Jeffery K. Hovis

Detection of color vision defects in chloroquine retinopathy1

OBJECTIVE The effect of chloroquine toxicity on color vision is unclear. The authors identified the color defects seen in chloroquine retinopathy and determined the sensitivity and specificity of clinical color vision tests for detecting the presence of previously diagnosed chloroquine retinopathy. DESIGN Case-control study. PARTICIPANTS Chloroquine retinopathy was defined using previously published criteria. Data from 30 patients with retinopathy and 25 patients using chloroquine but with no evidence of retinal toxicity were collected. METHODS All patients were tested with the following six clinical color vision tests: Ishihara, Farnsworth D-15, and Adams Desaturated-15 (Dsat-15), City University 2nd Edition (CU), Standard Pseudoisochromatic Plates Part 2 (SPP-2), and American Optical Hardy Rand Rittler (AO HRR). MAIN OUTCOME MEASURES The number of failures was determined for each test. The types of color vision defects were classified as blue-yellow (BY), red-green (RG), or mixed RG and BY (mixed). RESULTS Of the 30 patients with retinopathy, 28 (93.3%) of 30 patients failed at least 1 color vision test, demonstrating predominantly mixed defects. Five (25%) of 25 of the control subjects failed at least 1 test, and these defects were predominantly BY. The sensitivity and specificity of the tests are as follows: SPP-2 (93.3%, 88%), AO HRR (76.7%, 88%), Ishihara (43.3%, 96%), Dsat-15 (33.3%, 84%), D-15 (16.7%, 96%), and CU (20%, 92%). CONCLUSIONS Color vision can be affected by chloroquine and should be tested routinely with a color vision test designed to detect both mild BY and protan RG defects to maximize sensitivity for toxicity. The SPP-2 and AO HRR are two tests that meet these criteria. The Ishihara has a low sensitivity, as do the D-15 tests and CU. All of the tests have similar specificity for chloroquine toxicity. If color vision defects are detected in patients at risk of developing chloroquine retinopathy, additional testing is indicated to rule out toxicity.

Physical characteristics and perceptual effects of blue-blocking lenses

The transmission-optical properties of a “blue-blocking” lens and its influence on several aspects of human visual performance were assessed. Results showed that the lens was effective in absorbing ultraviolet and blue wavelengths and that its effects on contrast sensitivity and visual evoked potentials (VEPs) were similar to those produced by an equivalent neutral density (ND) filter. Although the lens did not alter stereopsis, it did produce severe color discrimination losses for normal and dichromatic subjects.

Review of dichoptic color mixing.

Dichoptic color mixing has been a controversial issue for nearly two centuries. The first dispute arose from the fact that dichoptic color mixtures occur only under certain conditions. A later controversy arose over the implications of dichoptic color mixtures to color vision theories. The present consensus is that dichoptic color mixtures occur under conditions which apparently minimize chromatic differences between the two monocular impressions. However, dichoptic mixtures do not match the corresponding monoptic mixtures. Dichoptic mixtures appear dimmer, and if a green light is mixed with either a red or violet light, then the dichoptic mixture appears greener relative to the monoptic mixture.

The Universal Standard Scale: Proposed improvements to the American National Standards Institute (ANSI) scale for corneal topography

PURPOSE To evaluate the American National Standards Institute (ANSI) corneal topography scale (ANSI Z-80.23-1999) and to develop a Universal Standard Scale (USS) based on scientific principles and clinical usefulness. DESIGN Retrospective data analysis and computer modeling of frequency of corneal power distributions. METHODS Four variations of corneal topography color scales were constructed using the ANSI standard description. The scales used 21 contour intervals with step sizes of 0.5, 1.0, or 1.5 diopters (D). In example 1, hue was varied, whereas saturation and brightness were held constant. In example 2, hue was varied systematically, whereas luminance was varied to compensate for spectral sensitivity. In example 3, hue was varied, whereas luminance was adjusted to improve color contrast at the center of the scale. In example 4, the palette was generated by varying the red, green, and blue color intensity levels. In the USS, colors were defined by hue, brightness, and saturation, and appearance was optimized by using contrast. The contour interval was determined from the standard deviation of keratometry for 27 normal corneas. The scale range was based on corneal powers found in 388 topography maps of 12 different corneal conditions. RESULTS ANSI-derived maps were difficult to interpret because of poor color contrast and the inability to associate contours with specific colors in the scale. The 0.5 D interval slightly improved the appearance of some patterns but reduced the useful clinical range of the scale. ANSI colors did not match the users expectations; abnormal patterns appeared in shades of green, which is associated with normality. The standard deviation of keratometry readings for the normal population was 1.59 D. Hence, the contour interval for the USS was set to 1.5 D. More than 99.9% of the corneal powers in 388 clinical maps were within the range of 30 to 67.5 D, which was chosen as the range for the USS. CONCLUSIONS The ANSI scale for corneal topography is a series of scales that lead to clinical misinterpretations. The alternative USS would provide uniform presentation, unambiguous interpretation, and greater ease of comparison among maps produced by different topographers.

Long wavelength pass filters designed for the management of color vision deficiencies

This study reports on the effectiveness of long wavelength pass filters dispensed as tinted spectacles as an aid for individuals with congenital red-green color vision deficiencies. The effectiveness of the filters was evaluated by the performance on a series of clinical color vision tests and a questionnaire after the subjects had tried the lenses for 1 week. The lenses improved performance on color vision tests that required discrimination between large color differences, particularly between red and green hues. However, performance was degraded on tests which required fine color discrimination or used colors that were located parallel to the tritan confusion axis. The improved performance on certain tests was primarily based on brightness artifacts induced by the filters, whereas the degraded performance on the other tests was due to the absorption of short- to midwavelength light by the filters. A slight majority (56%) of the subjects rated the filters as being moderate to highly effective in improving their color discrimination. Nevertheless, only 17% were interested in actually purchasing a pair. Common reasons for rejecting the filters were the color distortions produced by the red filters and fewer colors were actually perceived when wearing the filters.

Comparison of the Standard Pseudoisochromatic Plates to the Ishihara Color Vision Test

The Standard Pseudoisochromatic Plates (SPP) color vision test was compared to the Ishihara color vision test with respect to screening validity, digit confusion errors, and individual plate efficiency. Results from 315 1st and 3rd grade males confirmed previous reports that the SPP is an effective screening test. Moreover, the SPP test was superior to the Ishihara test with respect to digit confusion errors. Color normal children made about 5 to 7 times as many errors on the Ishihara test as on the SPP. Screening inefficiency values of individual plates of both tests were calculated. A high inefficiency value of a SPP plate was usually caused by its inability to detect color defective subjects.

A lantern color vision test for the rail industry

BACKGROUND Correct identification of wayside signal colors is critical for safe operation of railway equipment. However, evaluating color discrimination using just a screening test may not be occupationally relevant. METHODS A lantern test (CNLAN) was designed to provide a functional assessment of color discrimination for the rail industry. It was validated against a simulated field trial. 81 individuals with normal color vision and 74 individuals with congenital red-green defects participated. Color vision was classified using the Nagel Anomaloscope. RESULTS Using a criterion based on the worst-normal performance, 97% of the individuals with a color vision defect failed both the CNLAN and simulation trial. This value is slightly lower than the 100% who failed both the Ishihara test and simulation. However, the Ishihara test also failed 3.7% of the color-normals who passed both the simulation and lantern, whereas by definition none of the color-normals failed the lantern. CONCLUSIONS This lantern test provides a reasonable functional assessment of ones ability to identify rail signal colors; especially when a strict failing criterion is applied to screening tests.

The effect of multiple antireflective coatings and center thickness on resistance of polycarbonate spectacle lenses to penetration by pointed missiles.

Purpose. Previous work has shown that the impact resistance to blunt missiles is affected by coatings applied to either CR-39 or polycarbonate lenses. We investigated the effects of multiple antireflection (minimum angle of resolution [MAR]) coatings on the resistance of polycarbonate lenses to puncture on impact by sharp, high-speed missiles. Methods. Four groups of surfaced plano polycarbonate lenses were investigated. Two groups had a scratch-resistant (SR) coating applied to both surfaces. One of these groups had a 2-mm center thickness and the other had a 3-mm center thickness. The other two groups of 2-mm and 3-mm thick lenses had a MAR coating applied over the SR coating. The lenses were impacted by a missile consisting of an industrial sewing machine needle mounted in a cylindrical aluminum carrier. Results. The sharp missiles were able to pierce the lenses at speeds between 29.6 m/s and 46.2 m/s. Impact resistance was lowest for the thinner lenses and lenses with a MAR coating. The effect of the MAR and lens thickness was subadditive. Conclusions. We have confirmed previous observations that polycarbonate lenses are more susceptible to penetration by sharp, high-speed missiles than blunt missiles. We have also found that reducing lens center thickness and applying a MAR coating further reduces the penetration resistance. Therefore, the use of 2-mm center thickness and MAR-coated polycarbonate lenses should be discouraged for industrial eye protectors where sharp missile hazards are possible.

Comparison of the D-15 and City University (second) color vision tests.

This study examines the equivalence of the City University color vision test (CUT) to the Farnsworth Munsell D-15 (D-15). This information is important because a number of occupations require individuals to pass either the D-15 of the CUT. Using two or more major crossings on the D-15 as failure, our results indicate that agreement between tests can be improved if the failing criterion for the CUT is either > or = 5 total errors, or > or = 2 errors on the large circles. Our preference is to use the criterion based on the large circles because there is a marginal improvement in agreement between the two tests for protanopes.

Validity of the Holmes-Wright lantern as a color vision test for the rail industry

A simulated field test was designed to determine whether the Holmes-Wright A lantern (HWA) is a valid color vision test for the rail industry. The simulation replicated viewing rail signal lights at 0.8 km distance under daylight conditions. Using the worst-normal as the maximum number of allowable errors on the simulation, 94% of the color-defectives failed both tests on the first trial and 92% failed at the second session. The HWA had a higher false negative rate than a false alarm rate. The majority of individuals who had discrepancies on the two tests were mild deutans. Results from the Ishihara test were marginally better at predicting performance on the simulation.