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An Evaluation of Iridology

Allie Simon; David M. Worthen, MD; Lt John A. Mitas II, MC, USN

is an analysis of health based on examination of the iris of the

\s=b\ Iridology tions, areas of pigmentation that are
eye. One hundred forty-three patients had photographs taken of both eyes. sometimes incorrectly diagnosed as
Ninety-five patients were free of kidney disease, defined as a creatinine level melanosis. Tuberculosis, diabetes
of less than 1.2 mg/dL (mean, 0.8 mg/dL), and 48 had kidney disease severe mellitus, atherosclerosis, sarcoidosis,
enough to raise the plasma creatinine level to 1.5 mg/dL or greater (mean, and rheumatic disorders (Reiter's
6.5 mg/dL). Three ophthalmologists and three iridologists viewed the slides syndrome, ulcerative colitis, Crohn's
in a randomized sequence without knowledge of the number of patients in disease, juvenile rheumatoid arthri¬
the two categories or any information about patient history. Iridology had no tis, and ankylosing spondylitis) are
clinical or statistically significant ability to detect the presence of kidney among afew of the disorders and
disease. Iridology was neither selective nor specific, and the likelihood of syndromes too numerous to mention
correct detection was statistically no better than chance. with confirmed manifestations in the
(JAMA 242:1385-1389, 1979) iris."
Yet iridology offers a different
perspective. In a manner somewhat
THE EYE has long been an area of article. The technique has existed for akin to the motor homunculus in the
inquisitiveness for those in medicine. approximately 100 years and counts brain, the iris is sectioned into vari¬
Compelled by an appetite for eye physicians as proponents in its evolu¬ ous areas, each representing a differ¬
contact and the expressiveness ren¬ tion, including its founder. ent organ structure in the body (Fig¬
dered via the eye, diagnosticians have Signs of systemic disease in the iris ure). Though lacking a uniform scien¬
often looked to the eye for clues. are not new to Western medicine.'3 In tific explanation for how pathology in
Though unrecognized by most but not primary syphilis, reddish spots can be a distant corner of the body may come
all Western medical physicians, a observed sometimes on the lesser to be registered in the iris, iridolo-
relationship is reported to exist circle of the iris. Disappearing within gists yet maintain that the latter is
between the appearance of the iris of a few days, they are comparable to true.
the human eye and the functional the macular lesions seen on the skin Though iridology has been much
status of various organs and anatomy and are often present at the same criticized,5,6 it has never been scientif¬
of the body. The screening technique time. As the syphilis progresses, one ically studied. As scientists, however,
whereby one looks to the iris to may see iris atrophy or iris papulosa we need not reflect long to recognize
discern the functional state of these (gummatous iritis), which is a true the vulnerability of this practice.
areas is variously termed iridology, gumma—the tertiary lesion of syphi¬ Ophthalmologists have been able to
iris-analysis, and iris diagnosis, lis. rely only on personal belief in
henceforth called iridology in this Herpes zoster has been associated responding to inquiries by their
with a severe iritis, eventually ending patients and the press. The words of
From the University of California and the Veter- in a hyperpigmentation and necrosis an Indian scholar are appropriate:
ans Administration Medical Center, San Diego. of the iris. In neurofibromatosis (von "The cosmos would be fairly chaotic if
Reprint requests to Veterans Administration its laws could not operate without the
Medical Center (112G), 3350 La Jolla Village Dr, Recklinghausen's disease), one may
San Diego, CA 92161 (Dr Worthen). find, among other ocular manifesta- sanction of human belief." Medicine

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Pay Pat Pave,, Paiche,
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Hal Hallucination
IRIDOLOGY CHART developed by Dr. Bernard Jensen, D.C. Obi Obtain on

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Typical iridology chart.

should take care lest its attitudes research strategy as the most useful meth¬ tion. The third group reflected a wide
come parallel that of the guard dog
to od to study the manifestations of kidney variability in plasma concentrations, from
that, only too aware of his bounda¬ disease in the iris of the human eye. 6 mg/dL to extreme values in some pa¬
ries, barks each time he senses an tients with uremia in whom clearance
Selection of Patients values were 20 mL/min or less.
The study population consisted of pa¬ Seventeen (71%) of the 24 patients in
The intent of this study was to tients from either of two hospitals: the group 2 had chronic renal disease, defined
determine whether practicing iridol-
University of California Medical Center as a record of renal disease and rise in
ogists in southern California could and the Veterans Administration Medical plasma creatinine level for a period of not
demonstrate statistical- significance Center, both in San Diego. Patients were less than five months. The remaining
(P<.05) in distinguishing normal and selected on the basis of renal dysfunction, seven patients in group 2 (29%) had an
abnormal kidney function from 35- ranging from near normal to that requir¬ elevation in plasma creatinine level re¬
mm slides of the irides of patients. ing hemodialysis (Table 1). Determination corded for a period of not less than seven
Ophthalmologists were also asked to of kidney function was based on the days, and were thus deemed to have an
participate and give their assessment. patient's history in conjunction with the "acute rise."
The kidney was selected on the basis present plasma creatinine level, as ascer¬ All but three of the patients in group 3
of its relative utility: (1) The kidney tained by the alkaline picrate reaction on required maintenance hemodialysis at the
area of the iris, lying just medial of
dialyzed specimens of serum. Doolan et al" time of their participation in the study.
plotted plasma creatinine concentrations Following approval by the appropriate
the 6-o'clock position in each of the against clearance values. They found that institutional review boards and the acqui¬
irides, was easy to photograph. (2) if the plasma creatinine concentration is sition of informed consent, 35-mm slides
Kidney function is assessed on nearly less than 1.25 mg/dL in men and less than were taken of the irides of these patients
all patients admitted to our hospitals 1.1 mg/dL in women, the clearance value as they were seen at the renal clinics, on
via determination of plasma creati¬ will always be normal unless the patient admission to the hospital, or as they were
nine level. (3) Iridologists felt com¬ has extensive muscle wasting. (This receiving hemodialysis, between the period
fortable dealing with both 35-mm formed the basis for assigning patients to of November 1977 and December 1978. A
our control group, labeled group 1 in the Medical Nikkor lens, with a self-controlled
slides and the kidney area. In one
iridologist's words, "a careful study of study and Table 1.) Their data then strobe ring flash at a magnification of
showed a transition zone, where plasma Xl.75, was used to obtain transparencies
iris photographs can ascertain
. .. ...

creatinine concentrations from 1.75 to 5.5 that included the necessary landmarks
the condition of each organ in partic¬ mg/dL in men and 1.4 to 5.5 mg/dL in required by the iridologists to make their
ular—eg, acute, subacute or chronic women were associated with clearance analysis. The camera used belonged to one
conditions of the liver, kidney, etc. values ranging from slightly subnormal of the iridologists, so that the pictures
down to 20 mL/min. Patients with plasma obtained were of a quality to which he and
creatinine levels in this range were most iridologists were accustomed. Photo¬
assigned to group 2 in our study, those graphs were obtained in a total of 48 cases.
We selected case-control (retrospective) patients with moderate kidney dysfunc- Age, sex, range of plasma creatinine level,

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Of primary concern to all the iridolo¬
Table 1.—Clinical Comparison of Groups gists was having the patient they were
Group Characteristic_Group 1_Group 2_Group 3
analyzing before them, to see the whole
No. (%) ol patients_95(66)_24(17)_24(17) body and to talk with the subject. The
21-80 21-74 method of analysis was discussed briefly
Age range, yr 24-73
Sex, % male_57_9_708_54.2
with the expert iridologist (observer A) in
our study group prior to performing the
No. (%) with hypertension 6(6.3) 3(12.5) 4(16.6)
No. (%) with diabetes mellitus_3(3.2)_5(20.8)_2(8.3) study, with the intent to delve more deeply
into the methodology involved should the
Creatinine, mg/dL
Range_0.5-1.2_1.6-4.9_6.3-16.0 analysis demonstrate a clinically signifi¬
cant screening test. He stated that he
Mean_OS_2^5_10.6 would be looking primarily at the area of
SD ÔTîi TÔ9 Í37
the iris long designated by iridologists as
the kidney area (Figure). In this area, he
and other considerations are included in groups in terms of renal function. Each would interpret crypts (which are termed
Table 1. was told the number of the slides to be "inherent weaknesses" in iridology), tor¬
An attempt was made to minimize the viewed and that he or she could take as tuosity of the trabeculae (called by iridol¬
number of those patients undergoing long as necessary to analyze the slides. ogists "iris fibers" by virtue of their
hemodialysis as it is known that the proce¬ None knew the number in each group, or appearance), and increased visibility of
dure itself accelerates vascular changes."2 the ages of those involved. All were asked the pigment layer as signs of pathology in
Three (12.5% ) of the group 2 patients were to make whatever comments they thought the kidneys. This would be viewed in
known to have hypertension, a condition would be helpful during their analysis, conjunction with the remainder of organ
that affects the retinal vasculature and assessing limitations existing in this form systems in the body and the general
could potentially alter the iridal vascula¬ of analysis. constitution of the individual as repre¬
ture as well (no known reported cases). sented in the iris to determine his final
The Observers assessment of whether kidney filtration
Selection of Controls All three iridologists were in community compromise was present.
A comparison group was selected from practice. Two have DC (doctor of chiro¬
male and female inpatients more than 21 practic) degrees, and one has received a RESULTS
years old at the University of California degree in iridology alone under the direc¬ The Iridologists
Medical Center in San Diego. These tion of an expert in the field. One of the
In the initial data analysis, patients
patients were known to have normal renal iridologists (observer A) is world re¬
function on the basis of plasma creatinine nowned for his work in iridology and the were divided into those with kidney
values falling within the normal range. author of what is considered the most disease (groups 2 and 3) and those
Photography of the iris was performed on popular book in America on iridology. Two without (group 1) to detemine if the
the date the plasma creatinine level was of the iridologists have been using the observers could significantly distin¬
ascertained or within a period of five days. technique as their primary method of guish these two groups (P<.05). The
This group, labeled group 1, comprised a analysis of patients for more than 40 results of their analyses are shown in
total of 95 patients. None of the patients years; the third (observer B), for three to Table 2.
had a history of any degree of renal fail¬ four years.
ure. Six (6.3% ) were known to have hyper¬ All three iridologists were interviewed
Observer A, our best screener using
tension, and three (3.2%) were known to prior to their analyses. While they were iridology, correctly identified those
have diabetes mellitus. aware that a scientific study of this kind
with kidney disease (groups 2 and 3)
had never been performed in iridology, to 57% of the time, and likewise correct¬
Presentation of the
Slides to the Observers
their knowledge it was within the realm of ly identified those with no disease
iridology to discriminate the three levels 57% of the time. These results were of
All slides were coded, then arranged in a of kidney function in question, and they neither statistical nor clinical signifi¬
random fashion, using a table of random were accustomed to analyzing patients as cance (P>.05), and did not improve
numbers. The slides were presented to the if this were so. Their criticisms of the when those patients with only moder¬
iridologists in the accustomed manner: the technique used for analysis, which could ate kidney dysfunction (group 2) were
right and left eye slides were projected have limited their accuracy in this study, eliminated to determine if he could
simultaneously on rear projection screens, were as follows: (1) Brown eyes are diffi¬
using individual projectors for each eye. cult to diagnose. This observation has been distinguish normal subjects (group 1)
Each iridologist viewed the slides individ¬ made by physicians performing iris angi- from those with renal failure (group
ually in his own office and in the company ography. The apparent explanation is that 3).
of a registered nurse, unfamiliar with both the increased pigment "sequesters" the Observer B correctly identified 37%
the slides and their sequence, who re¬ trabeculae.11 (2) Iridologists are accus¬ of the patients with disease (groups 2
corded the iridologist's analysis. The tomed to analyzing the entire iris, and and 3), incorrectly labeling 63% of
observers were given the option of reject¬ found it difficult to concentrate on only them as normal. He correctly identi¬
ing any slides that they thought were of a the kidney area. (3) The iris photos are fied 56% of those in group 1 (normal
quality rendering analysis impossible or two-dimensional. When an iridologist is to
subjects) and incorrectly ascribed dis¬
errant; however, they were asked to give make an important analysis, he prefers
ease to 44% in this same group. He
an estimate of the renal function on the the patient to be present before him so
basis of these slides and to state the that he might better see depth in the iris likewise did no better distinguishing
reasons for their rejection. to judge the chronicity of the lesion. (4) group 1 from group 3.
Each screener was interviewed prior to Iridologists are accustomed to analyzing Observer C accurately diagnosed
the analysis to be certain he or she under¬ each kidney separately rather than assess¬ kidney disease in 88% of cases, and in
stood the distinction between the three ing overall kidney function. 95% of cases with severe kidney fail-

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Table 2. Iridologists' Data Analysis Table 4.—Screening Results

% of Patients % of Results

With Disease Without Disease True- True-

Positive Negative
True-Positive True-Negative
False-Positive P (Sensitivity) (Specificity)
_(Sensitivity) False-Negative (Specificity) Observer A 57 57
Observer A_57_43_57_43_.07 Observer B 37 44
B_37_63_44_56_.27 Observer
Observer C 88
88 .42 12 12
Observer E 53 48
Observer F 23 '6

Table 3.—Ophthalmologists' Data Analysis

% of Patients

With Disease Without Disease

Knowing the true prevalence of
renal disease in the population, one
True-Positive True-Negative can determine the predictive value of
(Sensitivity) False-Negative (Specificity) False-Positive P
the screening test. When the disease
Observer D 55 45 62 38 .035
Observer E 53 47 48 52 .57
prevalence is relatively low, as in
76 24
renal disease, even a fairly specific
Observer F 23 77 .43
test will yield many false-positives
and poor predictability. Assuming
ure. This accuracy seems to approach tics: (1) cataracts, from the conclusion that the prevalence of renal disease in
the accuracy of the creatinine test, that cataracts are of increased inci¬ the population is not more than 2% (a
yet he identified normal patients dence in those patients with kidney figure believed reasonable by our
correctly only 12% of the time, identi¬ disease requiring corticosteroid ther¬ renal consultant [J.A.M.]), we can go
fying them as having renal disease apy, (2) edema and anemia of the on to calculate the true value of ir¬
88% of the time (false-positives). conjunctiva,14 and (3) characteristic idology as a screening tool.
Thus, his seeming accuracy at identi¬ signs of hypertension in conjunctival Our best iridology screener was
fying kidney disease is more correctly vasculature.'5 observer A, who obtained a rate of
attributed to his diagnosis of the Using the .05 level of significance, 57% true-positives and 43% false-
disease in nearly all patients. Statis¬ the task was equaled by one of positives. By his predictions, in a
tical analysis rendered a P value of the ophthalmologists (observer D). population of 1,000, disease will occur
.42. Achieving the best results, observer D in 20 (2%), no disease in 980. There
The eye, like all parts of the human correctly assigned a disease category will be 11 true-positives (0.57X20) and
body, changes with age. Arcus senilis to 55% of patients with disease, 421 false-positives (0.43X980), total¬
and pterygium are well-recognized incorrectly labeling 45% as normal. ing 432. The predictive value is there¬
pathological features seen in the aged Observers E and F were less accurate. fore 11/432 or 2.5%.
eye but not often in those of younger Their results similarly did not im¬ Thus, 2.5% of those identified by
persons. Both limit visualization of prove when selecting for age of less our best screener as having renal
the iris. In addition, the relationship than 40 years. Table 4 summarizes abnormalities in the general popula¬
of age to the lucidity of the character¬ the screening results of the six tion will actually have disease.
istic anatomy of the iris is inverse. observers. The best score obtained by an
Bearing these considerations in mind, Predictive Value of the
ophthalmologist was observer D,
we speculated that the observers whose true-positive rate was 55%,
might improve their results by elimi¬ Screening Tests and false-positive rate 38%. Using
nating those patients and controls In our study population, 33% of the the same format for calculation of
over the age of 40. There remained 12 patients had renal disease. Yet the predictability, one obtains a pre¬
subjects and 40 controls. The results true incidence in the population is dictive value of approximately 3%.
again showed no sensitivity or speci¬ much less. Information from the Though better than that obtained by
ficity, and all statistical test results National Kidney Foundation in 1978 the iridologists, the predictive value
showed P>.05. suggests that 13 million Americans of the screening technique used by the
suffer from "all types of renal and ophthalmologists in assessing kidney
The Ophthalmologists urinary tract disease." This is ap¬ disease is not clinically appropriate.
The results of the three ophthal¬ proximately 6% of the general popu¬ One may contrast the accuracy of
mologists were no more impressive lation. This same report states that the plasma creatinine level, a stan¬
(Table 3). They were asked to assess 42,000 persons per year require dard used by Western medicine to
the level of kidney function by what¬ chronic dialysis (0.02% of the general distinguish normal from abnormal
ever methods they could best do so population). We might surmise that patients. Normal creatinine level is
from the 35-mm slides of the irides in the general population the true defined by the range found in 95% of
and surrounding conjunctiva. Totally incidence of renal disease of the type the healthy population. The normal
avoiding the iris, their method of with which we dealt in this study is population in this study had a mean
analysis involved three characteris- much less than 6%. plasma creatinine level of 0.8 mg/dL,

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with a standard deviation of 0.18, and reliance on this technique in the screening technique for detecting or
hence more likely is distributed with¬ detection of renal disease. diagnosing kidney disease. Patients
in a range in which 98% of the nor¬ should seek other, more traditional
mal population lies. Even so, using diagnostic means to draw conclusions
the 95% figure, 19 of 20 with disease Clearly, none of the six observers in in conjunction with their iris exami¬
will be correctly identified, whereas this study derived data of clinical nation. Beyond this, one must ques¬
5% of the normal population (in this importance or significance. Yet, the tion the negative value. There is the
example, 49 persons) will be incor¬ negative implications are significant. serious potential psychological harm
rectly identified as abnormal and Iridology is a practice of growing to the subject of carrying the burden
asked to undergo further testing. The interest among those turning to holis¬ of detected "disease." Of greater
predictive value is that 28% of those tic health care and alternative meth¬ interest to physicians is the false-
identified as abnormal will actually ods. Offering the dual attraction of negative "analysis." One of the
be so. Although this may not reflect simplicity and mystique, it provides observers (an iridologist), who em¬
an ideal level of accuracy in that 49 of to some people a welcome alternative ploys the technique and draws conclu¬
1,000 people in the normal population to the often painful and indisposing sions based on it, correctly identified
will undergo further testing to be diagnostic procedures of traditional only 26% of the patients undergoing
certain of their health, still it is medicine. Articles about iridology dialysis as having kidney disease.
considered worthwhile to identify and have recently appeared in the lay Physicians are well aware of the
help the 95% with disease who might press (Esquire, Cosmopolitan, Cleo, harm that can come to these patients
otherwise go on to develop sequelae of local newspapers, television, and ra¬ if they were to rely on iridology and
renal disease. The 2.5% level of renal dio programs). Ophthalmologists and thereby go without proper treat¬
disease diagnostic accuracy with iri¬ family practitioners are often asked ment.
dology—only 11 of 20 patients with by their patients about the tech¬
disease are correctly identified, while nique. Elizabeth Barrett-Connor, MD, and Brandon
421 normal people are identified as The results of this study show that Centerwall, MD, provided statistical guidance.
Barbara E. Stern, RN, helped retrieve and orga¬
having disease—does not warrant there is no value in iridology as a nize the data.

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