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[Color vision defects in chronic open angle glaucoma].

Glaucomatous optic nerve atrophy is associated with morphological and psychophysical changes. Using Roth's Besancon anomalometer, the Farnsworth 100 hue test and Nagel's anomaloscope, we examined color vision in 86 eyes of 51 patients suffering from chronic open-angle glaucoma and 57 eyes of 41 normal subjects. In the normal control group, blue und green sensitivity decreased and, accordingly, the anomaly quotient tested with Nagel's anomaloscope increased significantly (p less than 0.00001) with age. If the glaucoma and control groups were matched for age, refractive error and central visual acuity, decreasing blue sensitivity significantly (p less than 0.05) correlated with diminished visibility of the retinal nerve fiber bundles, a higher morphological glaucoma stage and larger perimetric defects. The presence and depth of localized defects of the retinal nerve fiber layer were not significantly different in glaucoma subgroups with lower and higher blue sensitivity, respectively, when the subgroups were matched for age, refractive error and visual acuity. No papillomorphologic marker for the cyanodyschromatopsia was detected. Red-green color vision was not significantly different between the normal and glaucoma eyes. Testing of blue color vision as an additional method is useful in the differential diagnosis of beginning glaucomatous optic nerve damage in patients with clear optic media and lack of macular changes.

Adult↗

Color plates to help identify patients with blue cone monochromatism.

A new color vision test distinguishes patients with X-chromosome-linked blue cone monochromatism from those with autosomal recessive rod monochromatism. The test consists of two instructional and four test plates. Each test plate has three identical blue-green arrows and one purple-blue arrow; test plates differ from one another only with respect to the chroma of the purple-blue arrow. All five patients with blue cone monochromatism, aged 5 to 31 years, easily distinguished the purple-blue arrow on all four test plates, whereas none of the seven patients with rod monochromatism, aged 6 to 60 years, could distinguish the purple-blue arrow on all four plates. If a boy has a reduced visual acuity, normal rod electroretinograms, and 30-Hz cone electroretinograms reduced more than 97% below normal, this test can be used to determine whether his condition is an X-chromosome-linked one or an autosomal recessive one.

Adolescent↗

Tritan pedigree without optic-nerve atrophy.

Results of several previous reports have questioned the occurrence of the tritan color deficiency independently of dominantly inherited optic atrophy. This report describes the results of testing 34 members of a pedigree (including four tritans) for whom optic atrophy can be ruled out according to criteria previously described by Krill et al.

Adolescent↗

Colour vision tests and colour naming by thirteen incomplete achromats in Bishnupur.

As an exploratory study six colour vision tests were given to nine male and two female achromats from the Shankhabanik community in Bishnupur, and to two additional similar males. All thirteen subjects had severe photophobia, fixation nystagmus, extreme weakness of vision (4/24 to 3/60) and the red end of the spectrum was much shortened. This research indicates that they had a form of incomplete achromatopsia, varying from an almost complete to a very severe partial loss of colour vision. The condition is inherited as an autosomal recessive. The most likely interpretation of these cases is that they are incomplete rod achromats. Their performance on the colour vision tests is tabulated, and shows complete inability to do the Ishihara test; nearly complete inability on the HRR test, with a possible slight tendency to do better in the yellow-blue than the red-green sub-tests; on Sloan's test they show approximate accordance with her results for achromats; they have severe difficulty with the dichotomous and 100-hue tests, with a possible slight tendency to make fewer errors on the G/B sections. The anomaloscope shows little abnormality of mid-matching points, but great increases in average matching ranges above the normal, although not absolute loss of colour sense, but with extreme darkening or shortening of the red end of the spectrum. Their colour naming was carefully recorded, and was fairly good occasionally, sometimes erroneous without being wildly at fault, and most often completely wrong. The records of colour naming were made, not, of course, as a form of colour vision test, but simply to illustrate the ways in which such defectives make an effort to use colour names in general use among their friends and relatives.

Adult↗

Evaluation of congenital colour vision deficiencies.

Three hundred patients who have congenital colour vision deficiencies were examined at the author's eye clinic for 3 years (1987-1990) using 5 types of colour vision tests: Hahn's, TMC's, Okuma's (new), H-R-R's colour vision tests and Double 15 Hue Test (Hahn). The results obtained from each test were quite different in type and grade, and the summarized results were considered to be the best: Type: protan 23.3%, deutan 76.0%, unclassified 0.7% Grade: mild 20.3%, medium 25.3%, strong 54.4% The frequency of coincidence both in type and grade between the summarized results and those of each test were compared, and the highest was 62.3% in Double 15 Hue Test. The efficiency of the author's colour vision test and Double 15 Hue Test were evaluated with the data in this clinical trial, and they were found to be useful for classifying the type and estimating the grade of the congenital and also acquired colour vision deficiencies.

Adolescent↗

Efficiency of the Ishihara test for identifying red-green colour deficiency.

The Ishihara test is the most widely used screening test for red-green colour deficiency. Results obtained by 401 people with red-green colour deficiency show that the combined sensitivity of the Transformation and Vanishing plates of the 38 plate Edition of the Ishihara plates is 95.5% on eight errors, 97.5% on six errors and 99.0% on three errors. The Hidden digit designs only identified approximately 50% of colour-deficient subjects. The protan/deutan classification plates were found to be more effective for deutans than for protans. No classification was obtained for 18% of protanopes and 3% of deuteranopes who saw neither figure on classification plates; 40% of protanomalous trichromats and 37.5% of deuteranomalous trichromats saw both classification figures and were classified on the relative luminance (clarity) of these figures. The specificity of the Ishihara test was determined in a previous study (Birch and McKeever, 1993) and the results combined with the present data to obtain the overall efficiency of the Ishihara plates for a representative cross section of colour-deficient subjects.

Adult↗

The dyschromatopsia of optic neuritis: a descriptive analysis of data from the optic neuritis treatment trial.

PURPOSE: We sought to characterize the dyschromatopsia of optic neuritis, to determine the type and severity of color defect present and its relation to central vision and spatial acuity, to examine changes in this dyschromatopsia over time, and to determine the applicability of Köllner's rule to patients with optic neuritis. METHODS: We analyzed the raw data on color vision performance as assembled within the Optic Neuritis Treatment Trial (ONTT). The ONTT was designed to evaluate corticosteroids as a treatment for acute demyelinating optic neuritis and to allow long-term outcome and natural history analyses. Between July 1, 1988 and June 30, 1991, 488 patients were enrolled in this trial. All patients underwent extensive neurologic and ophthalmologic examinations including standardized testing of visual function that included testing of color vision. The ONTT population thus afforded a unique opportunity to characterize acquired dyschromatopsias in a large, homogenous, well-characterized cohort of patients with optic neuritis. We used quantitative analysis of FM-100 scores from this patient cohort to determine the severity of the dyschromatopsia, the selectivity of the dyschromatopsia (polarity of errors) and the type of dyschromatopsia (axis of confusion) by employing quadrant analysis of FM-100 scores. RESULTS: The results of high-and low-selectivity analyses of the FM-100 data showed that during the acute phase of optic neuritis, blue/yellow, red/ green, and non-selective color defects occurred; among patients with pure defects, blue/yellow defects were more frequent than red/green defects. At 6 months after the acute event, however, analyses showed that red/green defects were more common than blue/yellow defects. Among patients with selective color defects both acutely and at 6 months, the defect was as likely to change over time as remain the same. The likelihood of persistent dyschromatopsia at 6 months was related to the severity of initial central acuity loss, but the type of dyschromatopsia present (red/green versus blue/yellow) was not. CONCLUSIONS: Our results suggest that at the time of the acute attack of optic neuritis, the majority of selective color defects were blue/yellow defects, whereas at 6 months, more of the selective defects were red/green defects, though both types of defects (as well as nonselective defects) were seen acutely and at 6 months. Despite the rigorous inclusion criteria of the ONTT, the large number of patients we studied, correlation of color vision with visual acuity, and longitudinal follow up, this study showed that no single type of color defect was consistently associated with optic neuritis. Demyelinating optic neuritis does not obey Köllner's rule. Moreover, the type of defect present changed in some patients over the course of recovery. Thus, the type of defect may not even be consistent in individual patients as they recover. The type of defect appeared to be related to spatial vision at the time of the test, but the type of defect present at 6 months was not related to the severity of the initial visual loss. Therefore, in evaluating color defects associated with optic neuritis, the level of central visual function must be considered.

Acute Disease↗

Color vision and age.

The results of pseudoisochromatic tests (TMC Ishihara, AOH-R-R) are relatively independent of age. In the Panel D-15, the NCT box 6/4 and the desaturated panel, ageing goes hand in hand with blue-yellow confusions. Fault-positive red-green confusions result from D8/2 examination. For the FM 100 Hue test and the Anomaloscope Nagel, the data found in the literature are confirmed. In nuclear cataract there is no increased shift of the Rayleigh equation towards the green, but towards the red.

Adolescent↗

Early detection of inborn dyschromatopsias in preschoolers and young schoolchildren.

Color vision is one of the most important factors of human vision. Early detection of color vision malfunction in children is of utmost importance, allowing parents and teachers to take appropriate and timely measures for children's future professional orientation. A cohort of 300 children aged 4-6 years (49-86 months) were examined by color vision testing and divided into three age groups of 4-5, 5-6 and > 6 years. Their ability to name the fundamental spectral colors and read Ishihara's pseudoisochromatic plates were recorded. The results obtained are presented in tables and figures. Data analysis showed the youngest group of children to be unsuitable for such testing of color vision. Numerical data revealed considerable percentage deviations as compared to the older groups. In addition, a great difference between the girls and boys indicated psychomotor development to be much faster in girls of that age. Generally, data obtained by the distribution of the results for the two older age groups were consistent with those found in the literature; thus, the authors propose an early examination for the detection of inborn chromatopsia to be performed in preschool children, but not before the age of five. Ishihara's pseudoisochromatic test can be useful in differentiating between dyschromatic and other children, but it is very difficult to implement for singling out dyschromates according to the protan or deutan type.

Age Factors↗

Sahlgren's saturation test for detecting and grading acquired dyschromatopsia.

A new sorting test requires only two minutes for quantitative estimation of saturation thresholds for bluish pigment colors. The test is highly sensitive to and specific for differences between normal subjects and individuals with acquired color vision defects. When combined with Ishihara's pseudo-isochromatic plates, it discriminates between congenital and acquired dyschromatopsias and identifies subjects with combined defects.

Adolescent↗

A new assessment of the normal ranges of the Farnsworth-Munsell 100-hue test scores.

We gave the Farnsworth-Munsell 100-hue color vision test to 232 normal subjects between 10 and 80 years of age. One half the subjects underwent binocular testing followed by monocular testing. In the other half monocular testing preceded binocular testing. Performance was better with both eyes than with either eye alone. The worst performance occurred on monocular tests in subjects without previous experience with the task (that is, those for whom this was the first test). The well-known age trend was apparent (children and elderly have the worst color vision). New data are provided for judging the point at which the total error score may be considered pathologic.

Adolescent↗

The UWCDot colour vision test and low vision.

PURPOSE: Previous studies have shown that colour vision defects are common in the low vision population even when properly designed tests are used. However, there are very few clinical tests available that are suitable for this group of patients. One of the more common is the Jumbo D-15 (JD15). Although this test uses caps more suitable for the reduced acuity, it requires the patient to have some knowledge of colour order and sufficient dexterity to manipulate the caps. We compared the JD15 with the University of Waterloo Colored Dot test (UWCDot), which has neither of these requirements, to determine whether the UWCDot test could be used as a substitute for the JD15. METHODS: The colour vision of 40 consecutive low vision patients was evaluated with both tests. Acuities ranged from 6/6 to 6/1600 with a median value of 6/30. RESULTS: All subjects could perform both tests. The kappa coefficient of agreement between tests was high at 0.85 when any major crossing was a failure on the JD15 and any mistake was a failure on the UWCDot. Classification of the type of defect was also reasonable when the defect was relatively severe. CONCLUSIONS: The UWCDot can be used as a substitute for the JD15 in the low vision clinic. Both tests identify individuals with moderate-to-severe deficiencies, but the UWCDot does not require any manual dexterity and it does not require knowledge of colour-order.

Adolescent↗

[Early detection of color blindness from the viewpoint of occupational medicine with various references to internistic and human genetic symptom complexes].

Vision screening tests within the limits of industrial medicine examinations, together with physical examinations, were done on human individuals by means of pseudo-isochromatic charts in order to detect "red-green blindness". The tests were carried out on 1589 individuals (males and females) from 10 medium-scale plants of the Saarbrücken area (Federal Republic of Germany). The results obtained from male individuals by 919 Ishihara-tests were only considered, categorized and graphically represented according to their age groups. The data have been collected from the cases examined mostly between the years 1976 to 1977. About 1500 cases were examined per year. Because the samples were not selected at random, one has to be cautious with regard to the statistical interpretations of the results. However, due to the large number of cases included in the study, it can be statistically represented. The histogram illustrating the distribution of colour-vision deficiency, according to each age group, shows the highest peak at an age range of 30 to 35 years. This indicates that a considerable number of cases with colour-vision deficiency was discovered late. The individuals have to be early examined by school physicians, house physicians, occupational physicians, internists or ophthalmologists with this colour-vision screening test, before they enter professional life. Some symptomatical complexes of internal diseases and human genetics, i.e. related to "colour-vision blindness" are also emphasized hemophilia and hemolytic anemia due to glucose-6-phosphate dehydrogenase deficiency.

Adolescent↗

Colour discrimination ellipses in patients with dominant optic atrophy.

Many colour tests require a visual acuity of at least 0.1, making them unsuitable for low vision patients. To assess colour vision in patients with sub-normal acuity, we re-designed a previously described test so that its spatial details would be coarse enough to be resolvable by subjects with severe visual impairment. The test measures chromatic discrimination along 20 axes evenly spaced in CIE 1976 L*u*v* colour space. We detail the results for this test in a group of patients with dominant optic atrophy. Despite the lack of evidence for genetic heterogeneity in dominant optic atrophy, we observed phenotypic variation both between and within families.

Adult↗

Can clinical colour vision tests be used to predict the results of the Farnsworth lantern test?

Clinicians usually do not have access to a lantern test when making an occupational assessment of the ability of a person with defective colour vision to recognise signal light colours: they must rely on the results of ordinary clinical tests. While all colour vision defectives fail the Holmes Wright Type B lantern test and most fail the Holmes Wright Type A lantern, 35% of colour vision defectives pass the Farnsworth lantern. Can clinical tests predict who will pass and fail the Farnsworth lantern? We find that a pass (less than two or more diametrical crossings) at the Farnsworth Panel D 15 Dichotomous test has a sensitivity of 0.67 and specificity of 0.94 in predicting a pass or fail at the Farnsworth lantern test: a Nagel range of > 10 has a sensitivity of 0.87 and a specificity of 0.57. We conclude that neither the D 15 nor the Nagel Anomaloscope matching range are satisfactory predictors of performance on the Farnsworth Lantern.

Color Perception Tests↗

Search for coloured objects in natural surroundings by people with abnormal colour vision.

BACKGROUND: People with abnormal colour vision often report difficulty seeing coloured berries and flowers in foliage, which suggests they will have a diminished capacity for visual search when target objects are marked out by colour. There is very little experimental evidence of the effect of abnormal colour vision on visual search and none relating to search for objects in natural foliage. METHOD: We showed 79 subjects with abnormal colour vision (seven protanopes, 10 deuteranopes, 16 protanomals and 46 deuteranomals) and 20 subjects with normal colour vision photographs of natural scenes and asked them to locate clumps of red berries, to trace the length of a red string on grass and to name the season depicted in a photograph taken in the Autumn and the same scene photographed in the Summer. Colour vision was assessed using the Ishihara, the Medmont C100, the Farnsworth D15, the Richmond HRR and the Nagel anomaloscope. RESULTS: All the subjects with abnormal colour vision located fewer clumps of red berries than those with normal colour vision. The subjects who failed the Farnsworth D15 performed significantly worse than those who passed but the distribution of scores in the two groups overlaps. The majority of subjects with abnormal colour vision could not trace the full length of the string: only 38 per cent of anomalous trichromats who passed the Farnsworth D15 test and three per cent of those who failed it were able to trace the full length of the string. Fifty-five per cent of those classed as having a mild deficiency by the HRR test could trace the whole string. Most dichromats were unable to identify the Autumn season and those who did may have been assisted by guessing. Most (94 per cent) of those who passed the Farnsworth D15 test and all those classified as having a 'mild' deficiency by the HRR test could identify the season. CONCLUSIONS: All people with abnormal colour vision, even those with a very mild deficiency, have some degree of impairment of their ability to see coloured objects in natural surroundings. A pass at the Farnsworth D15 test or a 'mild' classification with the Richmond HRR test identifies those likely to have the least problems with visual search and identification tasks. The results have practical implications for the selection of personnel in occupations that involve visual search in natural terrain.

Adolescent↗

Cavernous hemangioma with cone dysfunction.

We report a 13-year-old male who complained of strabismus and low visual acuity in the right eye. Saccular aneurysms filled with dark-colored blood were noted in the upper nasal quadrant of the right fundus. Ishihara color plates and Lanthony's new color test revealed a red-green color defect. Cone response and 30-Hz flicker responses were nearly absent. Cavernous hemangioma of the retina is a rare vascular hamartoma; the associated findings show cone dysfunction concomitant with this peripheral lesion.

Adolescent↗

Color vision characteristics of visually impaired children.

A classroom assessment of color vision characteristics of children with low vision was conducted using a battery of tests. The results showed 75% of the children failed one or more tests, although only 24% had a moderate or severe color vision defect. Comparisons with the low vision clinic color vision assessment showed that many of the children were not identified as being color vision defective. Considering the use of color-coded information in education, greater emphasis on color vision evaluations in routine low vision examinations is recommended.

Child↗