Irlen syndrome: systematic review and level of evidence analysis

Abstract

Background: Scotopic sensitivity syndrome, later called Meares-Irlen syndrome or simply Irlen syndrome (IS) has been described as symptoms of poor reading ability due to poor color matching and distorted graphic images. Individuals with this syndrome are considered slow, ineffective readers with low comprehension and visual fatigue. It is still uncertain whether the disease pathophysiology is an independent entity or part of the dyslexia spectrum. Nevertheless, treatments with lenses and colored filters have been proposed to alleviate the effect of the luminous contrast and improve patients' reading performance. However, no evidence of treatment effectiveness has been achieved. Objective: The aim of the present study was to obtain evidence about IS etiology, diagnosis and intervention efficacy. Methods: A systematic review was performed covering the available studies on IS, assessing the available data according to their level of evidence, focusing on diagnostic tools, proposed interventions and related outcomes. Results: The data showed high heterogeneity among studies, and lack of evidence on the existence of IS and treatment effectiveness. Conclusion: The syndrome as described, as well as its treatments, require further strong evidence. RESUMOBackground: A síndrome da sensibilidade escotópica, posteriormente denominada síndrome de Meares-Irlen ou simplesmente síndrome de Irlen (SI), foi descrita como indivíduos com sintomas de baixa capacidade de leitura devido à combinação de cores e distorções nas imagens. Indivíduos com essa síndrome podem apresentar leitura lenta e ineficaz, com baixo nível de compreensão e fadiga visual. A fisiopatologia da doença ainda é incerta como uma entidade independente ou como parte do espectro da dislexia. No entanto, tratamentos com lentes e filtros coloridos foram propostos com o objetivo de aliviar o efeito do contraste luminoso e melhorar o desempenho de leitura dos pacientes. Outrossim, nenhuma evidência de eficácia do tratamento foi alcançada. Objetivos: Obter evidências sobre a etiologia, eficácia diagnóstica e intervenção da SI. Métodos: Foi realizada uma revisão sistemática, cobrindo os estudos disponíveis sobre a SI, avaliando os dados disponíveis de acordo com seu nível de evidência, com foco em ferramentas de diagnóstico, intervenções propostas e desfechos relacionados. Resultados: Os dados mostram alta heterogeneidade, falta de evidência sobre a existência da SI e eficácia do tratamento. Conclusões: A síndrome descrita e seus tratamentos exigem evidências mais robustas.Palavras-chave: Transtorno da leitura; revisão sistemática; medicina baseada em evidência; síndrome de meares-irlen; lentes coloridas.

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“…Meares-Irlen syndrome is a visual perceptual dysfunction impacted by light, luminance, color contrast, and wavelength [ 7 ]. It is characterized by poor reading abilities and ineffective reading with limited comprehension [ 8 ]. Even though the symptoms are clearly described as visual stress symptoms (headache, photophobia, eye strain) and visual perceptual disorder (illusions of pattern, shapes, and colors), the precise nature of this syndrome has not been identified in the literature [ 9 ].…”

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“…A timing fault occurs when visual information is processed due to this defect (Australasian Association of Irlen Consultants, 2021;Miyasaki et al, 2019). A person's eyes transmit 70% of the information they receive, which their brains must translate into meaningful information (Miyasaka et al, 2019). The brain's ability to process, interpret, and interact with visual information can be compromised when there is a problem with how it processes visual input (Australasian Association of Irlen Consultants, 2021).…”

“…The brain's ability to process, interpret, and interact with visual information can be compromised when there is a problem with how it processes visual input (Australasian Association of Irlen Consultants, 2021). Miyasaka et al (2019) suggest that IS is caused by poor colour matching and distorted graphics. It is characterised by low comprehension levels, slow reading rates, and visual fatigue among individuals who suffer from this syndrome (Australasian Association of Irlen Consultants, 2021;Miyasaki et al, 2019).…”

“…Other symptoms of IS include poor concentration; difficulties with reading, writing, and comprehension; glare sensitivity; headaches, and poor depth perception. These symptoms, when experienced, can be heightened if the person is tired, overwhelmed, or under pressure (Australasian Association of Irlen Consultants, 2021; Miyasaka et al, 2019). Research has identified that up to 50% of people with dyslexia could also have IS (Australasian Association of Irlen Consultants, 2021).…”

“…However, whether it belongs to the dyslexia spectrum or is an independent entity remains unclear (Miyasaka et al, 2019).…”