Chiropractors are often called upon to treat headaches. As such, we are on the front lines to identify a condition called scotopic sensitivity syndrome or Irlen syndrome. It is a permanent hereditary condition that leaves its sufferers with visual disturbances that make it difficult to read and function.
Young people who have this syndrome often are misplaced in special education programs and/or develop behavior problems because of their disability. Early detection of this condition by a DC and referral to the appropriate certified screener for corrective colored lenses can profoundly affect the future of these students. For those who are "more experienced in life," correct diagnosis and treatment can be equally profound.
Scotopic sensitivity syndrome was first discovered by Helen Irlen, a psychologist who was working with a group of college students who "just didn't fit the mold." They seemed bright and capable, but had trouble keeping up with the required reading in college. Years of research identified a type of perceptual processing deficit. Irlen tried having one of the students use colored spotlight filters from the drama department for reading. After reading with the color instead of on a white page, the student exclaimed, "The letters stopped moving!"
Through continued research, Irlen eventually developed a two-step protocol that includes screening to identify if the person has the condition and fitting them with either colored plastic sheets or lenses worn as glasses. This balances out the visual overload the person experiences.
Children who suffer from Irlen syndrome often are difficult to identify. They learn very early in life to cover up their disability through various tactics. They fake being asleep in class or just close their eyes because of the pain. They wear sunglasses everywhere because the light hurts their eyes. They often feign illness to get out of reading assignments. Written math problems are simply not done.
Boys tend to develop behavior problems rather than be singled out as unable to read. Girls tend to become introverted. If identified as "problem children" early in life, they are often categorized and remain in a remedial education program for the rest of their academic life. Depression and low self-esteem often accompany this condition, resulting in medication and psychological challenges. If properly diagnosed, this grim outlook can be changed.
I was recently presented a case in which a 10-year-old girl was sent home by the school nurse for having a lazy eye. Upon doing an eye exam, it was discovered that her peripheral vision was reduced to an angle of approximately 45 degrees and her superior field of vision had reduced to almost horizontal. Her left eye would droop downward and lateral when trying to track upward. I performed an X-ray and an MRI, looking for a pituitary tumor. I also had her eyes examined by an optometrist. When all three exams came back negative, I began to talk to the girl in an attempt to find out more about her history.
She had always experienced depth-perception problems, often walking into doorways, crashing her bicycle, etc. She often complained of frequent and severe headaches and extreme light sensitivity. She was quite bright, but was having an extremely hard time reading in school. Her mother worked with her for hours on her homework, often commenting, "There's no such letter in that word." When asked why she never said anything, the patient responded that she didn't want to be put in a "nuthouse" because people would think she was crazy. Instead, she just shut down and didn't tell anyone.
After the girl was seen by a certified Irlen screener, prescribed colored lenses and provided with special text and computer overlays, the change was remarkable. She is now excited to go to school and realizes she is not a "psych" case. She was removed from special education and a "504" program was developed that makes accommodations for her disability. These include use of the special overlays, longer time for written exams, elimination of grid-type problems, and other adjustments to her learning environment. Her headache intensity and frequency has been greatly reduced.
Irlen/scotopic sensitivity syndrome is a "hardwired" problem that is permanent, but easily and inexpensively corrected. It ranges from mild to severe. Chiropractors would be well-served to put the following questionnaires into their standard headache screen. If any of your patients answer yes to three or more questions on either of the following self-tests, they might be experiencing the effects of Irlen syndrome.
- Do you skip words or lines when reading?
- Do you reread lines?
- Do you lose your place?
- Are you easily distracted when reading?
- Do you need to take breaks often?
- Do you find it harder to read the longer you read?
- Do you get headaches when you read?
- Do your eyes get red and watery?
- Does reading make you tired?
- Do you blink or squint?
- Do you prefer to read in dim light?
- Do you read close to the page?
- Do you use your finger or other markers?
- Do you get restless, active or fidgety when reading?
Headaches, Migraines, Stress/Strain Self-Test
Do any of the following activities or situations bother your eyes, head and stomach, making you dizzy, tired, nervous, anxious or irritable?
- Reading textbooks for extended periods?
- Reading on a computer for extended periods?
- Working or reading under fluorescent lights?
- Reading black print on high-gloss white paper?
- Doing visually intensive activities?
- Outside glare; glare off chrome on cars?
- Glare off high-gloss white paper?
- Glare on hazy days?
- Bright lights?
- Fluorescent lights?
- Headlights from oncoming traffic?
- Certain patterns or stripes?
- Bright or neon colors?
- Do you frequently wear sunglasses?
- Do you become tired or drowsy under bright or fluorescent lighting?
- Do you get a headache from fluorescent lighting?
- Do you feel antsy or fidgety when under fluorescent lighting?
- Does your performance deteriorate under bright or fluorescent lighting?
- Do you feel like there is too much light when reading?
- Do you feel like there is not enough light when reading?
- Do you read in dim lighting?
- Do you feel like you need less light to read?
Determining that a person may have Irlen syndrome does not eliminate the need to explore other factors which can also cause headaches, but as doctors of chiropractic, understanding the disability and being able to provide proper diagnosis and treatment options will help the sufferer for the rest of their life. Isn't that what it's all about?
The self-test questions referenced in this article are reprinted with permission from the Irlen Web site. For further information and additional questionnaires on Irlen/scotopic sensitivity syndrome, visit www.irlen.com and read Dr. Irlen's book, Reading by the Colors.
Dr. Jon Floto is a 1991 graduate of Palmer College of Chiropractic West. For questions or comments regarding this article, contact him at