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A consideration of the racial incidence of congenital dyschromats in males and females.

The female incidence of congenital dyschromats corresponds to the square of the males in the Northern European populations, but this relation is not always true in the non-white races. The above-mentioned facts in the non-white races which are theoretically strange are considered to be caused by an anti-glare factor of pigment epithelium in their eyes, on the assumption that the abnormal color sense of color defectives may be a special form of visual dysfunction glare pointed out by IINUMA.

Asian People

On the incidence of unilateral and bilateral colour blindness in heterozygous females.

In 303 mothers of colour-blind sons, both eyes were tested with pseudoisochromatic plates and with the anomaloscope. Two hundred thirty healthy normal and 56 colour-blind males served as controls. In good agreement with the expected proportion of homozygotes in our sample, 17 colour-blind mothers were detected. Eight others had difficulty reading pseudoisochromatic plates and were conspicuous at the anomaloscope. In these, both eyes were affected to a very similar, moderate degree. Monocular disturbances of colour vision were not observed in the entire series. Our data suggest that (1) in most (if not all) of the carriers with colour vision impairment, there is no complete lack of normal retina cones, and (2) the proportion of defective retina cones is remarkably similar in both eyes of individual heterozygotes. The latter observation may indicate that at the time of X-differentiation there is a common primordial cell pool for both retinas.

Adolescent

Congenital color blindness.

The term "color blind" is encountered frequently in areas pertaining to health, commerce, art, and entertainment, but in these cases it is generally not appropriate. Complete color blindness or achromasy is rare, but weakness or absence of discrimination to certain colors can be found in at least 8% of the male population. The most useful description of these color defects is in terms of hue and saturation, thresholds of which can be plotted as polar coordinates on a circular diagram. Plotting color thresholds with the chromagraph reveals more clearly than other clinical systems the true nature of color defects, as well as some inconsistencies in the traditional terminology and test methods. Fifty strongly color-defective subjects were tested by five different methods and the results compared. Normal values are also indicated.

Color Perception Tests

The influence of selected light intensities on color perception within the color range of natural teeth.

A study was undertaken to evaluate the influence of light intensity on the ability to discriminate color differences within the color range of natural teeth. The results show that shade selection is not significantly affected within the range of 75 to 300 fc. Neither the specialty of the dentist nor the amount of time in practice appeared to be a factor in making color discriminations. However, 7 of the 50 dentists serving as subjects were found to be color defective, and a difference was found between their color discrimination abilities and those of normal persons. This suggests that color-defective dentists should obtain assistance when matching tooth shades.

Color

Assessment of children's colour vision using the Pickford-Nicolson anomaloscope.

The colour vision of 439 boys, aged 4-11 years, was measured by the Pickford-Nicolson anomaloscope and four pseudoisochromatic tests. Matching range and dispersion of mid match point were found to be larger than adult values, but did not decrease with age. However, younger children took longer to establish matching range. Twenty-eight (6.4%) colour defectives were found and it is concluded that the Pickford-Nicolson anomaloscope gives valid results with children.

Age Factors

A simple eyesight screening programme for dental undergraduates: results after 7 years.

This paper reports the results of a simple eyesight screening programme for dental undergraduates which has been used for 7 years. Examinations were performed by orthoptists at a general hospital associated with the dental school. Defects in visual acuity, squints, limitations of convergence, defective stereopsis and colour vision were found. Many students were unaware of their visual defects, and the findings support the continued use of visual screening to identify and encourage those with defects to seek professional treatment at an early opportunity. Many of the defects were correctable or could be improved with help. Those with defective colour-vision were encouraged to seek assistance with shade selection during their clinical careers. The value of visual screening and the significance of the findings are discussed.

Color Vision Defects

A new way to use the Ishihara test.

The Ishihara plates are widely used as a test for colour vision. Originally designed for the purpose of detecting congenital red-green colour blindness, the test also has some value in demonstrating acquired colour vision defects. There are, however, several disadvantages in the present arrangement of the plates. A modification of the test, involving the rearrangement of the order of the plates, is presented which, together with a new recording chart, simplifies both the administration and the interpretation of the test.

Color Perception

The use of colour difference vectors in diagnosing congenital colour vision deficiencies with the Farnsworth-Munsell 100-hue test.

Colour difference vector analysis provides useful and meaningful information in scoring the Farnsworth-Munsell (FM) 100-hue test. However, the FM 100-hue test is limited in its ability to diagnose type and severity of congenital colour vision defect. Type classification for all subjects is incorrect in 21% of cases, and for deuteranomals the misclassification rate is 38%. Visual inspection of the plots yields a similar misclassification rate and classification of plots with few errors (under 180) is generally less reliable. The FM 100-hue test has a limited ability to separate dichromats from anomalous trichromats. A test protocol based on joint D15 and FM 100-hue tests should pass 36% of anomalous trichromats and 26% of all colour defectives yet fail all dichromatic observers. We conclude that administering the FM 100-hue test is of less value than a combination of D15 panels (Standard D15 and L'Anthony's desaturated D15) in the clinical diagnosis of congenital colour defective observers. Our results for the FM 100-hue panel are similar to those reported previously by other investigators.

Adult

Late onset dominant cone dystrophy with early blue cone involvement.

A dominant cone dystrophy spanning seven generations was found in a pedigree from the Netherlands. The onset of the decline of visual acuity started after the age of 20, while a near complete absence of blue cone function (a so-called tritan defect) already existed before the presence of any ophthalmological abnormalities.

Adolescent

A family with acquired and inherited blue-yellow axis.

The pedigree of a family with a blue-yellow axis in the Farnsworth 100-Hue is reported. The fact that a blue-yellow axis corresponds to an inherited defect in 6 subjects and to an acquired defect in 1 subject is discussed. Methodological conditions necessary for making the differential diagnosis between an inherited and an acquired blue-yellow defect are recalled.

Adult

Visual fields: simplified screening and recording procedures.

In some cases, visual field screening must be greatly simplified in order to obtain clinically useful information. This becomes possible when specific techniques are used for anomalies such as relative central scotoma, hemianopsia, and glaucomatous field defects. A working knowledge of visual pathway anatomy and function enables the optometrist to efficiently screen for these disorders by confrontation with red test objects, with pseudoisochromatic plates, and with the tangent screen. After the type of field defect has been determined by initial screening, recording its parameters with the tangent screen follows easily.

Color Perception Tests

Incomplete achromatopsia in Bishnupur.

Nine males and 2 females from the Shankhabanik Community in Bishnupur, provisionally diagnosed as incomplete rod achromats by Bose, Joardar and Sukul in 1968, with 2 new similar males, were tested more fully with six colour vision tests. All had photophobia, nystagmus of fixation, extremely low visual acuity and extreme loss of colour sense with shortened red spectrum. 40 other males and 24 females, relatives of the defectives, were also tested for comparison. The provisional diagnosis was confirmed, and the hypothesis of autosomal inheritance seemed most probably true. Various details about the relatives emerged.

Color Vision Defects

A time induced tritan defect.

It is hypothesized that if blue is signalled more slowly than red in the visual system, and if integration time is longer for blue than for red, then a tritan defect should be apparent for normal observers. Data from short-exposure viewing of the City University Colour Vision Test indicate that, at 3.75 msec. a significant tritan error occurs.

Adult

Visual deficits in children born at less than 32 weeks' gestation with and without major ocular pathology and cerebral damage.

AIMS: A study was carried out to compare the visual abilities of prematurely born children with those of matched full term controls. METHODS: The vision of 68 children born at less than 32 weeks' gestation and aged between 5 and 7 1/2 years at the time of testing was compared with that of a control group of children born at full term, and matched for sex and age from due date. RESULTS: The premature children had significantly poorer distance and near visual acuity, contrast sensitivity and stereopsis, and a high incidence of colour vision defects (predominantly tritan type). These differences were associated with the high incidence of ocular pathology experienced by 31 (45%) of the premature children compared with only nine (13%) of the controls. When excluding children with ocular and cerebral pathology, 32 matched pairs of premature and control children remained. The 32 premature children did not differ from their controls in terms of distance and near acuities or stereopsis, but they did have significantly poor contrast sensitivity in both their 'best' and 'worst' eyes. None of the 32 control children had colour vision defects, compared with seven of the matched premature children. CONCLUSION: This adds support to previous speculation that the preterm eye is at risk of subtle visual impairment independent of the occurrence of refractive error, manifest squint, disorders of the fundus and media, and cerebral damage.

Cerebral Palsy

[Cerebral achromatopsia (symptoms, course, differential diagnosis and examination strategy). II].

To the patient, the sudden onset of cerebral achromatopsia is like switching to black and white on a color TV. As a rule, the defect arises due to bilateral ischemic infarction in the inferior occipitotemporal region. Bilateral upper homonymous quadrantanopsias usually leave the macula more or less unimpaired, so that visual acuity is largely preserved. Prosopagnosia and loss of topographic memory are often associated with central achromatopsia. Investigations of color vision must include color-naming procedures and large-field tests in addition to the conventional methods. Color-naming tasks are indispensable in differentiating cerebral achromatopsia from the aphasic and disconnective types of color anomia. The authors' recommended strategy for investigating color vision relies on records of a case of cerebral achromatopsia obtained six months and two years, respectively, after the onset of symptoms. In addition to the above-mentioned procedures, spectral increment thresholds on white and colored backgrounds were determined. For the first time in cerebral achromatopsia, examinations with large-field spectral matches were performed using the projection anomaloscope. Large-field tests are indispensable for monitoring recovery in cases of central achromatopsia. In the author's patient, recovery of blue-green discrimination was far more complete than that of red-yellow-green discrimination, and for both conditions large-field color vision was far superior to small-field.

Anomia

[Cerebral achromatopsia (symptoms, course, differential diagnosis and strategy of the study). I].

To the patient, the sudden onset of cerebral achromatopsia is like switching to black and white on a color TV. As a rule, the defect arises due to bilateral ischemic infarction in the inferior occipitotemporal region. Bilateral upper homonymous quadrantanopsias usually leave the macula more or less unimpaired, so that visual acuity is largely preserved. Prosopagnosia and loss of topographic memory are often associated with central achromatopsia. Investigations of color vision must include color-naming procedures and largefield tests in addition to the conventional methods. Color-naming tasks are indispensable in differentiating cerebral achromatopsia from the aphasic and disconnective types of color anomia. The authors' recommended strategy for investigating color vision relies on records of a case of cerebral achromatopsia obtained six months and two years, respectively, after the onset of symptoms. In addition to the above-mentioned procedures, spectral increment thresholds on white and colored backgrounds were determined. For the first time in cerebral achromatopsia, examinations with large-field spectral matches were performed using the projection anomaloscope. Large-field tests are indispensable for monitoring recovery in cases of central achromatopsia. In the author's patient, recovery of blue-green discrimination was far more complete than that of red-yellow-green discrimination, and for both conditions large-field color vision was far superior to small-field.

Aged

Bishnupur achromats and their relatives (an exploratory study with six colour vision tests).

Thirteen subjects from the 'Sankhabaniks' of Bishnupur and two new similar cases were given six colour vision tests. All had photophobia, fixation nystagmus, low visual acuity and marked, though not complete, loss of colour sense. Forty other males and 24 females related to the defectives were also tested with at least five of the tests, for comparison. The tests were Ishihara, HRR test, Sloan's Achromatopsia test, the Dichotomous (D 15) test, Hundred Hue test and the Pickford-Nicolson Anomaloscope. The present research confirmed the provisional conclusion of Bose et al. (1968) that the achromatopsia in Bishnupur is an autosomal recessive character. That women relatives of the achromats showed greater average error scores with the Dichotomous test, the Hundred Hue test and the Sloan's test than male relatives, suggests that the defect is more readily manifested in males, and that the female relatives would include a number of genetic defectives with incomplete manifestation due to sex control. The defectives were clearly distinguished from the relatives as a group.

Adult