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Examination of colour vision by use of induced contrast colours. Design of a new series of tissue paper contrast tests.

The ability to induce contrast colours is evident in normal persons by the tissue paper contrast principle. However, tests of good quality are not easily available. The design of a new series of charts follows two principles: 1) Selection of background hues in accordance with the maximally desaturated regions of the spectrum as seen by the colour defectives. 2) Exact adjustment of the neutral test field (constituted by the chart figures) in order to eliminate any false clue due to brightness contrasts. By introducing chart figures of alternative grey values appropriate tests can be attained for each type of colour vision defect. 37 persons with congenital colour defect and 15 persons with acquired defects were examined. The charts, according to the criteria for selection, proved to be selective in their screening efficiency.

Adolescent

Color vision testing.

1. Color deficiency occurs in about 8% of the population, due to alterations in the chemistry of one of the three receptive pigments for colored light, or the substitution of one pigment for another in the photoreceptor cones. 2. Subjects with pigment alteration can see a broad range of color; those with substitution of one pigment for another have broad areas of color perception defect. 3. The most common tests are pseudoisochromatic (color confusion) plates, designed with patterns hidden to the color deficient. Other tests use colored caps, tracing patterns, or an anomaloscope.

Color Vision Defects

Results of colour vision tests in alcoholic and in mentally disordered subjects.

The responses at the Ishihara test, the Nagel anomaloscope, the standard Panel D--15 and the 100 hue test (with correction of the age effect) were recorded in 38 alcoholics in deprivation period (successively subdivided according to age, to abstinence duration and to liver condition) and in 32 subjects suffering from mental diseases (successively subdivided according to ethylic past, to age, to duration of the stay in the hospital and to activity). It is shown that alcoholism causes a diminution of the performance at the used colour vision tests and especially at the 100 hue test. The defect can be ascribed to psychical factors (chiefly in the cases of mental disease and in the younger people), but also to an acquired blue-yellow defectiveness of colour vision with a shift of the Rayleigh match to red (such a defectiveness can also be due to a liver damage and to some intoxications) and even to a Type II acquired red-green defectiveness of colour vision (possibly by tobacco or disulfiram intoxication). The defect due to alcohol itself soon disappears during desintoxication. The authors draw some practical conclusions.

Adult

Probable autosomal dominant optic atrophy with hearing loss.

The seventh family manifesting an entity described as automosal dominant optic atrophy with hearing loss is reported here. This disorder shows great inter- and intrafamilial variation in the onset time and the degree of loss of both vision and hearing. Unlike autosomal dominant optic atrophy without hearing loss, it appears to be associated with a red-green (deutan) defect in color vision.

Adult

A clinicopathologic study of autosomal dominant optic atrophy.

Of a family with 40 members, 12 had autosomal dominant optic atrophy. The affected members were aware of reduced vision from the first decade. Visual loss was moderate to severe, 6/12 (20/40) to 3/60 (10/200). The affected members showed similar centrocecal scotomata. Most affected patients had severe unclassified color defects. Electroretinography measurements were normal in all but one patient who had a small reduction in the scotopic response. The pathologic changes in a patient with autosomal dominant optic atrophy showed diffuse atrophy of the ganglion cell layer of the retina with a loss of myelin and nerve tissue within the optic nerves. We suggest that autosomal dominant atrophy is a primary degeneration of retinal ganglion cells.

Adult

An acquired color defect of the opponent-color system.

An acquired unilateral color defect in a 22-year-old man has been investigated with standard clinical tests and by using techniques which, it is thought, test specifically for the sensitivity of the luminance and opponent-color systems. The spectral sensitivity of the defective left eye, using 1 degree 200 ms. test flashes on a white background, has a single broad peak at about 550 nm. and resembles the photopic luminosity curve; in contrast, the normal curve, measured in the same conditions, has three peaks at about 440, 520, and 600 nm. However, the subject's spectral sensitivity curve for detecting 20 Hz. flicker is quite normal and is similar to his curve for 200 ms. flashes. It has recently been proposed that the three peaks of the normal curve for 200 ms. flashes reflect the activity of the opponent-color system, whereas the single peak for flicker detection is related to the luminance system. The preceding observations may thus be interpreted in terms of a specific loss of the subject's opponent-color system and this would explain his poor color discrimination. His luminance system appears to be normal, and evidence is presented for the maintained function of red- and green-sensitive (but not blue-sensitive) cones. The spectral sensitivity of the subject's right eye is nearly normal, suggesting a precortical origin of the defect; however, there seems to be some abnormality in this eye, indicating a less developed form of the same defect.

Adult

Color vision screening and viewing conditions: the problem of misdiagnosis.

The most popular techniques for assessing color vision, the pseudoisochromatic tests, have been found to differ widely in their sensitivity to changes in viewing conditions. A significant number of color-normal subjects will be misdiagnosed as color defective by some of the standard tests with even relatively minor variations from standardized viewing conditions. These results appear to have strong implications for the use of the tests in many applied settings which precise control over viewing conditions is difficult. In particular, as the consequences of a misdiagnosis become very serious, the tests must be used with special caution. If we were to recommend one test for use, our findings point to the Ishihara, which appears impervious to variation in viewing conditions.

Color Perception Tests

A family with congenital deutan and tritan defects.

A family has been found with deuteranopia and a tritan defect which is not sex-linked. It is proposed that there is also an autosomal dominant gene for tritan defects showing variable expressivity.

Adolescent