Prevention of Visual Stress and Migraine With Precision Spectral Filters

Pattern glare sensitivity distinguishes subclinical autism and schizotypy

INTRODUCTION

Schizophrenia and autism spectrum disorder are distinct neurodevelopmental disorders sharing clinically relevant behaviours. However, early sensory responses show divergent responses. Individuals with schizophrenia typically exhibit cortical hypo-excitability whereas individuals with autism show cortical hyperexcitability. Identifying reliable neurobiological differences between the disorders can diminish misdiagnosis and optimise treatments.

METHODS

The pattern glare test (PGT) is a simple measure of behavioural hyperexcitability. It measures the number of illusions seen in a static horizontal grating. We collected PGT data from non-clinical adults varying in traits of autism and schizophrenia (schizotypy). 576 undergraduate students completed an online survey consisting of the Schizotypal Personality Questionnaire - Brief Revised, the Autism Spectrum Quotient, and the PGT.

RESULTS

Subclinical autism and schizotypy traits were highly positively correlated. However, only schizotypy scores were significantly predictive of reporting more pattern glare (PG) illusions. When assessing the subcomponents of the schizotypy and autism scores, positive and disorganised schizotypy traits were predictive of reporting more PG illusions. Whereas, subclinical autism factors were not predictive of PG illusions.

CONCLUSIONS

High schizotypy performed the PGT in a manner consistent with behavioural hyperexcitability. The PGT distinguished subclinical autistic traits from schizotypy, suggesting potential clinical application.

Evidence for Overlapping Visual Processing Difficulties in Adult ADHD and Visual Stress

We investigated the viability of spectral filters as an adjunctive treatment for adults with both ADHD and visual processing difficulties. Fifty-nine adults (age 18-50), diagnosed with both ADHD and visual stress received either spectral filters (n = 39) or no intervention (n = 20) to address visual processing difficulties. We administered the MOXO d-CPT, a computer based continuous performance test, before the intervention and one hour after the intervention to assess any short-term change in the participants' attention profile. We used the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) before and 3-6 months after the intervention to assess any long-term intervention impact after 3-6 months. The intervention group had significant short- and long-term improvements in overall attention compared to the control group (X2(1, N = 59) = 20.10, p < .001). On the DSM-5, 49% of participants with short term and 64% with long-term intervention no longer met criteria for an ADHD diagnosis. Findings suggest that spectral filters may be an adjunctive treatment for many adults suffering from perceptually-based attention issues common to visual stress and ADHD.

Application of colored filters in patients post-traumatic brain injury: A review

BACKGROUND: Tinted lenses have been used to manage visual discomfort and photosensitivity in patients with migraines, benign essential blepharospasm (BEB) and epilepsy. OBJECTIVES: The purpose of this review is to examine the existing clinical research regarding the use of colored filters among patients recovering from traumatic brain injuries. METHODS: A review of English articles from PubMed, Embase from embase.com, Web of Science, APA PsycINFO (OVID), Scopus, and Cochrane Central Register of Controlled Trials with publication years from date of inception to June 10, 2021 was performed. Articles were first screened by title and abstract, followed by full-text review. The search strategy resulted in 7819 results. The final analysis included seven articles which discussed the use of tinted lenses in patients post-traumatic brain injury. RESULTS: While there is a paucity of information related to the therapeutic use of tinted lenses to mitigate post-traumatic light sensitivity and migraines, patients will subjectively report improved symptoms, specifically with precision tints or FL-41. CONCLUSION: Further studies are needed to understand the mechanism of action as well as objective and subjective benefits of tinted lenses in patient post-traumatic brain injury.

Visual Sensitivity in Complex Regional Pain Syndrome and Fibromyalgia: An Online Study

Perceptual anomalies can provide insights into underlying pathologies even when they are not the main symptom of many clinical conditions. Complex regional pain syndrome (CRPS) and fibromyalgia are chronic pain conditions associated with changes in the central nervous system, possibly leading to enhanced visual sensitivity. It is unclear whether this occurs more than for people with other types of pain. We examined visual sensitivity elicited by different stimuli and in daily life, through an online study of people with CRPS (n = 57), fibromyalgia (n = 74), other pain (n = 50), and no pain (n = 89). Respondents rated changes in pain, discomfort, or distress from viewing patterns with different spatial frequencies (lower-order visual processing), and reversible figures (bistable images; higher-order visual processing). We assessed visual sensitivity in daily life using the Leiden Visual Sensitivity Scale and Visual Discomfort Scale. Respondents with CRPS or fibromyalgia reported more visual discomfort than pain-related and pain-free controls while viewing striped patterns and a circle, with no effect of spatial frequency. They reported more pain while viewing a nonreversible square, but not reversible figures (Necker Cube, Duck/Rabbit). Finally, they reported more daily visual sensitivity than pain-related and pain-free controls. Suppressing visual cortical activity might benefit people with CRPS or fibromyalgia.

Visual stress responses to static images are associated with symptoms of Persistent Postural Perceptual Dizziness (PPPD)

BACKGROUND

Images that deviate from natural scene statistics in terms of spatial frequency and orientation content can produce visual stress (also known as visual discomfort), especially for migraine sufferers. These images appear to over-activate the visual cortex.

OBJECTIVE

To connect the literature on visual discomfort with a common chronic condition presenting in neuro-otology clinics known as persistent postural perceptual dizziness (PPPD). Patients experience dizziness when walking through highly cluttered environments or when watching moving stimuli. This is thought to arise from maladaptive interaction between vestibular and visual signals for balance.

METHODS

We measured visual discomfort to stationary images in patients with PPPD (N = 30) and symptoms of PPPD in a large general population cohort (N = 1858) using the Visual Vertigo Analogue Scale (VVAS) and the Situational Characteristics Questionnaire (SCQ).

RESULTS

We found that patients with PPPD, and individuals in the general population with more PPPD symptoms, report heightened visual discomfort to stationary images that deviate from natural spectra (patient comparison, F (1, 1865) = 29, p < 0.001; general population correlations, VVAS, rs (1387) = 0.46, p < 0.001; SCQ, rs (1387) = 0.39, p < 0.001). These findings were not explained by co-morbid migraine. Indeed, PPPD symptoms showed a significantly stronger relationship with visual discomfort than did migraine (VVAS, zH = 8.81, p < 0.001; SCQ, zH = 6.29, p < 0.001).

CONCLUSIONS

We speculate that atypical visual processing -perhaps due to a visual cortex more prone to over-activation -may predispose individuals to PPPD, possibly helping to explain why some patients with vestibular conditions develop PPPD and some do not.

Photophobia in migraine: A symptom cluster?

Photophobia is one of the most common symptoms in migraine, and the underlying mechanism is uncertain. The discovery of the intrinsically-photosensitive retinal ganglion cells which signal the intensity of light on the retina has led to discussion of their role in the pathogenesis of photophobia. In the current review, we discuss the relationship between pain and discomfort leading to light aversion (traditional photophobia) and discomfort from flicker, patterns, and colour that are also common in migraine and cannot be explained solely by the activity of intrinsically-photosensitive retinal ganglion cells. We argue that, at least in migraine, a cortical mechanism provides a parsimonious explanation for discomfort from all forms of visual stimulation, and that the traditional definition of photophobia as pain in response to light may be too restrictive. Future investigation that directly compares the retinal and cortical contributions to photophobia in migraine with that in other conditions may offer better specificity in identifying biomarkers and possible mechanisms to target for treatment.

Spectral Overlays for Reading Difficulties: Oculomotor Function and Reading Efficiency Among Children and Adolescents With Visual Stress

This study analyzed the effects of spectral overlays on ocular motility during reading among a clinical group of children and adolescents experiencing visual–perceptual distortions of text. We reviewed the records of 323 eye-hospital patients diagnosed with visual stress and divided this participant sample into two age-based cohorts: children ( n =  184; Mean [ M] age = 10.1, standard deviation [ SD]  =  1.3 years) and adolescents ( n =  139; M age = 14.6, SD = 1.5 years). We used a Visagraph III Eye-Movement Recording System to record ocular motor efficiency while reading with and without spectral overlays, and we examined the following parameters: (a) Fixations, (b) Regressions, (c) Span of Recognition, (d) Reading Rate, (e) Relative Efficiency, and (f) Comprehension. Our results showed that using one or some combination of 10 participant-selected spectral overlays immediately and significantly ( p <  .001) reduced the number of Fixations and Regressions per 100 words, while there were significant ( p <  .001) gains in positive factors such as Span of Recognition, Reading Rate, Relative Efficiency, and Comprehension. Our findings indicate that spectral filtering can be an effective tool for helping many young patients who experience visual–perceptual distortions while reading. Future expanded research employing eye-tracking technology is clearly needed.

Levels of Visual Stress in Proficient Readers: Effects of Spectral Filtering of Fluorescent Lighting on Reading Discomfort

Visual stress (VS) affects reading in 5-12% of the general population and 31-36% of children with reading disorders. Symptoms include print distortions and visual discomfort when reading, and are exacerbated by fluorescent lighting. Prior research has indicated that VS can also affect proficient readers. We therefore examined levels of visual discomfort in a group of expert readers (n = 24) under both standard and spectrally-filtered fluorescent lighting. Participants rated their awareness of six symptoms of VS under each lighting condition. Under the standard condition, 4(16.7%) of the group recorded moderate to high levels of VS. Differences in symptom levels and reading speed between conditions were analysed using the Wilcoxon Signed Rank Test. Under the filter condition, the group reported less discomfort regarding all six symptoms of VS surveyed. The differences were significant with respect to three of the symptoms (p = .029 - p < .001), with a medium effect size in all of them (r = .31 - r = .46) and total score (p = .007; r = .39). Variations in reading proficiency included significantly fewer self-corrections (p = .019) and total errors (p = .004). Here we present evidence that VS-type symptoms of reading discomfort are not confined to populations with reading difficulties and may also occur in proficient readers, and that simple adaptations to fluorescent lighting may alleviate such symptoms.

Functional MRI as a biomarker for evaluation and prediction of effectiveness of migraine prophylaxis

Migraine is a neurological disorder characterized by episodic head pain and visual cortical phenomena. The pathogenesis of migraine is unknown and remains to be determined. Bright light, flickering light and certain visual patterns can trigger a migraine attack, and visual cortical hyperexcitability has been hypothesized to be responsible. Interictally, the brain of migraineurs functions normally under general conditions but abnormally only under some specific conditions, such as the observation of stressful visual patterns, suggesting studying the brain function could provide insights in migraine pathophysiology. The functional MRI technique is unique in probing specific cortical area activation under various stimulation conditions and studying the abnormal cortical activation associated with functional disorders in migraine. In this perspective, we discuss how a novel functional MRI technique can be used to identify those migraineurs suffering visual cortical hyperexcitability, and its potential as a biomarker to evaluate and possibly predict effectiveness of migraine-preventive treatments.

Visual stress, its treatment with spectral filters, and its relationship to visually induced motion sickness

We review the concept of visual stress and its relation to neurological disease. Visual stress can occur from the observation of images with unnatural spatial structure and an excess of contrast energy at spatial frequencies to which the visual system is generally most sensitive. Visual stress can often be reduced using spectral filters, provided the colour is selected with precision to suit each individual. The use of such filters and their effects on reading speed are reviewed. The filters have been shown to benefit patients with a variety of neurological conditions other than reading difficulty, all associated with an increased risk of seizures.

A placebo-controlled trial of tinted lenses in adolescents with good and poor academic performance: reading accuracy and speed

Purpose

A placebo-controlled, double-masked study was designed in order to evaluate the effect of tinted lenses in adolescents with good and poor academic performance.

Methods

Teenagers from two different age groups were enrolled in this study, after ascertaining that no uncorrected visual anomalies were present. A rate of reading test was developed for Catalan as a first language and students were asked to read it aloud, in two different sessions. Students first read the test without lenses and, later, they read it again without lenses, with their lenses of choice and with a placebo set of clear lenses. Reading speed and accuracy were monitored.

Results

No significant difference was encountered between the baseline reading speed and accuracy from the first and second sessions, thus ruling out any effect due to experience or training. When comparing reading speed and accuracy without lenses, in placebo conditions, and with tinted lenses, reading accuracy was discovered to be more sensitive than reading speed in order to differentiate between these conditions. These differences were more noticeable when the group with poor academic performance was evaluated, in contrast to the group with good academic performance or the whole group.

Conclusion

It was concluded that reading accuracy should be evaluated as well as reading speed and that lenses were more beneficial if only adolescents with poor academic performance were targeted.