'nal Research IntporoGY: DncNosrrc Vnrmrry rN ORTHopEDTcTRAUMA RussellWorrall,Wayne Cannan, Mary Eastwood,dndDebwah Steinberg Iridology is a diagnostic method usedby somecomplementary and altemative medical practirioners. lt is basedon the assumption that the iris presents information on general health, and that specific iris pamems signifi' specific trauma and diseasescates. In this single-blind study,we presented3 iridologists and 10 optometry studentscolor iris slidesof 30 subjects with recent orthopedic ffauma to an arrn or leg, and 30 controls without rrauma history. Vatidity, sensitivity, and specificity values computed for the 3 iridologists and 10 optometry studentsshowed none ro have demonsnated diagnostic accuracyof significance. IutnooucnoN observationsand published a book on iris diagnosisin 1880.2He also pursueda careerin homeopathy. n Bemard Jensen, a chiropractor, has been che most I oMPLEMENTARYAND..ALTERNATIVE,'MEDICINEprominent iridology proponent in the United States.l*7 \r/ (CAM) practitioners sometimesutilize a variery Iridologists claim to assesssubjects' general condition of diagnostic methods basedon the assumption that the and then use detailed charts of r.he iris to diagnosecon- appearanceofa specific body surface area representsdis. ditions (seeFigures 1 and 2).Lta For example,an in- tant organ systems,disorders of which can be diagnosed flammation of the right knee would appear in the right by the practitioner. Among these areasand methods are iris at 6 o'clock, midway between the pupil and the the feet and hands in reflexology, the tongue in tradi- sclera. Iridology diagnosesare not congnrent with known tional Chinese medicine, the spine in chiropractic, and iris manifestations of systemic diseasessuch as diabetes the iris of the eye in iridology. According to Jon Miles, mellitus, tuberculosis,and rheumatoid disorders. a member of the Intemational Iridology ResearchAsso- ciation, there are an estimated 10 000 practitioners of iridology in the United States.lLiterature on iridology is MrrHots readily available at health food storesand in the "alter- native health" section of bookstores. Several iridologists, including Jensen,were consulted for Iridology was invented by lgnatz von Peczely,a advice on the study design. This study was originally young man who accidentally broke the leg of an owl he conceivedas a prospective,controlled, single-blindstudy had captured, After observing a dark stripe in the iris at using pre- and posttraumacolor iris slides.A prospective the 6 o'clock position on the sameside as the broken leg, test of the hypothesis that an iris change appearsas a re- he claimed that therefore the iris connected to distant sult of a broken bone was impractical. Approval was ob- orgaru. Von Peczelydeveloped iris charts basedon his tained from the U.C. BerkeleyCommittee for the Pro. tection of Human Subjectsfor the following project. Color slides of the right and left iris were taken of a Thisresearch was supported in part by a grantfrom the Council for Reliable subject pool consisting of 358 on- and off-campusath- HealthInlormation/National CouncilAgainst Health Fnud. RussellWonall, 0D; lJVayne Cannon, 0D; Mary Eastwood, 0D; and Deb- letesparticipating in an organizedteam sport (e.g.,foot- orahSteinberg, 0D, are in the Sdool olOptometry atthe University olCalifomia, ball, rugby) Close contact was maintained throughout Berkeley.Conespondence concerning this article should be addressed toRus- the school year with team trainers and coaches. There sellWorrall, 0D, School of OptometryUnivenity of California,Berkeley, CA was only 1 injury significant enough to quali! for the 94720-2020:e.mail: [email protected]. study populadon. To provide an adequatenumber of sub- jects to make statisticalcomparisons, the studywas mod- THE ScrENTrFrcRE14EW oF ALTERNATIVEM[DlclNE Vol.6, No. 2 (Sprino2002) 63 64 TneScrcNrtrrc Reurw oE ArrenNenve MrnrcrNr Figure1. lridologychart.3 Flgure2. Schematicrepresentation ofthe right and left eye bone zones: (1) cranial bone; (2) frontal bone; (3) orbit; (4) nasal bone;(5) u.np.er teeth;(6).loyer jaw (7) iryv-3nd andteeth; cervicalygrtebrae; {8)ear; (9) shoulder and ctavicte; (10) scaputa; (11 ') spineand ribs; (1 2) sternum and ribs; (1 3) hand and arm bones; (1 4) true pelvis; (1 5) pelvic crests; (1 6) foot and leg bones.to R'ooJ' L'.0J' ified and the application wasamended to include a pop- taken of subjectswith no history of orthopedic rrauma, ulation of orthopedic trauma patients with extremity to be usedas conffols. fracturesadmitted at 2 local hospitals. An iridologist provided the camemapparatus, which To isolate the patient from the iridologist and to included a Nikon 35mm single-reflex camera mounted limit the clinical observationonly to the eye,color slides on a portable sand with a chin rest and foreheadsupport were used irutead of direct patient contact. slides were and integral strobe flash illumination. The slideswere taken of the right and left iris of fracture patients be- screenedfor quality by a noninterestedphotographic ex- rween the 3rd and 14th posttraumaday. Slides were also pert before being selectedfor the sub;ectpoo[. Slides of Vonall, Camwn,Eatwood, E Steinberg:Indnlag1 Table1. ScreeningResults by lridologist (Chance = 50%) 0bserver Ualidityfirue Diagnosis) P Sensitivity(True Positive) Specifici$Frue llegative) A 43o/o.(1U28)t 0.58 40%{8t20) 50"/"(4t8) B 55%(16t29) 0.73 62%(13t21) 37%(3t8) c 47"/o(14130). 0.60 52%(11t21) 33%(3/e) *percentcorrect fnumbercorrecvnumber of subjects Table2. ScreeningResults by Observer Group (Chance = 50%) 0bserver Numherol ValidiU Sensitivity Specilicity Group Observerc (TrueDiagnosis) P (TruePositive) (Truel{egative} lridologists(total slides) 3 48%.(4U87)I 0.79 52%(3U62) 40%(1y25',) Iridologists (preferred slides) 3 47o/o(28160) 0.73 52%(21t401 35o/"(7t20]. 0ptometrists 10 53%G85n29) 0.10 50%(176i354) s6%(209t375) *percentcorrect fnumbercorrecVnumber of subjects the trauma patients and controls were chosen, coded, culated for each iridologist and optometry student. Sep- and randomized into a presentation set of 30 pairs of arate calculations were performed for the preferred slides right- and left-eye photos. and for the combination of preferred and nonpreferred A number of iridologists were invited to the U.C. slides.Slides judged unacceptable by each observerwere Berkeley campus to participate in the review of slides. not included in the calculation. Three practicing Aidologists from northem Califomia ac- cepted. To generatemore iridologiss'participation, we duplicated the slide set and assembleda packagewith in- RssuLTs structions to mail to iridologists. Despite this recruitment efforr, no additional iridologists enrolled in the study. The resultsare summarizedinThbles 1 and 2. None of the The 3 iridologists and a group of 10 optometry stu- diagnosdc setsof iridologists orof the optometry students dents participarcd in the study. The students were given approached statistical signiftcance for accuracy.The re- a brief introduction to iridology and an iris chart. Each sults of the iridologists were worse when only the pre- participant waspresented with the 30 pairs of slidespro- ferred slides were considered. lridologist B demonstrated jected side by side onto a high-quality screen.Each ob- the highest corect diagnosis rate, with a sensitiviry of serverrated each slide for quality, indicating its sta&s as 0.62. Howeveq iridologist B also demonstrated a low preferred, nonpreferred, or unacceptable. For each pair of specificity of 0.37, indicating that according to his esti- preferred and nonpreferred slides, the observer indicated mate, 637oof the controls had trauma when none waspre- whether orthopedic trauma to an extremity was present sent. The scatter plot in Figure 3 illustrates the random in rhe subject. nature of the data relative to the 507oguessing line. The study subjectswere placed into 2 groups:those with recent orthopedic trauma and those with none. The responseswere analyzed to determine if the ob- DrscussroN servers could reliably distinguish these 2 groups (p < .05). Values for validity (correct diagnosis),sersitivity The Berkeley iridology study was designed to remove (true positive), and specificity (true negative) were cal- ambiguity of diagnosisby using subjectswith orthopedic 66 THr Scmr'ffmcRwmw or Arrrrurertw Mnmcwt Figrre3. Scatterplot ol theperylnt of conectresponso$ by,observer forvalidity, sensitivity, and specificity. The50% line is theresponse rate expected by chanco-.' I 80 Vatidity(conect diagnosis) tr ,Sensitivity(true positive) o $pecificity(true negative) 70 I I I 60 I 'E .r tr 50% n li fItr trtr l; 40 3o ooo oi oo OO 30 I 'l I I 2A ABC,i lridologists Optometrists trauma verifiable on X ray" The experimerrt closely re- scheduled for gall bladder $rrgery and 39 controls:23 sembled the initial event in iridology as reported by von Simon, Worr{ren, and Mies evatrrated the clinical ac. Peczely. fiHncy of 3 iridolqgism peeenred with 1,43subjecrs, of All iris charts are in general agrrernent on the lca- wftro'rn48 had signiffcant kidney disease.None of *re iri. tions corresponding to the arms and legs" Fnrm the iri- dolcgi$ts deuronstrated results apprmching sratistical dology literature,'rnaay au*rors such as Msrwell con- significance.2+ tend that iridology is well suited ro this lxnpose, statirg Despite the laek ofevidence confimring the eficacy that "when it comes to err€rge{rcy rnedicine---urta- of iridology, pr$poneffs claim that irldolqy cannot be gious diseases,broken bones--+be