Marcelo Fernandes Costa

Colour vision and contrast sensitivity losses of mercury intoxicated industry workers in Brazil

We evaluated vision loss in workers from fluorescent lamp industries (n=39) who had retired due to intoxication with mercury vapour and had been away from the work situation for several years (mean=6.32 years). An age-matched control group was submitted to the same tests for comparison. The luminance contrast sensitivity (CSF) was measured psychophysically and with the sweep visual evoked potential (sVEP) method. Chromatic red-green and blue-yellow CSFs were measured psychophysically. Colour discrimination was assessed with the Farnsworth-Munsell 100-hue test, Lanthony D-15d test and Cambridge Colour Vision Test. Patient data showed significantly lower scores in all colour tests compared to controls (p<.001). The behavioural luminance CSF of the patients was lower than that of controls (p<.001 at all frequencies tested). This result was confirmed by the electrophysiologically measured sweep VEP luminance CSF except at the highest frequencies-a difference that might be related to stimulus differences in the two situations. Chromatic CSFs were also statistically significantly lower for the patients than for the controls, for both chromatic equiluminant stimuli: red-green (p<.005) and blue-yellow (p<.04 for all frequencies, except 2 cycles per degree (cpd), the highest spatial frequency tested) spatial gratings. We conclude that exposure to elemental mercury vapour is associated with profound and lasting losses in achromatic and chromatic visual functions, affecting the magno-, parvo- and koniocellular visual pathways.

Multifocal and full-field electroretinogram changes associated with color-vision loss in mercury vapor exposure

We evaluated the color vision of mercury-contaminated patients and investigated possible retinal origins of losses using electroretinography. Participants were retired workers from a fluorescent lamp industry diagnosed with mercury contamination (n = 43) and age-matched controls (n = 21). Color discrimination was assessed with the Cambridge Colour Test (CCT). Retinal function was evaluated by using the ISCEV protocol for full-field electroretinography (full-field ERG), as well as by means of multifocal electroretinography (mfERG). Color-vision losses assessed by the CCT consisted of higher color-discrimination thresholds along the protan, deutan, and tritan axes and significantly larger discrimination ellipses in mercury-exposed patients compared to controls. Full-field ERG amplitudes from patients were smaller than those of the controls for the scotopic response b-wave, maximum response, sum of oscillatory potentials (OPs), 30-Hz flicker response, and light-adapted cone response. OP amplitudes measured in patients were smaller than those of controls for O2 and O3. Multifocal ERGs recorded from ten randomly selected patients showed smaller N1-P1 amplitudes and longer latencies throughout the 25-deg central field. Full-field ERGs showed that scotopic, photopic, peripheral, and midperipheral retinal functions were affected, and the mfERGs indicated that central retinal function was also significantly depressed. To our knowledge, this is the first demonstration of retinal involvement in visual losses caused by mercury toxicity.

Red-green color vision impairment in Duchenne muscular dystrophy.

The present study evaluated the color vision of 44 patients with Duchenne muscular dystrophy (DMD) (mean age 14.8 years; SD 4.9) who were submitted to a battery of four different color tests: Cambridge Colour Test (CCT), Neitz Anomaloscope, Ishihara, and American Optical Hardy-Rand-Rittler (AO H-R-R). Patients were divided into two groups according to the region of deletion in the dystrophin gene: upstream of exon 30 (n=12) and downstream of exon 30 (n=32). The control group was composed of 70 age-matched healthy male subjects with no ophthalmological complaints. Of the patients with DMD, 47% (21/44) had a red-green color vision defect in the CCT, confirmed by the Neitz Anomaloscope with statistical agreement (P<.001). The Ishihara and the AO H-R-R had a lower capacity to detect color defects--5% and 7%, respectively, with no statistical similarity between the results of these two tests nor between CCT and Anomaloscope results (P>.05). Of the patients with deletion downstream of exon 30, 66% had a red-green color defect. No color defect was found in the patients with deletion upstream of exon 30. A negative correlation between the color thresholds and age was found for the controls and patients with DMD, suggesting a nonprogressive color defect. The percentage (66%) of patients with a red-green defect was significantly higher than the expected <10% for the normal male population (P<.001). In contrast, patients with DMD with deletion upstream of exon 30 had normal color vision. This color defect might be partially explained by a retina impairment related to dystrophin isoform Dp260.

Relationship between vision and motor impairment in children with spastic cerebral palsy: new evidence from electrophysiology

The aim of the present study was to measure visual acuity (VA) by the sweep visual evoked potential method (sVEP) and relate it to the degree of motor impairment in children with spastic cerebral palsy (SCP). Monocular VA was estimated in 37 SCP children aged from 6 to 48 months, classified as tetraplegic (n = 14), diplegic (n = 13), and hemiplegic (n = 10), without ophthalmological complaints with ages ranging from 6 to 48 months. Motor impairment was rated according to the Gross Motor Function Classification System (GMFCS), in five levels of severity. VA was below age norms in 13/14 (92%) tetraplegics, 10/13 (77%) diplegics and 4/10 (40%) hemiplegics. In addition, a two-way ANOVA within each subgroup showed significant differences in VA between the five GMFCS levels, with high positive correlation between VA loss and the GMFCS rating. Differences between the three types of SCP impairment in each level of GMFCS were not statistically significant, possibly due to the small number of patients. In conclusion, the use of an electrophysiological method (sweep-VEP) for the measurement of visual acuity in these patients allows a more precise and reliable estimate than behavioral measurements, since their motor impairment might interfere with the behaviorally assessed visual acuity. In addition, the finding of a high correlation between quantified motor impairment and VA loss in SCP patients is a new observation that might help to understand the causes of VA loss in these patients.

Color vision impairment in type 2 diabetes assessed by the D-15d test and the Cambridge Colour Test

Color vision impairment emerges at early stages of diabetes mellitus type 2 (DM2) and may precede diabetic retinopathy or the appearance of vascular alterations in the retina. The aim of the present study was to compare the evaluation of the color vision with two different tests – the Lanthony desaturated D‐15d test (a traditional color arrangement test), and the Cambridge Colour Test (CCT) (a computerized color discrimination test) – in patients diagnosed with DM2 without clinical signs of diabetic retinopathy (DR), and in sex‐ and age‐matched control groups. Both color tests revealed statistically significant differences between the controls and the worst eyes of the DM2 patients. In addition, the degree of color vision impairment diagnosed by both tests correlated with the disease duration. The D‐15d outcomes indicated solely tritan losses. In comparison, CCT outcomes revealed diffuse losses in color discrimination: 13.3% for best eyes and 29% for worst eyes. In addition, elevation of tritan thresholds in the DM2 patients, as detected by the Trivector subtest of the CCT, was found to correlate with the level of glycated hemoglobin. Outcomes of both tests confirm that subclinical losses of color vision are present in DM2 patients at an early stage of the disease, prior to signs of retinopathy. Considering the advantages of the CCT test compared to the D‐15d test, further studies should attempt to verify and/or improve the efficiency of the CCT test.

Visual impairment on dentists related to occupational mercury exposure

A detailed assessment of visual function was obtained in subjects with low-level occupational mercury exposure by measuring hue saturation thresholds and contrast sensitivity functions for luminance and chromatic modulation. General practice dentists (n=15) were compared to age-matched healthy controls (n=13). Color discrimination estimated by the area of Mac Adam ellipses was impaired, showing diffuse discrimination loss. There was also reduction of contrast sensitivity for luminance and chromatic (red-green and blue-yellow) modulation, in all tested spatial frequencies. Low concentrations of urinary mercury (1.97±1.61μg/g creatinine) were found in the dentists group. Color discrimination as well as contrast sensitivity function, assessed psychophysically, constitutes a sensitive indicator of subtle neurotoxic effect of elemental mercury exposure.

Absence of binocular summation, eye dominance, and learning effects in color discrimination

We evaluated binocular summation, eye dominance, and learning in the Trivector and Ellipses procedures of the Cambridge Colour Test (CCT). Subjects (n = 36, 18-30 years old) were recruited among students and staff from the University of São Paulo. Inclusion criteria were absence of ophthalmological complaints and best-corrected Snellen VA 20/20 or better. The subjects were tested in three randomly selected eye conditions: binocular, monocular dominant eye, and nondominant eye. Results obtained in the binocular and monocular conditions did not differ statistically for thresholds measured along the protan, deutan, and tritan confusion axes (ANOVA, P > 0.05). No statistical difference was detected among discrimination ellipses obtained in binocular or monocular conditions (ANOVA, P > 0.05), suggesting absence of binocular summation or of an effect of eye dominance. Possible effects of learning were examined by comparing successive thresholds obtained in the three testing conditions. There was no evidence of improvement as a function of testing order (ANCOVA, P > 0.05). We conclude that CCT thresholds are not affected by binocularity, eye dominance, or learning. Our results differ from those found by Verriest et al. (1982) using the Farnsworth-Munsell 100 Hue test and Hovis et al. (2004) using the Farnsworth-Munsell panel D-15 test.

Preliminary findings on the effects of occupational exposure to mercury vapor below safety levels on visual and neuropsychological functions.

Objective: To evaluate whether there are visual and neuropsychological decrements in workers with low exposure to Hg vapor. Methods: Visual fields, contrast sensitivity, color vision, and neuropsychological functions were measured in 10 workers (32.5 ± 8.5 years) chronically exposed to Hg vapor (4.3 ± 2.8 years; urinary Hg concentration 22.3 ± 9.3 &mgr;g/g creatinine). Results: For the worst eyes, we found altered visual field thresholds, lower contrast sensitivity, and color discrimination compared with controls (P <0.05). There were no significant differences between Hg-exposed subjects and controls on neuropsychological tests. Nevertheless, duration of exposure was statistically correlated to verbal memory and depression scores. Conclusions: Chronic exposure to Hg vapor at currently accepted safety levels was found to be associated with visual losses but not with neuropsychological dysfunctions in the sample of workers studied.

Contrast sensitivity threshold measured by sweep-visual evoked potential in term and preterm infants at 3 and 10 months of age.

Although healthy preterm infants frequently seem to be more attentive to visual stimuli and to fix on them longer than full-term infants, no difference in visual acuity has been reported compared to term infants. We evaluated the contrast sensitivity (CS) function of term (N = 5) and healthy preterm (N = 11) infants at 3 and 10 months of life using sweep-visual evoked potentials. Two spatial frequencies were studied: low (0.2 cycles per degrees, cpd) and medium (4.0 cpd). The mean contrast sensitivity (expressed in percentage of contrast) of the preterm infants at 3 months was 55.4 for the low spatial frequency (0.2 cpd) and 43.4 for the medium spatial frequency (4.0 cpd). At 10 months the low spatial CS was 52.7 and the medium spatial CS was 9.9. The results for the term infants at 3 months were 55.1 for the low spatial frequency and 34.5 for the medium spatial frequency. At 10 months the equivalent values were 54.3 and 14.4, respectively. No difference was found using the Mann-Whitney rank sum T-test between term and preterm infants for the low frequency at 3 or 10 months or for the medium spatial frequency at 3 or 10 months. The development of CS for the medium spatial frequency was equally fast for term and preterm infants. As also observed for visual acuity, CS was equivalent among term and preterm infants, suggesting that visual experience does not modify the development of the primary visual pathway. An earlier development of synapses in higher cortical visual areas of preterm infants could explain the better use of visual information observed behaviorally in these infants.

Effects of age and optical blur on real depth stereoacuity

Stereoscopic depth perception utilizes the disparity cues between the images that fall on the retinae of the two eyes. The purpose of this study was to determine what role aging and optical blur play in stereoscopic disparity sensitivity for real depth stimuli. Forty‐six volunteers were tested ranging in age from 15 to 60 years. Crossed and uncrossed disparity thresholds were measured using white light under conditions of best optical correction. The uncrossed disparity thresholds were also measured with optical blur (from +1.0D to +5.0D added to the best correction). Stereothresholds were measured using the Frisby Stereo Test, which utilizes a four‐alternative forced‐choice staircase procedure. The threshold disparities measured for young adults were frequently lower than 10 arcsec, a value considerably lower than the clinical estimates commonly obtained using Random Dot Stereograms (20 arcsec) or Titmus Fly Test (40 arcsec) tests. Contrary to previous reports, disparity thresholds increased between the ages of 31 and 45 years. This finding should be taken into account in clinical evaluation of visual function of older patients. Optical blur degrades visual acuity and stereoacuity similarly under white‐light conditions, indicating that both functions are affected proportionally by optical defocus.