Impact of ChromaGen lenses on colour vision test performance of individuals with congenital colour vision deficiency.

Objective: To screen, categorize and grade the severity of congenital color vision deficiency (CVD) by using Hardy-Rand-Rittler (HRR) pseudoisochromatic test plates and to detect the state of awareness of people about their abnormal color vision. Material and Methods: 2211 consecutive subjects aged between 15-45 years were recruited for the study. All patients underwent a color vision test by using HRR 4th edition pseudoisochromatic test plates. Both eyes were tested separately and the data of the right eyes were used for statistical analysis. The patients detected to have CVD were also asked if they were previously aware of their abnormal color vision. Results: Abnormal color vision was encountered in 59 out of 993 males (5.9%) and 4 out of 1218 females (0.3%). Congenital CVD cases were deutan in 47 (74.6%), protan in 11 (17.5%) and unclassified in 5 (7.9%) subjects. Five (7.9%) of the CVD subjects were classified as having mild, 21 (33.4%) having medium and 37 (58.7%) having strong color deficiency. Nineteen subjects (30.2%) were previously unaware of their abnormal color vision. The awareness of abnormal color vision was significantly associated with male gender and increased severity of the disease. Conclusion: HRR test may be used to detect, classify and grade severity of CVD. Approximately one third of the patients with CVD were previously unaware of their abnormal color vision. Female subjects and patients with mild CVD were more frequently unaware of their color vision problem.

One of the most common inherited vision disorders is congenital color vision deficiency (CVD). Its prevalence in men can be as high as 8% and 0.5% in women.[1] Men are predominately affected by the X-linked inheritance pattern, while women become carriers of the abnormal gene.[2] There are also different causes for acquired color vision defects, such as ocular or neurological disease, some metabolic disorders, drug toxicity and exposure to certain solvents.[3] Congenital CVD results from genetic mutations that affect the expression of the full complement of normal cone photoreceptors. They’re divided into three categories based on their intensity (anomalous trichromacy, dichromacy, and monochromacy). CVD places the sufferer at a distinct disadvantage when performing certain visual tasks—in particular those tasks in which a colored target is embedded in a variegated background of a different color. CVD affects many areas of life, and its adverse impact is experienced at all stages, i.e., from childhood to adolescence and adulthood.[45] Population is one of the biggest problems in India and the reason for so many compromises starting from lack of resources at every level. Healthcare is just one example. When providing even simple vision assessment in school children becomes a big task few tests like color vision examination is rarely being performed. Population diagnosis is usually late at the time of medical examination at the time of higher education or specific job. They are rarely diagnosed early in life. Late diagnosis leads to rejection for a particular job most of the time which has a psychological impact on individuals. In India where an education system doesn’t give a student to choose multiple streams, it turns out, several professional choices can be negatively impacted by a color blindness diagnosis. CVD is a hidden disability because, though present from birth, its role comes to play only when children begin to attend regular schools to learn some tasks.[6] From here onwards process of considerable difficulties in learning starts. Children with CVD are frequently marked as lethargic students, which could mentally affect them, or could evoke negative responses from instructors and guardian. This can lead to not only problems in learning but also in playing and in their social bonding. Various studies have been carried out all over the world to see the prevalence of CVD among school children.[789] Xie JZ, et al.[10] suggested that successful CVD testing can be done starting at age four. Cole stressed that school children should know if they have CVD so they can be helped more quickly to find adaptive strategies and be able to take it into account when planning their career.[11] Largest study on CVD in children is conducted to see the burden of this disability in India.[12] Authors have used Dalton’s psuedoisochromatic plates for color vision screening. It is based on Ishihara color vision chart principle. The Dalton screener consists of 6 sets with 4 plates in each that includes one demo plate and three screening plates. Those, who failed to read three or more plates in two or more random sets of the Dalton’s pseudoisochromatic plate were considered to have CVD after confirming with Ishihara’s PIP color vision testing (38 plate edition). The result shows CVD among boys was found to be 2.76%. Children from urban region (3.17%) were more likely to be color vision deficient than children from rural region (1.79%). These results are similar to the other parts of the country and few other countries from Asia. Screening of CVD is relatively easy does not require any formal training and can be performed by any assigned staff. Various plate tests are available, such as Ishihara, Tokyo, HRR plate test, which are highly sensitive and specific to detect CVD. Because of rapidly evolving technologies with more and more use of color coded tasks in each sector including education sector and specific job requiring color differentiation, the efforts should be made at a fundamental level in screening of color vision defects during comprehensive school eye health programs. Since CVD is congenital and there is no permanent cure for it. However, advice at an early age could help to find adaptive strategies, which enable them to avoid disappointments in the choice of their future career. Parental education, awareness, genetic counseling strategies in the regions with high CVD incidence could help a lot in minimizing the occurrence of the disorder among their offspring.

Clinical relevance Early screening is essential to counsel schoolchildren with congenital colour vision deficiency (CVD) in determining their future career path and to advise teachers of the impact of CVD on classroom difficulties. Background Congenital CVD is an X‐linked genetic abnormality relatively commonplace in humans. This study aimed to determine the prevalence of congenital CVD in the Republic of Ireland schoolchildren and associated socio‐demographic factors. Methods A total of 1,626 schoolchildren (882 boys and 744 girls), in two age groups (728 aged 6–7-years and 898 aged 12–13-years) were examined from randomly selected schools. Colour vision testing was carried out using the Richmond Hardy‐Rand‐Rittler pseudoisochromatic test for colour vision (fourth edition); diagnostic plates were used to determine CVD type and extent if participants failed to identify symbols on the screening plates. Results CVD was detected in 73 boys (8.3 per cent, 95% confidence interval (CI) 6.6–10.3) and in 13 girls (1.8 per cent, 95% CI 1.0–3.1, p < 0.001). As expected, deutan (boys 4.8 per cent, girls 0.8 per cent) was the most common type of CVD, followed by protan (boys 1.7 per cent, girls 0.1 per cent), unclassified red/green CVD (boys 1.2 per cent, girls 0.8 per cent) and then tritan (boys 0.5 per cent). One case of achromatopsia was detected based on failure on all diagnostic plates. Traveller participants (boys 21.0 per cent, girls 8.6 per cent) had a higher CVD prevalence than their White non‐Traveller (boys 7.2 per cent, girls 1.0 per cent) and non‐White (boys 5.4 per cent, girls 1.1 per cent) counterparts (odds ratio 3.00, 95% CI 1.1–8.1, p = 0.006). In boys, CVD was also associated with twin birth (odds ratio 2.7, 95% CI 1.1–6.7, p = 0.03) and low birthweight (p = 0.04). Conclusion This investigation of CVD in the Republic of Ireland schoolchildren should alert clinicians to the association between CVD and Traveller ethnicity, twin birth and lower birthweight. The prevalence of CVD found was similar to previous studies involving predominantly White populations and higher among Traveller participants; hence, counselling regarding inherited anomalies in the Traveller community is recommended. Early screening is essential to counsel schoolchildren with CVD in determining their future career path and to advise teachers of the impact of CVD on classroom difficulties.

Clinical Color Vision Testing and Correlation With Visual Function

To evaluate the thickness of the retinal nerve fiber layer (RNFL) in subjects with congenital red-green color vision deficiency (CVD). This study included 20 healthy subjects with congenital red-green CVD and 22 healthy subjects with normal color vision. After Ishihara test and examinations visual field by automated perimetry, all individuals underwent scanning laser polarimetry to measure the thickness of the RNFL. All scanning laser polarimetry parameters related to RNFL thickness were found to be similar in subjects with congenital CVD and normal color vision (p>0.05). This is the first report suggesting normal thickness of the RNFL in subjects with congenital red-green CVD.

Recent advancements in molecular biology have revealed genetic aspects of congenital color vision deficiencies (CVD). In many cases of CVD, the genotypes and phenotypes coincide with each other. But it is also known that there are cases in which the genotype alone cannot explain the clinical diagnosis of CVD. So it is still unclear whether routine gene analysis is useful as a clinical diagnostic tool for this anomaly. We evaluated the clinical usefulness of genetic analysis for congenital red-green color-vision deficiencies. The nucleotide sequences of red-green pigment genes of 62 CVD cases and 113 color-normal males were determined using PCR and a DNA sequencer (ABI PRISM 310 Genetic Analyzer). The CVD cases were diagnosed using clinical color-vision tests including an anomaloscope. The color-normal subjects were tested with Ishihara plates and, if needed, with an anomaloscope. All normals had two types of exon 5, i.e., both red and green pigment genes. Forty-seven (76%) of 62 CVD cases had genotypes that coincided with their phenotypes. Three dichromats (one protanope and two deuteranopes) had genetic potential to be anomalous trichromats. Twelve deutans (one deuteranope and 11 deuteranomals) could not be differentiated from the normals: they had both red and green types of genes, as did the normals. All in all, 15 cases (24%) had some inconsistencies between the phenotype and the genotype. Pigment gene analysis alone could not fully differentiate CVD from normals. © 2000 John Wiley & Sons, Inc. Col Res Appl, 26, S89–S92, 2001

Objectives:This study was designed to evaluate the thickness of the central macula, the retinal nerve fiber layer (RNFL), and the ganglion cell complex (GCC) in individuals with congenital red-green color vision deficiency (CVD) using spectral-domain optical coherence tomography (SD-OCT).Methods:This study included 22 males with a red-green CVD (Group 1) and 22 males with normal color vision (Group 2). The Ishihara test was used to determine CVD. SD-OCT was used to evaluate the central macula, RNFL, and GCC measurements of all of the study participants. The quantitative data of the 2 groups were compared. The Kruskal-Wallis test was used for the statistical analysis and a p value <0.05 was considered significant.Results:The mean central macula thickness observed in Group 1 and 2 was 255.00±25.50 µm and 248.95±24.70 µm, respectively. The mean RNFL thickness of Group 1 and 2 was 110.66±14.70 µm and 109.49±9.90 µm, respectively, and the mean GCC thickness of Group 1 and 2 was 97.70±10.80 µm and 97.56±5.10 µm, respectively. There were no significant differences between the groups in the assessment of the central macula, RNFL, or GCC thickness (p=0.20, p=0.34, p=0.37).Conclusion:The results of this study suggested that congenital red-green CVD does not affect the thickness of the central macula, RNFL, or GCC. To the best of our knowledge, this is the first study to evaluate the thickness of the GCC in individuals with congenital red-green CVD.

One hundred and thirty teachers were studied to evaluate their knowledge of congenital Color Vision Deficiency (CVD), and their ability to perform the Ishihara color vision test, so as to determine if they can provide color vision screening services for their pupils. The teachers were randomly selected from 13 schools in Port Harcourt City (PHC) and given a six hours training workshop on vision disorders in children and congenital color vision screening. They were given a self administered pre and post test questionnaires before and after training respectively. Subsequently, they screened 1,300 of their school pupils for congenital vision deficiency using the Ishihara color vision chart; and their results compared to that of the research team. Female teachers constituted 84.6% and males 15.4% of the study population. Seventy three teachers (53.8%) were from public schools while 46.2% were from private schools. Prior to the training workshop, only 6.2% of teachers had heard of the Ishihara color vision chart and none of the teachers could identify or knew how to use the chart. However with training there was significant improvement in knowledge of CVD. Comparison of the teachers' performance of color vision screening using the Ishihara chart to that of the research team showed a sensitivity of 67.6% with a specificity of 99.1%. The prevalence of congenital color vision deficiency in the 1,300 primary school screened was 2.6%, with males having a significantly higher prevalence than females. The study thus concludes that congenital color vision deficiency is prevalent amongst primary school children in Port Harcourt City, and with training, teachers can effectively perform color vision screening, and as such modify their teaching methods to accommodate the child with color vision deficiency.

A remarkable, and often underappreciated, property of the human visual system is its ability to perceive and distinguish colour. This occurs through a myriad of physiological and neurological processes with disruptions anywhere along the visual pathway having the potential to affect colour perception. This ability to perceive and process colour coded information, and human colour vision more generally, are valuable components of vision which, in addition to encoding information about our environment, provide clinicians with insights into the functioning of the retina and neural visual pathways. In clinics, monitoring occurs through tests that assess the ability to see, distinguish, and make use of colour.The primary purpose of colour vision assessment often varies in hospital clinics compared to community practice. In a hospital setting, the colour vision deficiencies of primary interest will be acquired in nature. The detection, classification, quantification, and measurement of such deficiencies can enable early‐stage detection of retinal disease and an additional measure for monitoring progressive conditions.Within community practice, the primary interest often will be congenital colour vision deficiency. Congenital defects are present in ~8% of males and ~0.5% of females and affect education and occupational suitability. The early detection of such deficiencies is important to identify any potential colour vision deficiency that may impact a child's education, or an adult's occupational suitability. Ensuring children are not educationally disadvantaged due to an inherited colour vision deficiency, whilst also ensuring that individuals employed in occupational roles that require a certain level of chromatic sensitivity are able to do so safely is hugely important and a key role of optometric practitioners working in the community.Although most colour vision deficiencies encountered in community practices will be congenital, patients will also be encountered with acquired defects from ocular or neurological pathologies. In these cases, colour vision testing may play a key role in diagnosis of pathology.There is a discrepancy between the quality of tools available in specialist centres and community and hospital clinics. Many of the insights gleamed from work carried out in specialised colour assessment clinics are currently not fully utilised within community practice. During this session we will review the main clinical colour vision tests, highlighting the differences between the tests that are most useful for diagnosing congenital and acquired defects.This presentation will provide a timely refresher on colour vision testing, its importance, and, critically, the limitations present in several colour vision tests in current use. This presentation is likely to be of interest to those who regularly assess colour vision, and even more important for those who do not often use colour vision tests and who may therefore benefit from adopting this additional clinical tool.

To assess the effect of type and severity of congenital color vision deficiency (CCVD) on depth perception. Thirty-one male patients with a known diagnosis of CCVD were included in the study group and 31 age-matched healthy subjects in the control group. After standard ophthalmological examination including best corrected visual acuity (BCVA) testing with Snellen chart, slit-lamp examination, non-contact tonometry, and fundus examination, all patients underwent color perception testing with Hardy-Rand-Rittler (HRR) 4th edition pseudoisochromatic test plates and stereoacuity testing with Titmus stereo test plates. Of the 31 patients with CCVD, 7 were protanope and 24 were deuteranope. Mean stereoacuity was 46.77 ± 11.3, 105.7 ± 69.0, and 134.1 ± 115.2 in the control, protanope, and deuteranope groups, respectively. Stereoacuity was significantly better in the control group than in the protanope and deuteranope groups (p = 0.039, p < 0.001 respectively). No significant difference was observed between protanopes and deuteranopes regarding stereoacuity (p = 0.73). Mean BCVA was -0.01 ± 0.03, -0.02 ± 0.07, and -0.10 ± 0.11 in the control, protanope, and deuteranope groups, respectively. Mean BCVA in deuteranopes was significantly better than the control group (p = 0.004), while mean BCVA in deuteranopes and protanopes did not differ significantly (p = 0.056). No significant difference was observed between the control group and protanopes regarding visual acuity (p = 0.921). Our study showed that color vision had an important effect on depth perception and CCVD may cause decreased stereoacuity.

Color vision research is not new for the Federal Aviation Administration (FAA); the Civil Aerospace Medical Institute has been conducting color vision research and publishing the results since 1967 ( 3 ). The FAA originally initiated color vision research because of the emerging use of color coding in the airport environment and the FAA has continued a line of color vision research because of the increasing use of color coding resulting from changing technology inside the cockpit, on air traffic control displays, and in the airport environment. Color can be used to convey meaning without supplemental signage such as the ubiquitous traffic signal that alerts drivers to proceed with caution via a yellow flashing light or to stop via a red flashing light. However, that meaning is only conveyed if the driver can distinguish between the yellow and the red colors. Approximately 8 to 10% of the male population ( 5 ) has a congenital color vision deficiency and, depending upon the type and severity of that deficiency, that task of interpreting the meaning of color coding may be difficult or impossible. Consequently, the FAA has long maintained a color vision standard for aero-medical screening to ensure that pilots and air traffic controllers can perform safety-related tasks without adverse consequences. Throughout the past few years, the FAA has explored a variety of color vision tests, searching for a valid screening test that has high sensitivity and specificity, meaning the ability to detect the presence or absence of the deficiency, respectively. Basically, color vision tests can be categorized as diagnostic, screening, or occupational tests. Diagnostic tests are designed to specifically diagnose the type and degree of deficiency, the screening tests focus on differentiating between normal or deficient color vision, and the occupational tests seek to separate those capable versus incapable of certain tasks such as identifying colors of wires or lights (e.g., the Farnsworth Lantern test that was developed to assess the ability of potential Navy signalmen for identifying red, green, and white lights). A few tests have been developed for the purpose of precisely diagnosing and classifying color vision; however, when color vision test scores are compared to performance on occupational tasks such as identifying or discriminating colors used in signal lights, precision approach path indicator (PAPI) lights, colored navigation lights, color coded map reading tasks, color coded air traffic control displays, and cockpit displays, a specific cut-point on those selection tests has not been found that can fully separate those who can from those who cannot accurately perform the color-coded pilot or air traffic control tasks. Some tests, including new computerized instruments, have been designed to differentiate defects involving the long wavelength sensitive cones (protan-type), middle wavelength sensitive cones (deutan-type), and short wavelength sensitive cones (tritan-type). Congenital protan and deutan deficiencies are, collectively, extremely common, affecting 1 in 12 men and 1 in 230 women; however, recent evidence indicates that tritan defects are virtually never present at birth (e.g., congenital) and the inherited forms involve S cone photoreceptor degeneration that develops later in life with the exact onset depending upon the specific mutation ( 1, 4 ). Thus, the exact frequency of inherited tritan defects is uncertain; however, it is probably less than 1 in 500. In part, because the underlying pathophysiology has not been well understood, few tests have been available that are capable of detecting tritan deficiencies. In the past, those tests included the single Farnsworth F2 pseudoisochromatic plate (PIP), the Moreland anomaloscope, the Hardy, Rand, Rittler PIP test, and, most recently, the Oculus anomaloscope. Consequently, the occupational color vision tests used by most agencies only screen for the most common (protan and deutan) types of defects. The newly developed computerized color vision tests, including the Colour Assessment and Diagnostic Test, the Cambridge Colour Test, the Cone Contrast Test, and the Computerized Color Vision Test, are all designed to detect tritan defects. However, tritan weaknesses have been noted in several of the FAA ‘ s recent studies in much higher than the traditionally expected numbers and diagnostic agreement is low among those tests when tritan deficiencies are involved. In the past, the FAA and other regulatory organizations have not, or have rarely, required tritan color vision screening in their occupational screening because of the following three factors: the rarity of the congenital defect, the unknown number of individuals affected by acquired deficiencies, and the lack of effective, reliable, valid, and affordable equipment with which to diagnose the deficiency.

This review analyses the literature on screening for congenital colour vision deficiency in school students, which predominantly uses the Ishihara test. The review was framed with respect to the established Wilson and Jungner criteria for screening programs. These criteria relate to the characteristics of the condition concerned, the performance of the screening test, the existence of treatment options and the performance of screening programs.The literature reviewed suggests that congenital colour vision deficiency has not been shown to increase risk of road traffic crashes and is not a preclusion to driver licensing in most developed countries. The occurrence of congenital colour vision deficiency has been used to limit entry into certain occupations; however, the value of screening school students with regard to occupational preclusion is questionable. Stronger evidence exists indicating no association between congenital colour vision deficiency and level of educational achievement. Studies showing any association between congenital colour vision deficiency and other health and lifestyle impacts were rare. The most commonly used screening test (using Ishihara pseudoisochromatic plates) performs well with respect to detecting red‐green colour vision deficiencies. Finally, the only interventions we identified for congenital colour vision deficiency were management ones around the availability of specific tinted lenses and computer programs to aid colour perception in certain tasks.Given this picture, the weight of evidence appears to be in favour of not adopting (or discontinuing) routine colour vision screening programs for school students; however, it may be worthwhile for a career advisor to refer school students to an optometrist or ophthalmologist for colour vision screening, upon expression of interest in an occupation where normal colour vision is either particularly desirable or is a regulatory requirement.

Color vision tests use estimative of threshold color discrimination or number of correct responses to evaluate performance in chromatic discrimination tasks. Both approaches have advantages and disadvantages. In the present investigation, we compared the number of errors during color discrimination task in normal trichromats and participants with color vision deficiency (CVD) using pseudoisochromatic stimuli at fixed saturation levels. We recruited 28 normal trichromats and eight participants with CVD. Cambridge Color Test was used to categorize their color vision phenotype, and those with a phenotype suggestive of color vision deficiency had their L- and M-opsin genes genotyped. Pseudoisochromatic stimuli were shown with target chromaticity in 20 vectors radiating from the background chromaticity and saturation of 0.06, 0.04, 0.03, 0.02, 0.01, and 0.005 u’v' units. Each stimulus condition appeared in four trials. The number of errors for each stimulus condition was considered an indicator of the participant's performance. At high chromatic saturation, there were fewer errors from both phenotypes. The errors of the normal trichromats had no systematic variation for high saturated stimuli, but below 0.02 u’v' units, there was a discrete prevalence of tritan errors. For participants with CVD, the errors happened mainly in red-green chromatic vectors. A three-way ANOVA showed that all factors (color vision phenotype, stimulus saturation, and chromatic vector) had statistically significant effects on the number of errors and that stimulus saturation was the most important main effect. ROC analysis indicated that the performance of the fixed saturation levels to identify CVD was better between 0.02 and 0.06 u’v’ units reaching 100%, while saturation of 0.01 and 0.005 u’v’ units decreased the accuracy of the screening of the test. We concluded that the color discrimination task using high saturated stimuli separated normal trichromats and participants with red-green color vision deficiencies with high performance, which can be considered a promising method for new color vision tests based in frequency of errors.

Background: Congenital colour vision deficiency (CCVD) is an untreatable disorder which has lifelong consequences. Increasing use of colours in schools has raised concern for pupils with CCVD. This case-control study was conducted to compare behavioural and emotional issues among age, gender and class-matched pupils with CCVD and normal colour vision (NCV).Methods: A total of 1732 pupils from 10 primary schools in the Federal Territory of Kuala Lumpur were screened, of which 46 pupils (45 males and 1 female) had CCVD. Mothers of male pupils with CCVD (n=44) and NCV (n=44) who gave consent were recruited to complete a self-administered parent report form, Child Behaviour Checklist for Ages 4-18 (CBCL/ 4-18) used to access behavioural and emotional problems. The CBCL/ 4-18 has three broad groupings: Internalising, Externalising and Total Behaviour Problems. Internalising Problems combines the Withdrawn, Somatic Complaints and Anxiety/ Depression sub constructs, while Externalising Problems combines the Delinquent and Aggressive Behaviour sub constructs.Results: Results from CBCL/ 4-18 showed that all pupils from both groups had scores within the normal range for all constructs. However, results from the statistical analysis for comparison, Mann-Whitney U test, showed that pupils with CCVD scored significantly higher for Externalising Problems (U=697.50, p=0.02) and Total Behaviour Problems (U=647.00, p= 0.01). Significantly higher scores were observed in Withdrawn (U=714.00, p=0.02), Thought Problems (U=438.50, p<0.001) and Aggressive Behaviour (U=738.00, p=0.04). Odds ratios, 95% CI, showed significant relative risk for high Total Behaviour Problem (OR:2.39 ,CI:1.0-5.7), Externalising Problems (OR:2.32, CI:1.0-5.5), Withdrawn (OR:2.67, CI:1.1-6.5), Thought Problems (OR:9.64, CI:3.6-26.1) and Aggressive Behaviour (OR:10.26, CI:3.4-31.0) scores among pupils with CCVD.Conclusion: Higher scores among CCVD pupils indicates that they present more behavioural and emotional problems compared to NCV pupils. Therefore, school vision screenings in Malaysia should also include colour vision to assist in the early clinical management of CCVD children.

Background: Congenital colour vision deficiency (CCVD) is an untreatable disorder which has lifelong consequences. Increasing use of colours in schools has raised concern for pupils with CCVD. This case-control study was conducted to compare behavioural and emotional issues among age, gender and class-matched pupils with CCVD and normal colour vision (NCV). Methods: A total of 1732 pupils from 10 primary schools in the Federal Territory of Kuala Lumpur were screened, of which 46 pupils (45 males and 1 female) had CCVD. Mothers of male pupils with CCVD (n=44) and NCV (n=44) who gave consent were recruited to complete a self-administered parent report form, Child Behaviour Checklist for Ages 4-18 (CBCL/ 4-18) used to access behavioural and emotional problems. The CBCL/ 4-18 has three broad groupings: Internalising, Externalising and Total Behaviour Problems. Internalising Problems combines the Withdrawn, Somatic Complaints and Anxiety/ Depression sub constructs, while Externalising Problems combines the Delinquent and Aggressive Behaviour sub constructs. Results: Results from CBCL/ 4-18 showed that all pupils from both groups had scores within the normal range for all constructs. However, results from the statistical analysis for comparison, Mann-Whitney U test, showed that pupils with CCVD scored significantly higher for Externalising Problems (U=697.50, p=0.02) and Total Behaviour Problems (U=647.00, p= 0.01). Significantly higher scores were observed in Withdrawn (U=714.00, p=0.02), Thought Problems (U=438.50, p<0.001) and Aggressive Behaviour (U=738.00, p=0.04). Odds ratios, 95% CI, showed significant relative risk for high Total Behaviour Problem (OR:2.39 ,CI:1.0-5.7), Externalising Problems (OR:2.32, CI:1.0-5.5), Withdrawn (OR:2.67, CI:1.1-6.5), Thought Problems (OR:9.64, CI:3.6-26.1) and Aggressive Behaviour (OR:10.26, CI:3.4-31.0) scores among pupils with CCVD. Conclusion: Higher scores among CCVD pupils indicates that they present more behavioural and emotional problems compared to NCV pupils. Therefore, school vision screenings in Malaysia should also include colour vision to assist in the early clinical management of CCVD children.