Visually-induced dizziness is associated with sensitivity and avoidance across all senses

BACKGROUND

Persistent postural perceptual dizziness (PPPD) is a common chronic condition presenting in neurology and neuro-otology clinics. Symptoms lie on a spectrum in the general population. The cause is unknown and thought to involve interactions between visual and vestibular systems, but symptoms also correlate with anxiety and migraine.

OBJECTIVE

To test whether PDDD symptoms are associated with reported differences in other senses (touch, hearing, smell and taste); to investigate possible mediation via anxiety or migraine; to discover the proportion of variance accountable to these non-vestibular factors.

METHODS

We measured self-report multisensory sensitivity, anxiety, visual difficulties, visual discomfort and migraine in patients with PPPD (N = 29) and a large general population cohort (N > 1100). We used structural equation modelling to examine relationships between the factors using a step-wise approach.

RESULTS

We found increased self-reported over-sensitivity in sensory domains beyond vision and balance in both patients with PPPD and non-clinical participants with more PPPD symptoms. SEM analysis revealed that anxiety partly, but not wholly, mediated this relationship. Adding visual difficulties and visual discomfort to the model allowed it to explain 50% of PPPD symptom variance. Most of the path coefficients and mediation effects in our model were unchanged between participants with and without migraine.

CONCLUSIONS

Our findings support the idea that PPPD is a complex neurological condition that includes broad perceptual factors, and may suggest that some brains are predisposed to generalised cross-modal sensory-overload. This may give rise to vulnerability to severe PPPD should a vestibular insult occur.

Interventions Addressing Vision, Visual-perceptual Impairments Following Acquired Brain Injury: A Cross-sectional Survey

BACKGROUND.

The existing literature on the effectiveness of interventions targeting vision, visual-perceptual impairments following acquired brain injury (ABI) is scarce and unlinked to occupational performance.

PURPOSE.

To explore current occupational therapy practice in vision-rehabilitation among adults with ABI in Canada, and to determine the evidence-practice gaps.

METHODS.

An online survey was made available through the Canadian Association of Occupational Therapists (CAOT) website, and disseminated to seven public healthcare institutions in Quebec. The survey collected respondent demographic information, and the types and frequency of treatments delivered. Descriptive statistics were conducted to determine interventions' frequency. Participant comments were collected and grouped into recurring themes.

FINDINGS.

Over half (55%) of respondents regularly use evidence-based interventions when addressing visual acuity (VA) and visual field (VF) deficits, but only very few (3%) use it when dealing with oculomotor function and visual stress impairments.

IMPLICATIONS.

Results gave a glimpse of interventions used and suggested the need for further research in vision rehabilitation.

A comparison of the effects of the colour and size of coloured overlays on young children's reading

This study compared the effects of the colour and size of overlays on reading time, reading errors and on the clarity of text with young primary school children. The sample comprised a non-clinical, typical, sample from an East London primary school. One hundred and six children aged between four and seven years were asked to read 11 short passages of text (60 words) either with full page overlays or smaller reading rulers (53 in each group). This sample included younger children than has often been tested before. The 11 short passages allowed an assessment of baseline reading performance (no reading aid) and performance while reading with each of a set of ten coloured reading aids. Two different, yet beneficial, colours were determined: the most effective and the clearest/most comfortable. Both of these measures are not usually recorded. All but four children had reduced reading times with one of the reading aids and all but one reported their aid improved the perceived visual clarity of the text: the size of the reading aid did not affect reading time or visual clarity significantly. The numbers of skipped words and errors/mis-read words also decreased when reading with the most effective and most comfortable reading aid. Near visual acuity was assessed with and without each child's most effective coloured aid. The most effective aid improved acuity in over a third of the children. Acuity has not been assessed in previous studies. As reported previously, different colours helped different children. In conclusion, coloured reading overlays reduced reading times on the reading test employed here and the size of the reading aid was not crucial to facilitate performance. The largest reductions occurred for the youngest readers, suggesting these aids may be particularly effective for early readers.

Effects of Spectral Overlays on Reading Performance of Brazilian Elementary School Children

OBJECTIVE

To investigate the effects of spectral overlays on reading performance of Brazilian elementary school children.

METHODS

Sixty-eight children (aged 9-12 years) enrolled in the 5th and 6th grade were included in the study. The Rate of Reading Test (RRT - Brazilian Portuguese version) was used to evaluate reading speed and the Irlen Reading Perceptual Scale was used to allocate the sample according to reading difficulty/discomfort symptoms and to define the optimal spectral overlays.

RESULTS

A total of 13% of the children presented an improvement of at least 15% in reading speed with the use of spectral overlays. Pupils with severe reading difficulties tended to have more improvement in RRT with spectral overlays. Children with severe reading discomfort obtained the highest gains in RRT, with an average of 9.6% improvement with intervention, compared to a decrease of -8.2% in the control group. Participants with severe discomfort had an odds ratio of 3.36 to improve reading speed with intervention compared to the control group.

CONCLUSION

The use of spectral overlays can improve reading performance, particularly in those children with severe visual discomfort.

A Delphi study to develop practical diagnostic guidelines for visual stress (pattern-related visual stress)

PURPOSE

Visual stress (VS) is characterised by symptoms of visual perceptual distortions and eyestrain when viewing text, symptoms that are alleviated by individually prescribed coloured filters. A recent review supports the existence of VS and its treatment, but noted that controversy remains, in part due to inconsistencies in the diagnosis of the condition. The present paper reviews the diagnostic criteria for VS in the literature and reports a Delphi analysis of the criteria currently used in clinical practice.

METHODS

Twenty-six eyecare practitioners were invited to participate in a Delphi study. They were selected because they were frequent prescribers of precision tinted lenses. In the first round they were sent a list of the indicators for which there is literature to suggest a relevance in the diagnosis of VS. The practitioners were invited to rank the indicators and add any additional criteria they use in diagnosis. In the second round a revised list was circulated, including items added from the responses in the first round.

RESULTS

The respondents included optometrists, orthoptists and opticians. In the first round the response rate was 85%. Ninety-one percent of those who participated in the first round also responded in the second round. Strong indicators in the second round included the symptom of words moving when reading, voluntary use of an overlay for a prolonged period, improved performance of ≥15% with an overlay on the Wilkins Rate of Reading test, and an abnormally high score on the Pattern Glare Test.

CONCLUSIONS

The strongest diagnostic criteria are combined in a diagnostic tool. This is proposed as a guide for clinical practice and further research.

A systematic review of controlled trials on visual stress using Intuitive Overlays or the Intuitive Colorimeter

Claims that coloured filters aid reading date back 200 years and remain controversial. Some claims, for example, that more than 10% of the general population and 50% of people with dyslexia would benefit from coloured filters lack sound evidence and face validity. Publications with such claims typically cite research using methods that have not been described in the scientific literature and lack a sound aetiological framework. Notwithstanding these criticisms, some researchers have used more rigorous selection criteria and methods of prescribing coloured filters that were developed at a UK Medical Research Council unit and which have been fully described in the scientific literature. We review this research and disconfirm many of the more extreme claims surrounding this topic. This literature indicates that a minority subset of dyslexics (circa 20%) may have a condition described as visual stress which most likely results from a hyperexcitability of the visual cortex. Visual stress is characterised by symptoms of visual perceptual distortions, headaches, and eyestrain when viewing repetitive patterns, including lines of text. This review indicates that visual stress is distinct from, although sometimes co-occurs with, dyslexia. Individually prescribed coloured filters have been shown to improve reading performance in people with visual stress, but are unlikely to influence the phonological and memory deficits associated with dyslexia and therefore are not a treatment for dyslexia. This review concludes that larger and rigorous randomised controlled trials of interventions for visual stress are required. Improvements in the diagnosis of the condition are also a priority.

Atypical Sensory behaviours in children with Tourette's Syndrome and in children with Autism Spectrum Disorders

Certain visual disturbances make it difficult to read text and have been attributed to visual stress, also called "pattern-related visual stress". 12 Children with ASD, 12 children with Tourette's syndrome and without ASD and 12 controls, all matched on age and non verbal ability, participated in an experiment exploring sensory behaviours and visual stress. Reading rate and accuracy were assessed with the Wilkins Rate of Reading test with and without the Intuitive Overlays. Both the children with Tourette's and the children with ASD showed a higher prevalence of atypical sensory behaviours and symptoms of visual stress than the typically developing control children. Six out of twelve children with Tourette's syndrome (50%) read more accurately and over 15% more quickly with a coloured overlay. Four of the 12 children with ASD and none of the control children read over 15% more quickly with an overlay. The findings are discussed in relation to problems in sensory modulation.

Identifying visual stress during a routine eye examination

PURPOSE

To investigate whether the clinical tests used in routine eye examinations can identify adults whose reading rate increases with their preferred coloured overlay(s).

METHODS

Routine optometric tests were used to measure 73 undergraduate students' refractive error, visual acuity, stereo-acuity, amplitude of accommodation, near point of convergence, associated heterophoria at near, colour vision and ocular motility. Participants chose an overlay or combination of overlays with colour optimal for clarity, and completed the Wilkins Rate of Reading Test with and without an overlay(s) of this colour.

RESULTS

Overall, there was a significant increase in reading speed with overlay (t(72)=-5.26, p<0.0005). Twenty-six participants (36%) increased their reading rate by >5% with their chosen coloured overlay(s). Ten participants (14%) had a reading speed increase of >10%. The increase in reading speed was not significantly associated with any clinical finding.

CONCLUSION

Tests which are completed in routine eye examinations did not identify those participants who benefitted from coloured overlays in terms of reading speed.

Assessment of trypophobia and an analysis of its visual precipitation

We developed and validated a symptom scale that can be used to identify "trypophobia", in which individuals experience aversion induced by images of clusters of circular objects. The trypophobia questionnaire (TQ) was based on reports of various symptom types, but it nevertheless demonstrated a single construct, with high internal consistency and test-retest reliability. The TQ scores predicted discomfort from trypophobic images, but not neutral or unpleasant images, and did not correlate with anxiety. Using image filtering, we also reduced the excess energy at midrange spatial frequencies associated with both trypophobic and uncomfortable images. Relative to unfiltered trypophobic images, the discomfort from filtered images experienced by observers with high TQ scores was less than that experienced with control images and by observers with low TQ scores. Furthermore, we found that clusters of concave objects (holes) did not induce significantly more discomfort than clusters of convex objects (bumps), suggesting that trypophobia involves images with particular spectral profile rather than clusters of holes per se.

The Effect of Clinical Visual Stress on Stereoacuity Measured with the TNO Test

We measured stereoacuity using TNO test on 25 patients without fixation disparity (FD) and compared the result with other 25 patients exhibited FD related to visual stress. All patients were presbyopes of ages ranging from 40 to 80 years, with visual acuity 6/6 or better in each eye, free from ocular diseases and generally healthy. The results showed statistically significant difference in the stereoacuities measured between the groups (Mann-Whitney U = 181.0, p < 0.01), suggesting that FD significantly reduced stereoacuity. Although the correlation between the magnitudes of FD and stereothreshold is statistically not significant (Spearman's r(s) = 0.33, p>0.01), elimination of FD using prisms correction statistically improved stereoacuity (Wilcoxon's Z = 2.43, p<0.01). The findings conclude that visual stress manifested as FD causes deficit in stereoperformance measurable with the TNO test and can be improved by prism correction.