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A Review on Today's Burden Affecting the Quality of Life for Colour Blind

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A Review on Today's Burden Affecting the Quality of Life for Colour Blind REVIEWS Ref: Ro J Neurol. 2020;19(2) DOI: 10.37897/RJN.2020.2.1 A REVIEW ON TODAy’s burden AFFECTING THE QUALITY OF LIFE FOR COLOUR BLIND PATIENTS Corina-Iuliana Suciu1,2, Vlad-Ioan Suciu3, Lacramioara Perju-Dumbrava3, Simona Delia Nicoara1,4 1 Department of Ophthalmology, Emergency County Hospital, Cluj-Napoca, Romania 2 University of Oradea, Romania 3 Department of Neuroscience, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania 4 Department of Ophthalmology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania ABSTRACT 1.3 billion people worldwide suffer from a kind of visual impairment. Color blindness (dyschromatopsia) is a visual impairment affecting the quality of life for these patients and is estimated to be the highest in the male population of the European countries. This condition is determined by genetic mutations and secondary acquired etiologies. Many causes have no effective treatment, so new strategies in order to increase the quality of daily living for these people is mandatory. For any human, being independent is an important aspect in the society. Public awareness of this condition is also important. We believe that a simple tweak of the classic traffic lights is one solution to this problem. Keywords: colour blindness, quality of life, traffic lights INTRODUCTION within the macular region, receive bright light and are responsible for high resolution-color vision, Colour blindness, or dyschromatopsia, is a con- while the rods, distributed in the rest of the retina, dition which represents the failure of normal colour mediate the low light and monochromatic vision – vision, rendering the patient disabled [1-3]. the scotopic vision. There are three types of cones, With this paper we aim to review the current lit- each responding to blue, green or red light [1,3,4]. erature regarding the subject of daily living for col- When the cones are dysfunctional or absent, the our blind patients, and to focus the attention of the color perception is hindered. Dyschromatopsia is general population and healthcare professionals on actually a spectrum of color vision dysfunction the disability of colour blind individuals. We would ranging from mild to severe forms. Beside the sig- also like to propose a new and simple traffic light- nificant influence on the colour blind individuals’ ing tweak which could allow these individuals to quality of life, another great concern arises in rela- function independently in traffic, thus increasing tion to traffic lights. These people are not allowed their quality of life. to drive vehicles of any kind and even their inde- pendency as citizens is restricted due to this condi- BACKGROUND tion [1,4,5,18]. The causes of colour blindness are multiple. The retina is a ten layered tissue within the eye Many individuals are born with a congenital defect which contains two main photoreceptor cells: cones in the development of the retina with the full com- and rods. The cones, which are grouped mainly Corresponding author: Vlad-Ioan Suciu E-mail: [email protected] ROMANIAN JOURNAL OF NEUROLOGY – VOLUME XIX, NO. 2, 2020 61 62 ROMANIAN JOURNAL OF NEUROLOGY – VOLUME XIX, NO. 2, 2020 plement of all three types of cones. Other condi- TABLE 2. Causes of color blindness [1-22] Developmental neuro-retinal defects tions leading to color blindness are the result of in- HEREDITARY Progressive cone-rod dystrophy flammatory, toxic, traumatic or metabolic factors a. Toxic acting on the retina or the optic nerve. Toxicity of • Drug toxicity (Digoxin, Ethambutol, various drugs and substances (digoxin, ethambutol, Hydroxychloroquine) • Ethanol intoxication (chronic) hydroxychloroquine, ethanol, methyl-alcohol) and • Methyl alcohol intoxication (acute) diseases such as glaucoma, age related macular de- b. Inflammatory neuropathy (optic neuritis) ACQUIRED generation (AMD), Parkinson’s disease and diabe- c. Miscellanea • Age related macular disease (ARMD) tes, are some of the most frequent causes of ac- • Glaucoma quired color blindness [1,3-7,22]. • Parkinson’s disease OPN1LW, OPN1MW, OPN1SW genes are de- d. Metabolic disease • Diabetes mellitus fective in different types of color vision impair- ments. These genes normally encode different op- Marechal et al. [15] insist that the late diagnosis sin pigments in cones, which respond to different of the hereditary forms of colour vision deficien- colors in the light spectrum: OPN1LW for yellow, cies has an impact on the quality of life and can OPN1MW for green and OPN1SW for blue (table 1) interfere with the careers of these patients. Moreo- [8-13]. ver, they explain that the hereditary forms affect 9% of male patients and 0.5% of female patients, TABLE 1. Genetic aspects of congenital color blindness [8-21] most of them being related to the involvement of Defective gene Opsin coding Inheritance pattern the X-chromosome. The red-green colour vision OPN1 LW Yellow X-linked recessive appears to be most affected [15]. OPN1 MW Green X-linked recessive Tsang et al [17] review an X-linked genetic dis- OPN1 SW Blue Autosomal dominant order, with later onset (adulthood), called Progres- sive cone-rod dystrophy. As the name anticipates, Red-green color defect is the most encountered the disorder is progressive and associates a severe impairment; it affects predominantly men and has a visual acuity decrease in later stages [17]. X-linked recessive inheritance. One in 12 males Stoianov et al. [18] (2019) reviewed 20 studies and one in 200 females have color vision deficits in related to the impact on the quality of life of pa- North European communities. Other color vision tients with colour vision deficiencies and conclud- impairments (such as blue-yellow deficits) are rare ed that the support offered to these patients is today [8-21]. insufficient. They also emphasize on the need for The World Health Organization (WHO) in- implementing newer strategies to enable these peo- formed in 2018 by a fact sheet that globally there ple to live a better life [18]. are more than 1.3 billion people worldwide suffer- Fanlo et al. [19] (2019) reviewed the current lit- ing from one type of visual impairment (any etiolo- erature regarding the testing for colour vision defi- gy). The most frequent causes of visual impair- ciencies. Their work concluded that the most used ment, according to WHO, are: refractive errors, clinical test was Ishihara (10.88%) despite the fact cataract, AMD, glaucoma, diabetic retinopathy, that the Anomaloscope testing (1.28%) being the corneal opacity and trachoma. Three of these major gold standard in this field. This test is considered conditions worldwide are also potential causes of complex, difficult to apply to all patients and time color blindness [5-7]. Table 2 summarizes the caus- consuming. Their recommendation is to use at least es of color blindness. two different tests in order to ensure an accurate Color blindness can associate other neuro-oph- evaluation of colour deficiencies [19]. thalmic symptoms or signs, such as nystagmus, Simunovic [20] also notes that the colour defi- photophobia or amblyopia [1,4]. ciencies are classified into two separate categories Chakrabarti et al. [14] emphasizes the need for - acquired and hereditary. The acquired form of col- awareness on the subject of quality of life in pa- our vision deficiency is caused by lesions from oc- tients with colour vision disturbances [14]. ular, neurologic or systemic diseases [20]. ROMANIAN JOURNAL OF NEUROLOGY – VOLUME XIX, NO. 2, 2020 63 FIGURE 1. A suggestion for improved traffic lighting Hofmann et al. [21] implied that the genetic mu- these people in their routine activities, to render tations which cause colour vision disturbances af- them independent and increase their quality of life. fect the structure of G protein-coupled receptors in First, the traffic light coding could be upgraded. the light sensitive receptors of the retina [21]. The coding of the red light meaning “stop” and of The management of colour blind patients is the green light meaning “go” are well known and complex. Different causes mean different ap- should be kept to avoid confusion. Therefore, we proaches to managing the disease. Some acquired propose a simple tweak in traffic lights, enabling causes can be effectively treated if the cause and colour blind people to perceive them easier. The effect are reversible. Congenital causes are howev- new traffic lighting system should have two colours er not treatable, rendering the patient colour blind for each sign (figure 1). The “stop” sign should all his/her life. Even some of the most frequent ac- have the center red and a peripheral yellow rim. quired causes such as drug toxicities, inflammatory The “go” sign should have the center green and a neuropathies, glaucoma, Parkinson’s disease or di- peripheral blue rim. Thus, most color blind individ- abetes have unpredictable progression patterns, uals (red-green blindness, although suitable for making the treatment more difficult [4,6-8,22]. most color vision impairments) will detect the yel- Hassall et al16 emphasize on the importance of low rim for “stop” and the blue rim for “go”. Fur- AAV gene therapy for achromatopsia being more thermore, the traffic lights should have only these effective if applied early in the course of the dis- two signals: “stop” and “go”, eliminating the inter- ease (childhood). The isolated retinal cone distur- mediate orange sign. bance is called achromatopsia and, according to We believe that this simple idea might be help- Hassall,
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