della Sella and Mike Andeson.
A Scholarly book by Edinburgh based neuroscientist that that takes a critical look at neuroscientific interventions in education and in particular the use of coloured lenses and overlays.

I could go on. My point is this; scepticism about the use of coloured lens and overlays (whether AW agrees with those criticisms or not) is not confined to or orchestrated by 'one or two individuals'.
It ranges across countries and continents; for example, from the UK, Germany, Italy, France, Switzerland, USA, Australia and New Zealand. Furthermore, it ranges across academic disciplines including optometrists, psychologists, neuroscientists, ophthalmologists, statisticians, health care economists and basic scientists. How does AW believe this level of scepticism has been orchestrated by one or two individuals? Optometry Today should explain.

On the other hand.........


If you look at the literature supporting the use of Intuitive Overlays and Precision Tinted Lenses and the organisations that promote their use you could make a much more convincing case for a campaign orchestrated by two individuals.
The research literature is dominated by two or three workers in a way I have not seen in any other area of research.  If you look at the pseudo-systematic review published in the Journal of Optometry by Bruce Evans and Peter Allen (reviewed Jan 2018) 8 of the 10 studies of Intuitive overlays were authored by at least one out of Arnold Wilkins, Bruce Evans and Peter Allen. Similarly, in the section on the Intuitive Colorimeter 2 of the 3 papers was authored by Arnold Wilkins. The failure of this research to generalise from a small clique of researchers over the last 25 years tells its own story.
Again, if you look at some of the bodies that promote the use of Intuitive Overlays and Lenses the same names keep recurring.
The Institute Of Optometry The IOO is a self-funding charity that relies to an unknown extent on sales of Visual Stress paraphernalia through its trading arm i.o.o sales. Bruce Evans is director of research at the IOO.
Society for Coloured Lens Prescribers.  Among the claims of this body is that it promotes an evidence-based approach to the use of coloured lenses and overlays. For this reason, I believe most of its members are in breach of the code of conduct. The committee includes Arnold Wilkins and Bruce Evans.
Arnold Wilkins' Web page at the University of Essex. AW answers his critics, at least to his own satisfaction and provides a partial list of references. Through the University of Essex, Intuitive Overlays and Precision Tinted lenses receive the kind of endorsement that money can not buy through advertising.

Reason between the extremes?


The article implies that Arnold Wilkins and Bruce Evans are in some way in the centre ground of a scientific debate. First, this is not a rational reason for believing an opinion to be well founded. The middle ground between 2+2=4 and 2+2=6 is not 2+2=5. Second, it is not even true. When your opinions are out of step with almost every independent body that has reviewed the evidence for the use of coloured lenses and overlays to facilitate the acquisition of reading in people with the putative disorder visual stress, you probably do not occupy the middle ground. That does not in itself mean that you or right or wrong but if you are going to use that line of argument at least make sure it is true.




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