Colour Assessment And Diagnosis Research Articles

The value of assessing progressive loss of red/green and yellow/blue chromatic sensitivity in glaucoma

*Correspondence: franziska.rauscher@medizin.uni-leipzig.deThe value of assessing progressive loss of red/green and yellow/blue chromatic sensitivity in glaucoma.The study employed visual stimuli designed to isolate and reveal how spatial, temporal and chromatic aspects of visual processing change from normal sensitivity to extreme loss in glaucoma. The experiments carried out examined the fovea and each of four paracentral retinal regions, arranged diagonally away from fixation at an eccentricity of 6°. Spatial vision was investigated by measuring both absolute detection thresholds and functional contrast sensitivity using Landolt ring stimuli (Ophthalmic Physiol Opt 2022;42:1363–1378). These psychophysical tests based on Landolt C optotypes measure both detection thresholds and gap orientation discrimination thresholds in the same experiments using randomly interleaved test locations. First‐order motion perception was examined by using moving stimuli embedded in static luminance contrast noise. Red/green (RG) and yellow/blue (YB) colour thresholds were measured with the Colour Assessment and Diagnosis (CAD) test, which makes use of random, dynamic luminance contrast noise (±45%) to isolate the use of RG and YB colour signals. Subjects were normal controls (n = 65) and glaucoma patients with binocular visual field defects (n = 15) classified based on their Humphrey Field Analyser mean deviation (MD) scores. The impairment of visual function varied depending on the stimulus attribute and location tested. The severity of loss increased monotonically with disease progression. For subjects with mild glaucoma (MD −0.01 to −6.00 dB), significantly more data points exceeded the upper normal threshold limits for the corresponding age for RG colour thresholds than for any other visual test (Br Med Bull 2017;122:51–77), followed by motion thresholds. This was particularly the case for the parafoveal locations when compared with the equivalent thresholds measured at the fovea. The results suggest that a multifaceted measure of binocular visual performance based on foveal and parafoveal tests of RG colour vision and first‐order motion, can best inform on the progression of glaucoma and the overall loss of visual performance for comparison with other measures of changes in the quality of life in patients with glaucoma.Keywords: Glaucoma, Visual function, Colour vision, Motion detection, Contrast, Acuity, Colour Assessment and Diagnosis, CAD.

Development and validation of a new colour vision screener: A multi‐centre study

Aims/Purpose: The detection of acquired and congenital colour vision deficiency is of importance in the clinic for the early detection of ocular disease and determination of occupational suitability. Conventional methods of colour vision screening often fail to pass all normals and/or correctly identify those with acquired and congenital colour vision deficiency. The Colour Vision Screener (CVS) test [1] was developed to utilize an improved understanding of colour vision mechanisms to overcome the limitations present in conventional colour screening methods. This study aimed to use a robust multi‐centre methodology to fully validate the CVS test.Methods: Over 400 participants, including 124 normal trichromats, 166 deutans and 62 protans, were recruited from 10 international Colour Assessment and Diagnosis (CAD) testing centres. Each participant completed the CVS and the CAD test with calibrated visual displays. The red/green (RG) and yellow/blue (YB) CVS test sensitivity and specificity were established. The RG statistics were compared to the ‘gold standard’ reference for screening for RG congenital colour vision deficiency—the Ishihara pseudoisochromatic plate test.Results: The CVS test correctly identified ~99.1% of normal trichromats. All subjects with congenital RG loss and acquired loss on top of congenital RG deficiency were identified as having abnormal colour vision by the CVS. The Ishihara test, based upon 0 errors on the first 25 plates of the 38‐plate edition, correctly identifies ~80.6% of normal trichromats and 99.5% of subjects with congenital RG loss.Conclusions: Data collected across 10 international CAD centres demonstrate that the CVS can achieve a high sensitivity without sacrificing specificity. This multi‐centre study demonstrates that the CVS is quick, efficient, and easy to use and allows for the rapid and reliable screening of congenital and acquired colour vision deficiencies in large populations.Reference1. Barbur JL, Rodriguez‐Carmona M, Evans BEW. Colour vision assessment‐3. An efficient, two‐step, colour assessment protocol. Colour Research & Application 2021; 46: 33–45. https://doi.org/10.1002/col.22599

The use of colour and rapid flicker sensitivity tests for early detection and monitoring of vision changes in diabetes

Aims/Purpose: There is increasing evidence of impaired visual function prior to the presence of diabetic retinopathy (DR), yet current diagnostic criteria and treatment onset rely mostly on retinal vascular changes. In this study we measured changes in chromatic and rapid flicker sensitivity in subjects with prediabetes and diabetes to establish the value of such tests as a potential biomarker in the detecting early diabetes.Methods: Three groups of subjects were recruited: 1) normal controls, 2) subjects with prediabetes (HbA1c between 42‐47 mmol/mol), and 3) diabetics (with or without DR). Monocular cone‐ and rod‐enhanced flicker modulation thresholds (FMTs) were measured at the point of regard and in four parafoveal (5°) locations using the Flicker‐Plus test. Monocular red/green (RG) and yellow/blue (YB) colour thresholds were also measured at the fovea using the Colour Assessment and Diagnosis (CAD) test.Results: Both the RG and YB thresholds, as well as rod‐ and cone‐mediated flicker thresholds were significantly higher in both diabetic and prediabetic groups (when compared with healthy controls). When examined individually, ~50% and ~ 63% of the prediabetics and ~ 58% and ~ 70% of the diabetics revealed abnormal RG and YB thresholds, respectively (when compared with the upper normal limits for the corresponding age). HBA1c levels also revealed a positive trend with increasing RG and YB thresholds in the prediabetic group.Conclusions: In agreement with previous findings, both colour and FMTs are affected in patients diagnosed with diabetes. Unexpectedly, those deemed prediabetic that do not meet the clinical criteria for diabetes exhibit considerable loss of both colour and flicker sensitivity. The results suggest that colour and rapid flicker tests can provide useful information when screening for diabetes.

Association between chromatic sensitivity and peripapillary retinal nerve fibre layer thickness in healthy eyes

Purpose: Knowledge of the retinal structure—chromatic sensitivity relationship of healthy eyes would be important for early detection of retinal neuropathies such as glaucoma. This study investigated the association between colour vision thresholds and the thicknesses of the retina in healthy young eyes.Methods: Measurements were made in 56 healthy eyes of 56 young subjects of mean age 25 ± 2.4 years (range 20–31 years), and distance visual acuity ≤0.1 logMAR. Chromatic sensitivity was measured using the Color Assessment and Diagnosis (CAD) test. The macular thicknesses of the central fovea, parafovea, and macular ganglion cell complex (mGCC), and the thickness of the peripapillary retinal nerve fibre layer (pRNFL) were measured by spectral‐domain optical coherence tomography (SD‐OCT). Relationships between red‐green (RG) and yellow‐blue (YB) thresholds and the retinal thicknesses were examined through Spearman correlation.Results: Significant correlations were detected between pRNFL thickness, in the inferior hemisphere, and the RG and YB‐thresholds (r = −0.30, p = 0.03 and r = −0.31, p = 0.02; respectively). Decreased pRNFL thickness correlated with worse colour thresholds. No significant correlations were found between macular thicknesses and colour thresholds.Conclusions: Greater inferior pRNFL thickness was related to better chromatic sensitivity in healthy eyes of young subjects.

Color Vision in Blue Cone Monochromacy: Outcome Measures for a Clinical Trial.

Blue cone monochromacy (BCM) is an X-linked retinopathy due to mutations in the OPN1LW/OPN1MW gene cluster. Symptoms include reduced visual acuity and disturbed color vision. We studied BCM color vision to determine outcome measures for future clinical trials. Patients with BCM and normal-vision participants were examined with Farnsworth-Munsell (FM) arrangement tests and the Color Assessment and Diagnosis (CAD) test. A retrospective case series in 36 patients with BCM (ages 6-70) was performed with the FM D-15 test. A subset of six patients also had Roth-28 Hue and CAD tests. All patients with BCM had abnormal results for D-15, Roth-28, and CAD tests. With D-15, there was protan-deutan confusion and no bimodal tendency. Roth-28 results reinforced that finding. There was symmetry in color vision metrics between the two eyes and coherence between sessions with the arrangement tests and CAD. Severe abnormalities in red-green sensitivity with CAD were expected. Unexpected were different levels of yellow-blue results with two patterns of abnormal thresholds: moderate elevation in two younger patients and severe elevation in four patients ≥35 years. Coefficients of repeatability and intersession means were tabulated for all test modalities. Given understanding of advantages, disadvantages, and complexities of interpretation of results, both an arrangement test and CAD should be useful monitors of color vision through a clinical trial in BCM. Our pilot studies in BCM of arrangement and CAD tests indicated both were clinically feasible and interpretable in the context of this cone gene disease.

Colour‐related, binocular interactions in patients with dyschromatopsia

AbstractWe report findings of monocular and binocular assessments of colour vision and thresholds for rod‐ and cone‐mediated sensitivity in two young patients (P1 and P2) diagnosed with monocular dyschromatopsia. Altered, monocular, colour perception with no clear diagnosis was reported in each patient based on results from a number of clinical visual assessment tests carried out over several years. Electrodiagnostic tests also revealed reduced Yellow / Blue (YB) chromatic sensitivity in P1. Both patients exhibited unexpected binocular interactions of colour signals. This abstract focuses mostly on the results obtained in P1, but similar results using the same visual assessment tests will also be presented for P2.P1 experienced visual discomfort, often manifested as differences between monocular and binocular viewing, noise‐like appearance of uniform fields and colours over the field, when viewed monocularly with either eye. As a result of these reports, we re‐examined P1's visual deficits using the Colour Assessment and Diagnosis (CAD) and the Flicker‐Plus (FP) tests (http://www.city-occupational.co.uk/). The FP test measures rod‐ and cone‐mediated rapid flicker sensitivity centrally (along the direction of gaze) and at 6 deg eccentricity in each of the four quadrants.Colour Vision. P1 shows significant loss of YB colour vision when tested monocularly in the right eye, but normal red‐green (RG) and YB colour vision in the left eye. When tested binocularly, P1 continues to show the same loss of YB colour vision observed when using only the right eye. These results were unexpected since P1 shows ‘normal’ binocular summation for both colour and flicker sensitivity, even when the thresholds are above the normal range.Rod‐ / Cone‐sensitivity. The patient's cone‐mediated, flicker sensitivity at all five locations investigated (under binocular viewing) was normal (with flicker detection thresholds, often under 2%), but only for the cone‐enhanced condition. When tested with rod‐enhanced stimuli, P1 shows much reduced sensitivity with larger thresholds in the periphery, but only in binocular viewing. Such responses have not been observed previously.In conclusion, P1 shows loss of YB colour vision in the right eye and also significant loss of rod‐mediated sensitivity at each of the five locations investigated. The patient's cone mediated thresholds, at every location tested, were consistently below the mean expected for normal trichromats, both binocularly and with each eye. The YB colour vision measured binocularly remained severely abnormal with thresholds similar to the right eye, in spite of normal colour vision in the left eye. Preliminary observations also suggest that the patient's colour and rapid flicker sensitivity can be affected by fatigue and other factors.Although patient, P2, varied significantly to P1 in monocular thresholds, a similar binocular, inhibitory interaction between the two eyes was observed when processing colour signals. These observations and the unusual interactions between signals derived from the two eyes point towards abnormal central processing of colour signals.

Cerebral achromatopsia

AbstractChromatic sensitivity was assessed in patients with pregeniculate and postgeniculate lesions. We examine changes in central vision along at foveal fixation and in each of the four paracentral quadrants of the visual field using the Colour Assessment and Diagnosis (CAD) test, a dynamic luminance contrast masking technique that isolates the use of Red / Green (RG) and Yellow / Blue (YB) colour signals. Because the extraction of colour signals in early visual processing involves opponent mechanisms, subjects with congenital RG loss of sensitivity exhibit symmetric increase in thresholds towards the long wavelength (“red”) and middle wavelength (“green”) regions of the spectrum locus. This is also frequently the case with acquired loss of chromatic sensitivity as a result of retinal or optic nerve disease. The findings from this study represent an exception to this rule. The patients investigated showed a marked asymmetry in colour thresholds. The study reveals how discrete, localized damage to visual pathways can cause selective loss of visual function and how the latter varies with retinal topography.The 36 pregeniculate patients investigated exhibited impairment in both RG and YB. Loss of colour vision was symmetrical for both RG and YB discrimination. Some pregeniculate patients exhibited substantial loss of colour vision in areas where perimetric loss was largely absent. All quadrants revealed similar symmetric loss of colour sensitivity.In 23 patients with postgeniculate lesions, patients with pre‐striate damage exhibited symmetric loss of chromatic sensitivity which affected either one or both chromatic mechanisms. Striate or extra‐striate lesions tended to exhibit general loss of colour vision within the area identified by visual field testing. More specific chromatic loss was associated with less impaired areas that were often normal on perimetric testing. Some patients with striate or extra‐striate lesions presented with asymmetric chromatic loss for one or more colour categories. When striate or extra‐striate lesions were also accompanied by underlying pre‐striate damage, chromatic sensitivity loss was always symmetric.The findings from this study show that the loss of chromatic sensitivity in cerebral achromatopsia depends strongly on the exact location and extent of the lesion with significant variation over the visual field. The same subject can exhibit loss of chromatic sensitivity that is either RG or YB specific, but also, spatially localized, non‐opponent loss of sensitivity for primary colours.

Changes in visual function associated with hydroxychloroquine retinal toxicity

AbstractIntroduction: Non‐infectious inflammatory diseases, such as systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, antiphospholipid antibody syndrome and others cause significant morbidity and are treated with immunosuppression. Hydroxychloroquine (HCQ) sulfate is used as a second line immunosuppressant and has many advantages over other agents. These include increased life expectancy, reduced risk of neoplasia, reduced risk of diabetes and hypercholesterolaemia. HCQ is safe in pregnancy. After more than 5 years of treatment, HCQ can cause a degenerative maculopathy characterized by loss of parafoveal photoreceptors and RPE cells, leading to a ring‐like visual field defect. Current detection of early retinal toxicity relies on central visual field testing, optical coherence tomography (OCT) scan and fundus autofluorescence. The reason for the parafoveal predilection for retinopathy is not understood. HCQ is concentrated in melanin‐containing cells, and there is increased melanin concentration in the macular RPE cells. A hypothesis is that HCQ concentrated in the macular RPE cells leads to toxicity, with macular pigment protecting the fovea but leaving a ring of potentially vulnerable tissue in the parafoveal region. We were interested to investigate parafoveal function in patients with mild HCQ maculopathy and report the results of detailed macular function assessment of red/green (RG) and yellow / blue (YB) colour vision and rod‐ and cone‐mediated rapid flicker sensitivity.Methods: Two patients with confirmed early hydroxychloroquine maculopathy participated in the study. RG and YB colour thresholds were measured with the Colour Assessment and Diagnosis (CAD) test. Cone and rod‐mediated rapid flicker sensitivity was also measured in both central and paracentral vision using the Flicker‐Plus test. Both patients had taken HCQ for more than 15 years and had paracentral scotomas on 10–2 field test and loss of the parafoveal outer nuclear layer and ellipsoid layer, confirming the presence of maculopathy. To test the hypothesis of parafoveal toxicity risk, 20 short wavelength (BAF) and infrared wavelength (IRAF) autofluorescence images were reviewed. The BAF images are surrogate markers of the macular pigment and the IRAF the melanin concentration. Normalized maps of the difference between BAF and IRAF were calculated to investigate the possibility of a ring of vulnerable tissue.Results: Both patients had normal RG, but abnormal YB colour thresholds. One subject had normal cone flicker thresholds, but the rod flicker thresholds were raised in all quadrants in both eyes. The second subject had significantly elevated rod thresholds and elevated cone flicker thresholds in both eyes. Of note is that the degree of retinopathy in the second patient was greater than in the first. The areas of greatest threshold elevation correlated with the areas of greatest field loss and anatomical disruption on OCT.Conclusion: These new findings show that hydroxychloroquine retinopathy affects preferentially both YB colour vision and rod‐mediated flicker sensitivity. The cone‐mediated flicker sensitivity is also affected in more advanced disease. A model for the anatomical location of the toxicity will be presented, based on the hypothesis outlined above.

Effects of color-enhancing glasses on color vision in congenital red-green color deficiencies.

As commercially available glasses for color vision deficiency (CVD) are classified as low risk, they are not subject to stringent marketing regulations. We investigate how EnChroma and VINO glasses affect performance on the Colour Assessment and Diagnosis (CAD) test in individuals with CVD. Data were obtained from 51 individuals with red-green CVD. Blood or saliva samples were collected to examine the structure of the OPN1LW/OPN1MW array. Individuals completed the CAD test twice without glasses and once with each pair of glasses. Although there was a statistically significant effect of both glasses, only that of VINO could be considered functionally meaningful.

Long-term effects of blue-blocking spectacle lenses on color perception.

The use of blue-blocking filters is increasing in spectacle lens users. Despite the low absorption in the blue range, some users complain about these filters because they affect their color perception. In a pilot study we have evaluated how the long-term use of 8 different blue-blocking filters impact the color perception during more than 2 weeks on a group of 18 normal color vision observers, compared with a control group of 10 observers. The evaluation was done using the FM100, the Color Assessment and Diagnosis (CAD) and an achromatic point measurement. Our results show that there is a trend to worsen with the filters on.

Color Vision Testing, Standards, and Visual Performance of the U.S. Military.

Color vision deficiency (CVD) is a disqualifying condition for military special duty occupations. Color vision testing and standards vary slightly among the U.S. military branches. Paper-based pseudoisochromatic plates (PIPs) remain a screening tool. Computer-based color vision tests (CVTs), i.e., the Cone Contrast Test (CCT), the Colour Assessment and Diagnosis (CAD) test, and the Waggoner Computerized Color Vision Test (WCCVT), are now replacing the Farnsworth Lantern Test (FALANT) and its variants to serve as a primary or secondary test in the U.S. Armed Forces. To maintain consistency in recruitment, performance, and safety, the study objectives were to examine military color vision testing, passing criteria, and color discrimination performance. Study participants were 191 (17% female) students, faculty, and staff of the U.S. Air Force Academy and the Naval Aerospace Medical Institute. All subjects performed six CVTs, and 141 participants completed two additional military relevant color discrimination tasks. Friedman non-parametric test and Wilcoxon signed-rank post hoc test with Bonferroni adjusted P values were used to compare CVTs and standards. Analysis of variance and Bonferroni adjusted post hoc test were used to describe effects on color discrimination performance. The Heidelberg Multicolor-Moreland and Rayleigh (HMC-MR) anomaloscope diagnosed 58 CVD (30.4%). There were no statistically significant differences in identifying red-green CVD by the HMC-MR, CCT, CAD, WCCVT, and PIP tests (P = .18), or classifying deutan, protan, and normal color vision (CVN) by the HMC-MR and the CVT (P = .25). Classification of tritan CVD was significantly different depending on which CVT was used (P < .001). Second, overall passing rates were 79.1% on the CAD (≤6 standard normal unit (SNU)), 78.5% on the combined PIP/FALANT, 78.0% on the CCT (≥55%), and 75.4% on the WCCVT (mild) military standards. The CVTs and the PIP/FALANT standards were not significantly different in number of personnel selected, but CAD and CCT passed significantly more individuals than WCCVT (P = .011 and P = .004, respectively). The previous U.S. Air Force standard (CCT score ≥75%) passed significantly fewer individuals relative the U.S. Navy pre-2017 PIP/FALANT or the current CVT standards (P ≤ .001). Furthermore, for those who failed the PIP (<12/14), the FALANT (9/9 or ≥16/18) agreed with the CVTs on passing the same CVN (n = 5); however, it also passed moderate-to-severe CVD who did not pass WCCVT (n = 6), CCT (n = 3), and CAD (n = 1). Lastly, moderate/severe CVD were significantly slower and less accurate than the "mild" CVD or CVN in the two color discrimination tasks (P < .001). In comparison to CVN in the in-cockpit display color discrimination task, mild CVD (CCT ≥55% and <75%) were significantly slower by 1,424 ± 290 milliseconds in reaction time (P < .001) while maintaining accuracy. CVTs are superior to paper-based PIP in diagnosing, classifying, and grading CVD. Relative to the PIP/FALANT standard in personnel selection, the current U.S. military CVT passing criteria offer comparable passing rates but are more accurate in selecting mild CVD. Nevertheless, military commanders should also consider specific operational requirements in selecting mild CVD for duty as reduced job performance may occur in a complex color critical environment.

Chromatic and flicker threshold changes in age-related macular degeneration following anti-VEGF treatment

ABSTRACT Clinical relevance Red-green chromatic sensitivity and photopic (cone-mediated) flicker sensitivity showed marked improvement after anti-VEGF treatment. The use of flicker and chromatic sensitivities as potential functional tests to monitor treatment outcomes in age-related macular degeneration highlights the clinical importance. Background High-contrast visual acuity (VA) is not a sensitive clinical marker in the management of age-related macular degeneration (AMD). Therefore, flicker and chromatic sensitivity changes were assessed following anti-VEGF treatment in subjects with neovascular AMD. Methods Subjects diagnosed with neovascular AMD were recruited. VA was measured using a COMPlog chart. Flicker (in central 5°) and chromatic thresholds (red-green and yellow-blue) were measured using Flicker-plus test and Colour Assessment and Diagnosis (CAD) tests, respectively. Baseline thresholds and foveal thickness were measured on the same day, just before anti-VEGF injection delivery and 5 weeks ± 5 days later. Results Thirteen subjects (8 males, 5 females) with a mean age of 67.5 ± 8.2 years completed the study. Median VA was not significantly different post-treatment (0.57 logMAR [~6/22: Snellen equivalent], IQR: 0.33) compared to baseline (0.56 logMAR, IQR: 0.33), Wilcoxon matched-pair test, p = 0.55). Median Red-Green thresholds improved significantly post-treatment (22.15 CAD units, IQR: 26.06, n = 9), compared to baseline (24.24 CAD units, IQR: 26.21, p = 0.02). Median photopic and mesopic FMT did not show significant change post treatment compared to baseline (p > 0.01, statistical significance of p-value corrected for multiple comparisons was set to 0.01). Similarly, the foveal thickness was not significantly different at post-treatment visit than baseline (p = 0.53). Conclusion Red/green sensitivity recovered better than yellow/blue sensitivity, thus, providing insight into recovery mechanisms in AMD and usefulness of these tests as clinical markers in the management of AMD.

This issue of ACTA, printed and electronic

This issue of ACTA, printed and electronic

Predicting the Farnsworth-Munsell D15 and Holmes-Wright-A lantern outcomes with computer-based color vision tests.

This study determined the AC1 agreement values between computer-based color vision tests and the Farnworth-Munsell D-15 (F-D15) and the Holmes-Wright Type A lantern (HWA). The computer-based tests were the United States Air Force Cone Contrast Test (OCCT), Cambridge Color Test, Innova Rabin Cone Contrast, Konan-Waggoner D15 (KWC-D15), and Color Assessment and Diagnosis (CAD). Sixty-eight color-vision-defective persons participated. The KWC-D15 had the highest AC1 with the F-D15 (${\rm AC1} = {0.88}$AC1=0.88). Both the CAD and OCCT had the highest values with the HWA (${\rm AC1} \gt {0.96}$AC1>0.96). The KWC-D15 would be the best substitute for the F-D15. Either the CAD or OCCT would be appropriate substitutes for the HWA.

Türk Çocuklarında Renkli Görme Bozukluklarının Sıklık ve Ağırlığının Değerlendirilmesi

Objective: To determine the prevalence of color vision deficiency, ratio of deutan/protan and the distribution of the severity of color vision deficiency among Turkish children and to evaluate the usability the Color Assessment and Diagnosis (CAD) test in children. Material and Methods: A total of 1374 children (627 girls and 747 boys) of age 6-16 years were included in this study. The first 15 plates of the Ishihara test were used to evaluate to screen for color deficiency. Those who made three or more errors had their color vision examined using the CAD test to determine the type and severity of color vision deficiency. The prevalence of color vision deficiency in boys and girls, ratio of deutan and protan deficieny and the distribution of the severity of loss were calculated. The correlations of the CAD test result and number of mistakes on the Ishihara test with age were also evaluated. Results: Thirty seven boys (4.95%) and 3 girls (0.47%) made 3 or more errors and were categorized as having color vision deficiency. In total, 32 subjects completed the CAD test, 22 subjects (68.7%) were classified as deutan and 10 (31.2%) as protan with the ratio of 2.2:1. In terms of the CAD based color vision grading system for red-green deficiency 3 subjects (9.3%) were classed as color vision (CV) category 3, 5 subjects (15.6%) as CV category 4 and 24 subjects (75%) as CV category 5. There was no significant correlation between the CAD test result and number of mistakes on the Ishihara test with age (r=-0.075, p=0.684 and r=-0.191, p=0.295 respectively). Conclusion: The results reveal severe loss of red-green color vision in 75% of the children with color vision deficiency. The study also demonstrates that the CAD test can be used in children as young as six years.

Analysis of current colour assessment protocols for the cabin crew

AbstractColour vision (CV) requirements for cabin crewmembers are set in accordance with the regulations of the European Aviation Safety Agency (EASA).They are required to identify correctly 9 of the first 15 plates of the Ishihara (IH)24‐plates.The aim of this study was to assess the severity of CV loss of applicants in relation to certification outcome based on the EASA cabin crew protocol. 126 applicants (78 deutans, 46 protans and 2 normal trichromats) were tested.The IH, CAD(Colour Assessment and Diagnosis) and anomaloscope were carried out to the specification required for Class I certification. 72% (56/78) of deutans passed the IH, but only 37% (17 /46) of protans passed.For all subjects 40% (51/126) passed both the IH and CAD.8% (7 protans and 3 deutans) of subjects failed IH and passed the CAD.19% (23 deutans and 1 protan) passed the IH and failed the CAD and 7 of these subjects had severe CV loss on the CAD and unusual anomaloscope results. The IH is used widely in aviation, and the number of errors is often used as a measure of the severity of CV loss. This study shows that the number of errors is not a good indicator of the applicant’s severity of CV loss. When the current EASA protocol for cabin crewmembers based on IH is applied, severe colour deficient subjects can pass and less severe subjects fail. A revision of the current colour assessment protocol for the cabin crew is needed to produce justifiable minimum CV requirements using colour assessment tests that are less variable.

Color Vision Tests in Pilots' Medical Assessments.

The aim of this study was to evaluate the ability of eight color vision tests to screen for and accurately measure hereditary color-deficiency in order to improve color vision assessment methods for aircraft pilots. This prospective study included 29 color-deficient subjects and 23 healthy subjects. All performed the following tests: Ishihara plates, Farnsworth D15, Lanthony desaturated 15 Hue, Munsell 100 Hue, Beyne and Fletcher-Evans CAM lanterns, Nagel anomaloscope, and the Color Assessment and Diagnosis (CAD) test. The sensitivity and specificity of color-deficiency diagnosis were evaluated for each test, as well as the test's relevance for assessing aircraft pilots. The Ishihara plate test demonstrated a sensitivity of 0.97 and a specificity of 1.00 for color-deficiency screening. The CAD test and anomaloscope showed both a sensitivity and specificity of 1.00. The Beyne lantern, Fletcher lantern, Farnsworth D15, and the Lanthony 15 Hue tests all showed a specificity of 1.00 and sensitivities of, respectively, 0.69, 0.97, 0.58, and 0.79. During aircraft pilot selection tests, the CAD test classified 10% of color-deficient subjects as safe to fly, the anomaloscope 17%, and the Beyne and Fletcher lantern tests, respectively, 31% and 3%. The discrepancy in results confirms that current color vision test protocols need to be reassessed. The CAD test could be an interesting alternative to the series of tests used to assess flight crew, but it seems more selective than current tests.Marechal M, Delbarre M, Tesson J, Lacambre C, Lefebvre H, Froussart-Maille F. Color vision tests in pilots' medical assessments. Aerosp Med Hum Perform. 2018; 89(8):737-743.

Detection of Early Loss of Color Vision in Age-Related Macular Degeneration - With Emphasis on Drusen and Reticular Pseudodrusen.

To evaluate chromatic sensitivity in patients with age-related macular degeneration (AMD) characterized by drusen and reticular pseudodrusen. To investigate whether the severity of color vision loss can distinguish between various stages of AMD and hence be used as an index of progression toward advanced AMD. Chromatic sensitivity was measured by using the Color Assessment and Diagnosis (CAD) test in asymptomatic individuals with early and intermediate AMD and compared to normative data. All study participants had logMAR visual acuity of 0.3 or better. The CAD thresholds measured in eyes with and without reticular pseudodrusen were also compared and related to central macular thickness (CMT). Student's t-test P values < 0.05 were considered significant. All early- and intermediate-AMD eyes (n = 90) had chromatic sensitivity loss in either RG (red/green) or YB (yellow/blue), or both (P < 0.0001) as compared to age-matched normal subjects. The eyes exhibited a range of CAD thresholds affecting both color mechanisms, but YB color thresholds were in general higher than RG thresholds (P < 0.001). Intermediate-AMD patients exhibited large intersubject variability. In general, eyes with reticular pseudodrusen and eyes with CMT < 200 μm had significantly higher CAD thresholds. The anatomic integrity of cone photoreceptors remains relatively unaffected in early and intermediate stages of AMD. The processing of cone signals in the retina can, however, be heavily disrupted with subsequent loss of both YB and RG chromatic sensitivity. The greatest losses were observed in eyes with reticular pseudodrusen.

Assisted Night Vision and Oxygenation State: ‘Steady Adapted Gaze’

Visual effects of hypoxia relevant to viewing through night vision devices (NVD), or beneath them at dim instrument panel (IP) information, include elevation of color discrimination and contrast acuity thresholds, whereas supplementary oxygen enhances sensitivity. This study examined the effects of respiratory disturbance on low contrast acuity and color sensitivity under steady state visual adaptation representative of NVD and IP viewing. Foveal low contrast acuity (with and without distractors) and color signal thresholds were estimated using versions of the Contrast Acuity Assessment (CAA) test (8) and Color Assessment and Diagnosis (CAD) test (2). NVD viewing was simulated using an isochromatic green background field at 1.0 and 3.0 cd x m-2 while IP adaptation employed an achromatic background at 1.0 and 0.1 cd x m(-2). Respiratory conditions were normoxia (breathing air), hyperoxia (100% oxygen), and hypoxia (13.7% oxygen, balance nitrogen). Breathing gas was a significant determinant of contrast acuity and color thresholds under all four viewing conditions. Contrast acuity thresholds were elevated consistently under hypoxia by up to 25% relative to breathing oxygen. Both red-green and S-cone color thresholds were elevated by -20-25% during NVD viewing and up to 50% during IP viewing at 0.1 cd x m(-2). Hypoxia degrades mesopic visual performance substantially during steady state IP viewing, but also compromises NVD viewing at low photopic luminance. Low contrast acuity and color sensitivity will be compromised upon arrival at 10,000 ft (3048 m) viewing through or beneath NVDs. Unexpectedly, visual distractors enhanced acuity at 0.1 cd x m(-2), with possible implications for mesopic visual displays.

Occupational color vision standards: new prospects

Occupational color vision standards in transport have been implemented for 100 years. A review of these standards has taken place early this century prompted by antidiscrimination laws in the workplace and several transport accidents. The Australian and Canadian Railways have developed new lanterns to address their occupational medical requirements. The Civil Aviation Authority in the UK has adopted the Color Assessment and Diagnosis (CAD) test as the standard for assessing color vision for professional flight crews. The methodology employed using the CAD test ensures that color deficient pilot applicants able to complete the most safety-critical task with the same accuracy as normal trichromats can be accepted for pilot training. This methodology can be extended for setting new color vision standards in other work environments.