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Computerized colour vision testing.

There are many advantages to the computerization of colour vision tests. However, previous computerized colour vision tests have involved equipment and methods not commonly used in clinical practice. We created computer emulations of the City University Colour Vision Test (CUT), Ishihara plates and American Optical Hardy-Rand-Rittler (AO-HRR) plates using a commonly available 24-bit colour Macintosh computer. Our colour monitor was calibrated to standard display white (D65), and colour plates were imaged with a colour scanner. The computerized colour images were compared with the standard test plates in a sample of 21 subjects with normal colour vision, 10 patients with congenital red-green defect and 1 patient with an acquired mixed colour defect. The computer images of the three tests correlated well with their conventional counterparts on kappa statistic analysis (p < 0.001), for both the colour normal and colour defective groups. We conclude that our computer emulations of the CUT, Ishihara and AO-HRR tests screen subjects with normal colour vision with high specificity and delineate congenital colour defects with a sensitivity comparable to that of their conventional counterparts.

Adult↗

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.

Color Perception↗

New color vision tests to evaluate faulty color recognition.

PURPOSE: To develop and assess new color vision tests to be used in evaluating faulty color recognition. METHODS: We developed new color vision tests to evaluate faulty color recognition. The two types of color vision tests, designed to assess faulty color recognition in color vision deficiencies, are based on principles that are different from those of the conventional color vision tests. In the first test plate, the subject is asked to choose either a red, green, or gray line from among 10 lines that are randomly colored red, green, gray, yellow, or blue. The score is the difference between the number of correct answers and the number of incorrect answers. In the second test plate, the subject is asked to identify a total of 10 red azalea blossoms, which are dispersed among numerous green leaves. Seventy-five persons with congenital color deficiencies and 20 subjects with normal color vision were examined using these new test plates. RESULTS: The scores differed significantly between dichromats and anomalous trichromats, and between anomalous trichromats and subjects with normal color vision. CONCLUSIONS: The new tests are easy to use, sensitive, and have good reproducibility for use in discriminating subjects with color vision anomalies. These tests reveal the faulty color recognition that occurs unconsciously in persons with color deficiencies, and are useful in judging the quantification of color vision required in their daily life and occupations.

Adolescent↗

[Value of the Bébé-Vision test in the screening of strabismus and anisometropic amblyopia in infants].

PURPOSE: To evaluate the accuracy of the Bébé-Vision test for detecting strabismic, ametropic and anisometropic amblyopia in childhood. METHODS: We screened 199 infants under 20 months of age. The screening consisted of a full orthoptic examination by a trained orthopist (cover test, fixation test), a forced choice preferential looking technique (Bébé-Vision test) prior to cycloplegia to test visual acuity, cycloplegic refraction by retinoscopy, and examination of the fundi. RESULTS: Fifteen infants were abnormal on orthoptic examination (clinical evidence of esotropia and/or limitation of abduction and/or amblyopia). The Bébé-Vision test demonstrated a significant interocular difference on the same side of the suspected amblyopic eye in 3 cases and on the opposite side in 3 cases, and no difference in 9 cases. The monocular Bébé-Vision test was abnormal in 51 cases and there was an abnormal cycloplegic refraction in 33 cases. Statistical analysis of these tests demonstrated a very low sensitivity (42%) and a good specificity (90%) for the Bébé-Vision test in detecting amblyopia related to refractive error. CONCLUSION: The Bébé-Vision test does not reliably reveal strabismic or anisometropic amblyopia and is not recommended as a screening test. Diagnosis should continue to be based mainly on the classical clinical methods.

Amblyopia↗

Assessment of age-related maculopathy using subjective vision tests.

This paper reviews non-standard, clinical vision tests that may be used to detect the earliest visual loss in age-related maculopathy (ARM), before fundus changes are detected. We recommend a clinical test battery for all patients aged 60 years and older, comprising low luminance/low contrast (SKILL) VA or low contrast VA, desaturated D-15 colour vision assessment, flicker perimetry, glare recovery and dark adaptation if possible, together with conventional assessments of case history, ophthalmoscopy and high contrast visual acuity (VA) for the detection and diagnosis of ARM. Reading rate is also discussed as a potential indicator of early visual loss. For monitoring the progressive visual loss in age-related macular degeneration (AMD) and determining the requirements for optometric vision rehabilitation, we recommend more conventional clinical vision tests of distance and near visual acuity, reading rate, the effects of varying illumination and a functional central visual field assessment.

Color Perception↗

Use of vision tests in clinical decision making about cataract surgery: results of a national survey.

AIM: To provide information on the use of vision tests in clinical decision making about cataract surgery in the UK. METHOD: A questionnaire survey was mailed to 703 consultant ophthalmologists. RESULTS: A response rate of 70% was obtained. Monocular distance visual acuity was the only visual function that was tested routinely by all surgeons. Supplementary use of contrast sensitivity and glare testing was low. Many surgeons (35%) were willing to consider surgery at acuity levels better than 6/9 and a small but substantial number (12%) indicated that they did not use an acuity criterion. Being prepared to consider surgery at relatively good levels of acuity was not associated with more common use of other tests of vision. CONCLUSION: Many UK surgeons are prepared to consider cataract extraction at relatively good levels of visual acuity and use other vision tests infrequently.

Aged↗

The effect of decreased visual acuity on clinical color vision testing.

PURPOSE: Evaluate the effect of visual acuity on color vision testing. DESIGN: University based clinical experimental study. METHODS: Right eyes of 12 healthy subjects were fogged with plus lenses to logMAR 1.88 and assessed with D-15 panel, Ishihara, and Hardy-Rand-Rittler (HRR) plates. Subjects were tested at lesser degrees of fogging, 0.1 logMAR intervals. The acuity at which 5% of the population tests abnormally was estimated as follows. The average acuity at which a 10% reduction in correct responses occurred was determined. From this, two standard deviations were subtracted. Examination devices were compared using repeated measures analysis of variance. RESULTS: Color vision testing did not significantly differ from baseline up to logMAR 1.40 (D-15 panel), 1.10 (HRR plates), and 0.72 (Ishihara plates). Testing devices were significantly different (P < .005). CONCLUSIONS: Color vision testing is accurate up to logMAR 1.40 (20/501) with D-15 panel, 1.10 (20/252) with HRR plates, and 0.72 (20/106) with Ishihara plates.

Adult↗

Critical issues in the use and analysis of the Lanthony Desaturate Color Vision test.

The Lanthony Desaturate Color Vision test (D-15d) has been used to demonstrate the incidence of acquired color vision defects resulting from toxic exposure. The D-15d is a sensitive test designed to grade color deficiencies, but results can be difficult to interpret beyond the qualitative level, and the high incidence of errors reported for controls in some toxicology studies raises questions about how to effectively use this test. This article reviews standard administration of the test, physical determinants of performance, classification of acquired color vision defects, and methods of analysis that have been used to quantify results. The basis for a new method of analysis is discussed, illustrating the source of some characteristic errors, and recommendations are made for test protocols to attempt to more closely identify the type of color vision loss with the goal of identifying the site of toxicological insult.

Color Perception↗

Eduard Jaeger's Test-Types (Schrift-Scalen) and the historical development of vision tests.

PURPOSE: Eduard Jaeger's original Test-Types were carefully evaluated: (1) to determine whether Jaeger had maintained a consistent standard, (2) to establish the correct Snellen equivalent for Jaeger's Test-Types, (3) to answer the question of why and how the standard was lost, and (4) to compare the visual angle of optotypes to lines of continuous text. METHODS: All original Viennese editions of Jaeger's Test-Types, as well as first generation United Kingdom (UK) and United States (US) versions, were evaluated. Data were collected objectively using a microruler with a 20X loupe and subjectively using a laser distance-measuring device. The data were analyzed using Microsoft Excel. All previous measurements of Jaeger's Test-Types, objective and subjective, collected over the past 133 years were compared to the current data and to each other. RESULTS: The correct Snellen equivalent of Jaeger's Test-Types was determined. The visual angle created from the measurement of the height of lowercase letters, without ascenders or descenders, provides an accurate method of assigning a visual angle of a line of continuous text. Comparing the typefaces used in printing first generation UK and US versions of Jaeger's Test-Types to the Viennese editions provided an explanation for the absence of a consistent standard for Jaeger's Test-Types today. CONCLUSIONS: All 10 versions of Jaeger's original Test-Types are virtually identical and established a gold standard for reading vision tests. Jaeger's standard was lost when his Test-Types were first printed in the UK and the US using local typefaces. The Jaeger standard has been re-established. Visual angles determined using continuous text are comparable to those obtained by using optotypes.

Austria↗

Contrast sensitivity and other vision tests in the optic neuritis treatment trial.

PURPOSE: To determine the intercorrelation, prevalence of abnormality, and incremental detection value of vision tests in optic neuritis. METHODS: We calculated the linear correlation of paired vision tests and prevalence of abnormal test values from baseline and six-month measurements of Snellen visual acuity, Pelli-Robson contrast sensitivity, Humphrey Field Analyzer mean deviation, and Farnsworth-Munsell 100-hue color vision in 438 patients entered in the Optic Neuritis Treatment Trial from 1988 to 1991. The incremental detection value of nonvisual acuity tests was defined as their frequency of abnormality when visual acuity was 20/20 or better. RESULTS: All four vision-test results were highly intercorrelated at baseline and at six months. At baseline, contrast sensitivity had the highest prevalence of abnormality, but all vision tests were so often abnormal that differences were not clinically relevant. At six months, when visual recovery had occurred, contrast sensitivity was most often abnormal (2.2 X visual acuity; 1.8 X mean deviation; 1.5 X Farnsworth-Munsell 100-hue color vision test); when contrast sensitivity, mean deviation, or Farnsworth-Munsell 100-hue color vision was normal, visual acuity was 20/25 or better in 98% of patients. CONCLUSIONS: The high intercorrelation of four vision tests suggests that optic neuritis affects a broad range of visual functions. Among non-visual acuity tests, Pelli-Robson contrast sensitivity proved to be a particularly practical and sensitive indicator of visual dysfunction in optic neuritis.

Adolescent↗

Contrast sensitivity vision testing: new screening technology for family physicians.

Contrast sensitivity vision testing is the new technology in visual screening. Easy to administer and quick to perform, contrast sensitivity vision testing appears to be cost-effective for use by family physicians. It is a more sensitive indicator of ocular disease than traditional Snellen acuity testing and may detect ocular pathology at an early stage when Snellen acuity is still normal.

Adult↗

Vision testing in atrophic macular degeneration.

PURPOSE: To determine the correlation between a group of vision tests in atrophic macular degeneration (AMD) in an office setting. METHODS: Patients with documented vision loss from atrophic macular degeneration in one eye were invited to attend an eye clinic every three months for a series of six vision tests for their good eye followed by fundus photography. Modified contrast sensitivity, blue/yellow anomaloscopy, flicker fusion frequency, Amsler grid, and photostress recovery time were correlated with Snellen acuity using the Pearson correlation coefficient. The regression of the Snellen acuity on sex, age and the presence of disciform macular degeneration in the other eye was obtained using a general linear model. RESULTS: The correlation with Snellen acuity result was low for all tests. It was highest for Amsler grid abnormality (r = -0.33345) and blue/yellow anomaloscopy matching range (r = -0.20742), where r denotes the correlation coefficient. Patient age was strongly correlated with Snellen results (P = 0.0001), but it was not significantly related to sex (P = 0.1187) or the presence of disciform macular degeneration in the other eye (P = 0.9989). The photostress recovery time showed enormous inter-visit variations and poor correlation with Snellen acuity (P = 0.0526). CONCLUSIONS: The course of AMD is routinely assessed by Snellen acuity and any of several additional tests. When employing a test battery in an office setting, a clinician needs to know the relative utility and correlation between the tests at his disposal. Of the tests used in this study, the Amsler grid was the most useful addition to the Snellen acuity at all stages of atrophic macular degeneration, and blue/yellow anomaloscopy was useful only in mild macular degeneration where Snellen acuity was 6/12 or better.

Aged↗

Colour vision tests and colour naming by thirteen incomplete achromats in Bishnupur.

As an exploratory study six colour vision tests were given to nine male and two female achromats from the Shankhabanik community in Bishnupur, and to two additional similar males. All thirteen subjects had severe photophobia, fixation nystagmus, extreme weakness of vision (4/24 to 3/60) and the red end of the spectrum was much shortened. This research indicates that they had a form of incomplete achromatopsia, varying from an almost complete to a very severe partial loss of colour vision. The condition is inherited as an autosomal recessive. The most likely interpretation of these cases is that they are incomplete rod achromats. Their performance on the colour vision tests is tabulated, and shows complete inability to do the Ishihara test; nearly complete inability on the HRR test, with a possible slight tendency to do better in the yellow-blue than the red-green sub-tests; on Sloan's test they show approximate accordance with her results for achromats; they have severe difficulty with the dichotomous and 100-hue tests, with a possible slight tendency to make fewer errors on the G/B sections. The anomaloscope shows little abnormality of mid-matching points, but great increases in average matching ranges above the normal, although not absolute loss of colour sense, but with extreme darkening or shortening of the red end of the spectrum. Their colour naming was carefully recorded, and was fairly good occasionally, sometimes erroneous without being wildly at fault, and most often completely wrong. The records of colour naming were made, not, of course, as a form of colour vision test, but simply to illustrate the ways in which such defectives make an effort to use colour names in general use among their friends and relatives.

Adult↗

Repeatability of the C-100 colour vision test.

BACKGROUND: The C-100 colour vision test has been shown to have a high validity for diagnosing the type of red-green colour vision defect, however, there is little information on the repeatability of the test. This study examines the repeatability of the C-100 in classifying the colour vision defect as either protan or deutan. METHODS: The C-100 was administered on two occasions to 58 subjects with congenital red-green colour vision defects. The sessions were separated by a minimum period of 10 days. RESULTS: The repeatability of the C-100 was high with a kappa coefficient of agreement for diagnosis of 0.96. The few discrepancies were misclassifying protans as deutans. CONCLUSION: The C-100 is a highly repeatable test in terms of separating protans from deutans. However, if a discrepancy occurs, it is more likely to be a protan misclassified as a deutan rather than vice versa.

Adult↗

A table of color distance scores for quantitative scoring of the Lanthony Desaturate color vision test.

The Lanthony Desaturate Panel D-15 (D-15d) color vision test is used in neurotoxicological testing to assess acquired color vision deficits. The original test design included a qualitative scoring method. Quantitative scoring requires mapping the colored objects used in the test into a color space describing perceptual distances. A table of these distances has previously been published for the saturated version of this color vision test, but not the desaturate test. This communication includes a table of color distances for the calculation of Bowman's Total Color Distance Score (TCDS) for the D-15d. This table should be useful for non-computerized scoring under field test conditions or for devising one's own computerized scoring methods using the tabulated color distances for a look-up table. Data analysis programs using SAS or Matlab are available from the author.

Color↗