Reading; through the eyes of a university student: A double-masked randomised placebo-controlled cross-over protocol investigating coloured spectacle lens efficacy in adults with visual stress.

Background: Visual stress is a reading disorder characterised by perceptual distortions, asthenopia and headache whilst reading, alongside increased sensitivity to repeated striped patterns (‘pattern glare’), in the absence of underlying ocular pathology. Coloured filters including tinted spectacle lenses and coloured overlays/acetates have been reported to ameliorate visual stress symptoms. However, evidence on coloured spectacle lenses efficacy at managing symptoms of visual stress, particularly in adults, is lacking, with two recent systematic reviews advocating the need for large-scale randomised control trials. Methods: This is a double-masked randomised placebo-controlled trial. University students identified with symptoms of visual stress, through use of a reading symptom questionnaire and mid-spatial frequency pattern glare test, will be recruited. Sample size for power of 90% at 5% significance, accounting for 10% dropout will be 65. Participants will be randomly assigned experimental and control coloured spectacle lenses to wear for six weeks followed by a two week washout period, prior to wear of the alternate lenses for a further six weeks with a two week washout period. Participants will compare both sets of spectacle lenses in a ‘head-to-head’ comparison after the secondary washout period, prior to choosing the preferred lenses for voluntary future wear. Long-term adherence to the preferred lenses will be assessed three months post-comparison. Researchers and participants will be masked to spectacle lenses worn throughout the duration of the trial. Reading performance will be assessed with both sets of lenses at various time points within the trial. A range of reading tests, reading symptoms and pattern glare evaluation will be used to monitor change in reading performance and visual stress symptoms during the trial. Discussion: The study will evaluate the hypothesis that coloured spectacle lenses increase reading speed and reduce severity and frequency of reading symptoms in adults with visual stress. Trial Registration: The trial is registered at clinicaltrials.gov: NCT04318106