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Review of the Color Vision Tests Currently in Use

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Review of the Color Vision Tests Currently in Use Open Access Journal of Ophthalmology & Visual Sciences Review Article Review of the Color Vision Tests Currently in Use Almustanyir A* Department of Optometry, King Saud University, Saudi Abstract Arabia Purpose: Color vision testing is essential for people who perform tasks *Corresponding author: Almustanyir Ali, Department where color is used to convey information and accurate color judgments are of Optometry, King Saud University, Saudi Arabia essential for safe and efficient performance. A large number of color vision tests are currently available to screen for color vision deficiencies or detect the type Received: April 28, 2020; Accepted: May 18, 2020; and severity of the defect. Computerized color vision tests are now becoming Published: May 25, 2020 more common in the clinical setting. Different programs are available that screen for color vision defects or perform both screening and diagnosis of the severity of the defect. This study aimed to review some of the color vision tests currently available in the market Method: This study primarily focused on reviewing seven color vision tests: Ishihara, Hardy-Rand-Ritter plates (HRR), Waggoner PIP, Color Assessment and Diagnosis (CAD) test, Cone Contrast Sensitivity test, Farnsworth D15 (F- D15), and Waggoner D15 (W-D15). Results and Conclusion: The majority of these tests showed very good agreement with the anomaloscope in assessments of a red-green color vision defect. The level of agreement, sensitivity, and specificity for most tests were comparable to the anomaloscope in terms of screening for color vision deficiency. Keywords: Color vision test; Ishihara; HRR; Waggoner color vision test; CAD test; Cone Contrast Sensitivity test; Farnsworth D15; Waggoner Introduction be discussed in this paper. The remaining categories of CVD psresent with a normal visual function and just CVDs, or they may show color The number of commercially available color vision tests in the vision independent of any visual problem. Dichromatism requires two market has increased, and it has become essential to determine which primaries to match colors, whereas anomalous trichromats requires tests can be used in a convenient, valid, and reliable manner. A test three primaries to make a match, but the amounts are significantly can be considered good if it has the ability to accurately and quickly different from CVN. categorize subjects into Color Vision Defect (CVD) and Color Vision Normal (CVN) groups. However, a working knowledge of the test Red-green color defects can be further classified based on protocol is insufficient, and an understanding of the test design is whether the M-cone or L-cone photopigment is missing or essential to ensure high confidence in interpreting the results [1]. different from the CVN population. Protanopes lack the long- Moreover, it is necessary to understand the need and aim of color wavelength sensitive pigment (L-cone), and deuteranopes are vision testing, which can be summarized as follows: missing the medium wavelength sensitive pigment (M-cone). The anomalous trichromats can also be divided into parallel categories. 1. The test can screen and detect the presence of color vision Protanomalous trichromats possess an anomalous photopigment in deficiency. This situation would be the most common color activity. their L-cone, while deuteranomalous trichromats have an anomalous 2. The test has the ability to determine the type and severity of photopigment in their M-cone [2]. the color vision deficiency. Blue-yellow defects are very rare. Blue-yellow defects include the 3. The test can assess the significance of color vision deficiency dichromatic (tritanope) and anomalous trichromat (tritanomalous) in those carrying particular color-dependent tasks. This commonly forms. Both tritanope and tritanomalous forms show problems with pertains to congenital red-green color vision deficiency rather than the S-cones. In tritanopes, the S-cone pigment is non-functioning, congenital tritan or acquired deficiencies. This group of tests would whereas in tritanomalous cases, the S-cones are only partially mimic the aspects of the intended occupation or a particular test at functional [3]. the actual place using the real system of work. CVDs can be further categorized as congenital or acquired [1]. In CVD can be classified into three general categories based on the the congenital form, the congenital visual system is otherwise normal number of primary colors that are required to make color matches. except for the loss of color discrimination and the defect remains In monochromatic CVDs, patients require only one primary color stable throughout, whereas in the acquired form, the CVD is related to match all colored lights. Individuals with this form of CVD lack to an ocular disease or disorder and some other aspect of visual most of the normal cones and show a severe reduction in visual function is also affected by the condition. The defect can progress acuity. Because they have additional visual problems, they will not and regress along with the underlying condition [1,2]. Acquired J Ophthalmol & Vis Sci - Volume 5 Issue 1 - 2020 Citation: Almustanyir A. Review of the Color Vision Tests Currently in Use. J Ophthalmol & Vis Sci. 2020; 5(1): ISSN: 2573-8593 | www.austinpublishinggroup.com 1036. Almustanyir. © All rights are reserved Almustanyir A Austin Publishing Group Table 1: Scoring criteria for the color vision tests. Test Failure Criteria Classification Criteria for Red-Green Defects Severity Criteria Ishihara Most of the errors or less distinct figures (on each plate) More than two errors on plates 1-17 NA (38 plates) on the diagnostic plates in protan or deutan columns Red-Green Very mild: Any red-green error on the screening plates and no errors on plates 11-20 Mild: Any error on plates 11-15 and no errors Blue-Yellow: on the rest of the diagnostic plates. on screening plates Moderate: Any error on plates 11-18 and no HRR (any error) errors on plates 19 and 20. The least number of errors in protan or deutan columns 4th edition Red-Green: Severe: Any error on plates 19-20 >1 error on screening plates; and no Blue-Yellow errors on the diagnostic plates Mild: The blue-yellow screening plates (any error) and plates 21-24 (no errors) Moderate: Plates 21-22 (any error) and no errors on plates 23 and 24. Severe: Any error on plates 23-24 Red-Green (defect with the majority of errors on the type of defect) Mild:more than 4, but less than 17 errors More than four errors on the red-green Moderate: more than 16, but less than 28 plates errors Waggoner PIP More errors on protan vs. deutan diagnostic plates More than two errors on the blue- Severe: more than28 errors yellow plates. Blue-Yellow Mild: more than 3, but less than 7 Moderate: more than 6, but less than 9 Severe: more than 9 Based on sensitivity value Mild: more than 54, but less than 75 Sensitivity value less than 75 for any RCCT Classification based on the minimum cone sensitivity Moderate: cone type More than 39, but less than 55 Severe: less than 40 Screening mode: percentage correct less than 66.6% for any color Protan, deutan, or unclassified based on the directions CAD Threshold values Threshold mode: that have the highest thresholds. Red-green SNU more than 1.77 OR Blue-yellow SNU more than 1.75 Visual Inspection: depending on the error pattern to score sheet Color Difference Vector angle size: Visual Inspection: Deutan More than one major crossing F-D15 -20°< Angle < -3° Color Difference Vector value: NA Protan C-index >1.78 -3°< Angle < 20° Scotopic 20°< Angle < 60° Tritan 60°< Angle < 120° OR -120°< Angle <= -60° Color Difference Vector angle size: Deutan -20°< Angle < -3° Color Difference Vector: C-index Protan W-D15 >1.78 -3°< Angle < 20° NA Scotopic 20°< Angle < 60° Tritan 60°< Angle < 120° OR -120°< Angle <= -60° CVDs are less common in the general population. However, these to have deutan defects. Type III acquired blue-yellow defects are the defects are very common in the elderly. This is expected since the most common type of acquired CVD. This type of defect is defined incidence of visual disorders also increases with age [2]. There are by discrimination losses along the blue-yellow axis and is observed in three types of acquired CVDs. Type I acquired red-green defects macular degeneration, glaucoma, diabetes, nuclear cataract, and optic occur in photoreceptor/retinal pigment epithelium diseases. Patients nerve disorders [2]. with this type of defect tend to have protan defects. Type II acquired red-green defects are related to optic nerve diseases such as optic An accurate measurement of color discrimination is essential atrophies and optic neuritis [2]. Patients with this type of defect tend for jobs that require precise color vision to ensure safe and efficient Submit your Manuscript | www.austinpublishinggroup.com J Ophthalmol & Vis Sci 5(1): id1036 (2020) - Page - 02 Almustanyir A Austin Publishing Group performance of the tasks, since patients with CVDs are at a higher [8,9]. The reported an AC1 value of 0.86.They also found that the risk of making errors in such tasks. A large number of color vision sensitivity and specificity were 0.95 and 0.91, respectively [7]. tests are currently available to detect CVD and estimate the patient’s Hardy-Rand-Ritter plates ability to discriminate colors. Computerized color vision tests are widespread and have become more common in the clinical setting. The HRR pseudo iso chromatic test was developed by Hardy, Some programs can screen for CVD or have the capability to screen Rand, and Ritter in 1955 [10]. It is designed to detect tritan as well as and diagnose the severity of the defect. The purpose of this paper red-green CVDs and grade their severity. The fourth edition was well is to review the color vision tests that are commercially available in designed as its colors aligned on the confusion lines and was isomeric the market and widely used in the clinic.
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