A new mass screening test for color-vision deficiencies in children

Abstract

Five thousand one hundred and twenty-nine Wis- consin children, ages 4 -12 years, were tested for color- vision deficiencies using a newly devised, precisely cali- brated paper-and-pencil test. The disposable 1-page test consisted of 1 demonstration and 8 test panels. Thousands of copies of the test were produced, and they were distrib- uted and administered in classrooms by teachers. Children wrote directly on the test and were allowed to trace over the symbols with a pencil or crayon, if they had difficulty. Performance on the paper-and-pencil color vision test was compared with that on conventional tests of color vision including Ishihara's tests, the American Optical-Hardy Rand and Rittler (AO-HRR) plate test, and the APT-5 Color Vision Tester. Older children were also tested on the Nagel Anomaloscope. All the children who were classified as having a color vision deficiency by the paper-and-pencil test also failed one or more of the conventional tests. Likewise, among children who passed the paper-and-pencil test, none were classified as having a color-vision defect from the results on the conventional tests. In the sample of all males, 7.5% were classified as having a color-vision deficiency, which is consistent with what has been observed previously in large population studies. Children who were classified as having color vision deficiencies were examined further us- ing a new minimalist genetic test that was shown to be accurate and reliable. Genetic material derived from buccal swabs was used to determine the type of deficiency, protan vs. deutan, and to provide added information about severity. Among the subjects for whom type could be determined, 27% were protans, consistent with large population studies in which approximately 25% of red-green deficiencies have been found to be of the protan type. Classification of the severity of the deficiencies determined from the paper-and- pencil test plus minimal genetics were in good agreement with classification based on a battery of conventional tests. In conclusion, we found the methods used here to be rapid, efficient, and reliable for testing color vision in children.