Tuesday 5 February 2019

Not a treatment for reading or dyslexia?


The title says it all - Reading through Colour
The public could reasonably assume, from
this title, that coloured filters can facilitate
reading in at least some people with dyslexia.
A complaint of visual stress enthusiasts is that their work is misunderstood by their critics. They are not treating reading or dyslexia itself and for that reason, some systematic reviews have asked the 'wrong question'. In truth, a systematic review only takes the data that is presented in the results sections of the included papers. So if the reviews are asking the wrong question then so are papers being assessed.
A further problem is that whatever conclusion you are trying to draw from the data, nearly all of the studies are at high risk of bias in multiple domains due to major flaws in study design and data interpretation. For that reason, it is hard to draw meaningful conclusions from these studies, whatever it is that the authors think they are trying to treat.
For example, a systematic review that Bruce Evans has criticised (wrongly)for 'asking the wrong question' was published in the house journal of the College of Optometrists in September 2016. However, a selection criterion for this review was treating subjects with visual stress (according to the multitude of diagnostic criteria that exist) and some measure of reading as an outcome measure. That review found that almost all studies were at high risk of bias in multiple domains and those that were not, offered no support for the use of coloured overlays and lenses. The review asked the right question - what is the risk of bias of the included studies?- It is the conclusions that have not been appreciated by visual stress enthusiasts.
If it is not reading or dyslexia that is being treated, it is reasonable to ask why is the dependent variable of most of the trials some measure of reading? - either naturalistic text or the Wilkins' Rate of Reading Test and why are participants so often reading impaired?
A pseudo-systematic review of controlled trials on visual stress using Intuitive Overlays or the Intuitive Colorimeter by Bruce Evans and Peter Allen published in 2016  in the Journal of Optometry (reviewed in my blog of Jan 2018) contained the following statement.....
'Individually prescribed coloured filters have been shown to improve reading performance in people with visual stress but are unlikely to improve the phonological and memory deficits associated with dyslexia and are therefore not a treatment for dyslexia'
This statement makes no sense. Dyslexia is poor reading that is why it is called- dys-lexia. It is wrong to think of garden-variety poor readers and poor readers with dyslexia and the prevalence of dyslexia depends on exactly where you draw the line along the spectrum of reading ability. So it is being claimed that coloured filters are a treatment for dyslexia, albeit in the subgroup who have the putative disorder visual stress.
The argument is that 'visual stress' is an impediment to reading and by removing that impediment reading should improve. When enthusiasts state that coloured filters are not a treatment for reading impairment one might, with equal logic, state that improving phonological awareness is not a treatment for dyslexia but a treatment for poor phonological awareness.

Elsewhere, in a letter to the British Medical Journal, Bruce Evans and Peter Allen state that
'we know of more than twenty studies of the effects of overlays on reading rate, and few of them were included in these reviews. These studies published in peer reviewed journals include various controls for placebo effects none of which provides for an improvement in reading rate as great as that observed with overlays
Ignoring that fact that all the studies showing an improvement in reading rate are at high risk of bias. Evans and Allen clearly state that overlays can improve reading rate albeit in people with VS or the overlap group with VS and dyslexia. For that reason, they are saying it is a treatment for that sub-population of poor readers.

The title of Arnold Wilkins' book is Reading Through Colour - therefore, you might reasonably think that if you have a reading disorder such as dyslexia your reading might improve as a result of using Intuitive Overlays and Precision Tinted Lenses if you belong to the subgroup with visual stress.
In my experience that is what the majority of parents who buy into this system (and other tinting systems) for their children are expecting both in the short and long term.  Unfortunately, the best available evidence says otherwise.

Thursday 17 January 2019

International Institute of Colorimetry

Is the International Institute of Colorimetry a front for Cerium Visual Technologies?




The International Institute of Colorimetry (IIoC) is a rather grand-sounding organisation that operates out of some unbranded private serviced offices at 7-10 Adam Street. Adam House, according to its website, offers mailing addresses for £65 a month and mail forwarding for £85 a month and offers the means to 'register your company at a prestigious London West End address' without, I suppose, being able to afford a prestigious London West End address.
The IIoC  'is committed to raising awareness in schools, relevant professions and the community at large, of the need for early diagnosis of visual stress.'
The IIoC website contains the usual visual stress misinformation. For example, the claim that a double-blind placebo-controlled trial in 1994 proved the beneficial effect of colour on the perceptual distortions, said to be associated with visual stress, that was not entirely attributable to the placebo effect. In fact, this trial reviewed elsewhere in this blog showed nothing of the sort. It was so hampered by follow up that no conclusions could be drawn.
The IIoC appears to have 18 UK individual members and 12 corporate members. There is also a list of international users of the intuitive colorimeter but it is not clear if they are members or not.
All in all a pretty small scale outfit.
The IIoC website contains a link to purchase overlay products that will take you to Cerium Visual Technologies.

Cerium Visual Technologies a company that markets the Intuitive Colorimeter and Precision Tinted Lenses as well as its own branded overlays. I don't have much of a problem with their website apart from the usual misrepresentation of exploratory studies at high risk of bias. It is obvious that they have product sell and it is a case of buyer beware.

Things start to look interesting when you look at the Companies House entries for the International Institute of Colorimetry and Cerium Visual Technologies. Click on the people tab for each listing and you will find the same names albeit in a different order -Marlyn Ann Sangster and Kimberley Jane Harrison are active members of both organisations. Even if you look at the resigned members - Peter Roy Collier and Clive Laurence Sangster were formerly active for both organisations.

There is nothing illegal in this. However, the Institute of Colorimetry might appear at first sight to be an independent scholarly body with an international reach. It seems to me that it is something different and I think there is a public interest in knowing how these two organisations are intertwined. For example, the IIoC pushed the BBC to revise an article reporting research that showed visual factors do not play a big role in dyslexia and to include a comment from Bruce Evans who argued (wrongly in my view) that the tests used in this particular study would not have detected visual stress among dyslexics. In fact, contrast sensitivity at the spatial frequencies said to be aversive in VS was measured and there was no difference between normal and impaired readers. My point is this, would the BBC have taken the IIoC so seriously if it had been aware of the overlap with Cerium who have a financial interest in visual stress treatment?