November 2022: Case on acceptable advertising claims in clinical practice

Read through the scenario below, think about what you would do and then check our expert advice to see if we agree.

Case on acceptable advertising claims in clinical practice

My practice offers overlays and tinted lenses for visual stress. How can I publicise the service and can I claim it is a treatment for dyslexia?

Our advice

Daniel Hardiman-McCartney MBE FCOptom, Clinical Adviser, says: “You can publicise the service; however, as with any other publicity or promotion, you must not make any misleading statements and therefore you must not claim it is a treatment for dyslexia. 

Visual stress is a term used to describe a person’s hypersensitivity to patterned stimuli, in particular high-contrast stripes. People susceptible to visual stress experience discomfort and visual disturbance when viewing certain patterns, and these symptoms may in some cases be alleviated with appropriate precision-coloured filters. Some people experience visual stress when reading because lines of printed text typically present a pattern of high-contrast stripes, thus coloured filters have been reported to help make reading easier and more comfortable. However, claims that coloured filters are beneficial for reading, and in particular that they benefit people with dyslexia and other specific learning difficulties (SpLDs), are controversial due to the conflicting interpretations of the strength and reliability of the current evidence base. Therefore, although they may help to alleviate symptoms of visual stress sometimes for some patients, including in people with SpLD, you must not claim that coloured filters treat SpLDs such as dyslexia, dyspraxia or attention deficit disorder.

The Guidance for Professional Practice section A162-A170 on examining patients with SpLDs and the use of tints, sets out our related guidance on the use of tints and includes links to the recent evidence base. A Delphi study of optometrists with experience in this field has led to proposed diagnostic criteria for visual stress, that may help to reduce the risk of over-prescribing coloured filters.

It is also important to note that dyslexia can only be formally diagnosed by a certified assessor, who is either a psychologist specialising in specific learning difficulties or a specialist teacher, as specified by an accredited body such as the British Dyslexia Association(BDA). Therefore, the diagnosis, assessment and treatment of dyslexia are outside the scope of an optometrist’s core competency, with the primary validated treatment for dyslexia being specialist teaching. Certified assessors are recommended to refer children with visual symptoms for a sight test. 

It is vital that all optometrists maintain the trust of the public by making the care of their patients their first and continuing concern. This means that you should tell patients if any investigation or treatment that you recommend is not supported by evidence or established practice and you must not make misleading, confusing or unlawful statements in your advertising, communications and the consultation room. The ASA recently upheld a complaint and ruled that a company should withdraw certain claims relating to tints and the management of dyslexia.  The rules for advertising are found in the Advertising Standards Agency’s UK code of practice (CAP Code), and although it is best to seek independent expert advice, there are helpful sources of information available to ensure you don’t inadvertently confuse or mislead your patients (see references).

When publicising tinted lens services, you could say that you can help manage the symptoms of visual stress, and the treatment of visual stress may help a person to read more comfortably and easily. For any claim you make, you should ensure it is backed by robust evidence, and you should hold documentary evidence on file in case it is requested by an appropriate authority. Professor Bruce Evans FCOptom and Professor Arnold Wilkins Hon FCOptom have produced a table of examples when considering the publicity of tints for visual stress. This includes avoiding confusing terms such as ‘visual dyslexia’, ‘dyslexia overlays', ‘dyslexia eye tests', and unsubstantiated claims relating to the prevalence of visual stress in people affected by dyslexia. 

In addition to maintaining trust, your publicity could affect the validity of your patient’s consent. For a consent decision to be valid, you need to ensure adequate information is made available to your patient, or their parents, so they can voluntarily make an informed decision to proceed, in addition to having capacity. You must present the information impartially, and you should not omit material information that a reasonable person is likely to attach significance to. Your publicity and advertising form part of the information that your patients use to make treatment decisions, so confusing publicity could invalidate the consent to investigate or treat. Attention should also be given to the adequacy of information given by your practice team in telephone and email communications and the use of testimonials and anecdotal reports to promote products and services. 

It is essential that practices carefully consider marketing in all aspects of clinical practice, both in the services they offer and the medical devices they supply. Although your question relates to precision tinted coloured lenses, it equally applies to spectacle lenses, coating, contact lenses, diagnostic investigations and many other aspects of practice.  Being aware of the ASA CAP code, and scrutinising every claim you make, will help to ensure all communications are best placed to keep your patients and customers well-informed and maintain the high levels of trust and respect they have for our profession.”