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We examined 50 patients with endogenous depressions and 50 patients with schizophrenic psychosis. We found disturbed colour vision in 54 % of the endogenous depressions and in 72 % of the schizophrenic psychosis. We discuss the aetiopathogenic from disturbed colour vision in the endogenous psychosis.
BACKGROUND: The color arrangement test can be applied for early diagnosis of diabetic retinopathy, even small confusion of colors influence clinical diagnosis. It is therefore necessary to be aware of influential factors. METHODS: Forty-four patients with color-experience (VW-Werk Wolfsburg) were included and devided in two groups: group 1: non-smokers without ophthalmological and systemic diseases (n = 27, 42+/-9 years), group 2: smokers without ophthalmological and systemic diseases (n = 17; 43+/-8 years). The control group 3 (n = 30; 42+/-4 years) included non-smokers and the control group 4 (n = 10; 42+/-8 years) smokers, both groups without color-experience, ophthalmological and systemic diseases. Besides the ophthalmological examinations (visual acuity, refraction, intraocular pressure, slit lamp and fundus examination) the color-vision was tested by the color-arrangement-test Roth 28-hue (E) desaturated monocularly under standard conditions: The background used was black cardboard, illuminated by two Osram fluorescent lamps (L36W/12LDL Daylight) providing 2000 lux at the test table. RESULTS: Ophthalmological examination in all subjects was without pathological findings. The mean error score in the non-smokers with color-experience (median+/-mean absolute deviation: 48+/-47) was lower than in the non-smokers without color experience (72+/-45; Mann-Withney-U-Test: p = 0.02). The mean error score in the smokers with color-experience (60+/-60) was lower than in the smokers without color-experience (156+/-65; p = 0.0014). No statistically significant difference was found between the measurements of the right and left eye (Wilcoxon-Test: group 1: p = 0.89; group 2: p = 0.9; group 3: p = 0.77; group 4: p = 0.87). CONCLUSION: Color experience improves the results in color-arrangement-tests like the Roth 28-hue (E) desaturated and should be considered in quantitative evaluation.
Unexplained visual acuity loss requires a systematic approach to gather as many findings of diagnostic value as possible. Most retinal or optic nerve diseases are accompanied by color vision disorders. The type and severity of color vision disorders may provide additional diagnostic or guiding information or may uncover aggravating or simulating factors.
BACKGROUND: Rapidly progressing bilateral night blindness in an elderly patient suggests primarily a diagnosis of paraneoplastic retinopathy. Occasionally diffuse rod dysfunction can result from vitamin A deficiency. HISTORY AND SIGNS: A 70-year-old man complained of progressive night blindness and xanthopsia for the past 6 months. Visual acuity was 0.8 in both eyes with severe dyschromatopsia. Slit-lamp and fundus examination were normal. Visual field disclosed bilateral depression. Scotopic full-field ERG was severely reduced. The patient's medical history revealed an acute pancreatitis one year ago, followed by chronic jaundice and an increased blood bilirubin. Serum vitamin A level was decreased to 0.1 micromol/L (normal range 1.5 to 4.0). THERAPY AND OUTCOME: Intramuscular injections of vitamin A were provided. Subjective visual improvement was reported already one day after initiation of therapy. Scotopic full-field ERG was markedly improved 3 days after the injection and was only slightly subnormal 3 months later. CONCLUSIONS: In developed countries, vitamin A deficiency usually results from malabsorption syndromes and manifests initially by rod more than cone dysfunction. This diagnosis should be entertained early as vitamin A supplementation induces a rapid restoration of vision.
Colors play a major role in the endoscopic diagnosis of many gastrointestinal conditions. Gastrointestinal endoscopists in the Netherlands are predominantly male (> 90%), and from population data it is to be expected that approximately 8% will have a color vision deficiency. The present study was designed to assess the prevalence of color vision deficiencies amongst Dutch gastrointestinal endoscopists and to determine whether color vision deficiency affects an endoscopist's diagnostic skill. One hundred and thirty-nine gastroenterologists and physicians of internal medicine took an F2 color vision test and assessed nine videofragments of endoscopies. Color vision deficiencies were detected in 8% of Dutch gastrointestinal endoscopists. In one out of the nine video excerpts of endoscopies, a statistically significant difference was detected between test subjects with and without a color vision deficiency. However, this video excerpt showed a green pea, which could not be mistaken for a polyp at polypectomy. The study therefore does not show any effect of color vision deficiencies on endoscopic skills, nor does it show any deviant prevalence of color vision deficiencies amongst Dutch gastrointestinal endoscopists.
We recorded electroretinograms (ERG) with white and color stimuli in normal persons and four patients with cone dystrophies. Kodak Wratten-filters in blue, blue-green, green, yellow and red were used for the color flashes. ERGs to all color stimuli were recorded at dark and light adapted conditions with different stimulus intensities, to 30 Hz flicker stimulation and with special filtering for oscillatory potentials. Selective blue cone-responses were obtained using strong blue flashes at a yellow background. Patients with cone dystrophies showed slightly to moderately reduced responses at dark adaptation to blue, blue-green, green and yellow stimuli. Red stimuli elicited only small responses with a markedly delayed b-wave implicit time. The light adapted recordings, flicker responses and oscillatory potentials were reduced to all color stimuli. However, differences between patients with cone dystrophies could be detected concerning the responses to red and green. In two patients the responses were reduced to the same degree to all color stimuli. Another patient had very small responses and no oscillatory potentials to red, but his responses were only moderately reduced to green. A patient with combined red-green cone and rod dystrophy had a blue cone hypersensitivity. Responses to blue and blue-green were large at all stimulus conditions, but responses to all other stimuli were much smaller. The blue cone ERG showed a prominent blue cone response. ERG recording to colored stimuli allows a separation of retinal dysfunction in patients with cone dystrophies.
This computer program is designed for faster elaboration of the Farnsworth-Munsell 100-Hue test. It is thus made user friendly, in that faultless input of data can be achieved, even by an untrained person. Evaluation is facilitated by the opportunity of representing two results at the same time. Examples of typical colour vision deficiencies are stored in a file and can then also be called up. Storing the results in a special data file helps to avoid the time consuming printing process. However, a hardcopy is supported by storing the last grafic in a standard PostScript-file, thus giving easy access to any printer. This program is applicable for IBM- or compatible PCs. Extensive use is possible by means of a software interface with the wide spread database-system DBASE.
In 1980 we started a long-term study at our department examining 54 Patients with p.c.t. (42 male, 12 female). Out of these patients, 32 were re-examined (23 male, 9 female) in 1986. No ocular lesions were found that might be attributable to the underlying disease. Possible symptoms of p.c.t. are an increased filling of the conjunctival vessels, a decreased tear's formation, as well as brownish pigmentations in conjunctiva, in the lid margin. These changes occur in the anterior eye segment. At the fundus, a dry, in part side-different macular destruction and uncharacteristic peripheral retinal degeneration were found. The most prominent functional disorders are the acquired colour vision deficiency Verriest Type III and FSM Type I, respectively. It is based upon the small decrease of the visual acuity (relative central scotoma), the decline in immediate adaption and the macular destruction. Possible etiopathogenetical links between the underlying disease and the tapetoretinal degeneration are discussed. The morphological and functional eye lesions are limited and show hardly any progression.
A patient who had been exposed to toluol for ten years developed acute erythropsia. The examinations leading to the diagnosis and the possible differential diagnosis are discussed.
Color contrast sensitivity was measured in laser operators before and after laser sessions. The tritan threshold was elevated after the sessions in all laser operators who had used argon (blue-green) lasers. No change was observed when lasers with longer wave-lengths were used. Elevation of the tritan threshold to above-normal levels was observed even before laser sessions. The thresholds remained increased even when the laser operator did not use a laser for 3 weeks. Thus, it appears that the damage caused by the argon blue-green laser is cumulative. Elevated tritan thresholds were also observed in patients with peripheral retinal breaks who were treated with an argon (blue-green) laser.
In the neurophysiological organization of the visual system, form, color, movement, and depth perception are processed separately. Therefore, sensorial examination methods should test each of these basic functions separately, since they may be affected individually or to different extents by pathologic processes. For diagnosis the limit of visual acuity, i.e., the capacity for discrimination must be searched for, using Paliaga's "limits method". Visual acuity can also be tested in infants by the preferential looking method. Contrast sensitivity is tested using sinusoidal grid patterns of varying contrast and spatial frequency. In routine practice, however, this is usually achieved more easily with acuity cards on which contrast is reduced in several stages. The "two-equation method" is a colorimetric test combining two metameric matches, red + green = yellow, and blue + green = cyan, for testing color vision. The test requires an anomaloscope or anomalometer with four light channels. With this method it is possible to test the "red", "green", and "blue" cones and the "red-green" and "blue-yellow" opponents. The test provides a qualitative and quantitative evaluation of color vision disorders. If no colorimeter is available, classic printed test can be used. However, they might never achieve the same qualitative and quantitative precision.
Cone and rod functions of three blue cone monochromats (age 13-20, male) from three different families were investigated. In contrast to rod monochromats, they lack prominent nystagmus. Color matches as determined using the Nagel anomaloscope came close to those of rod monochromats but the green primary appeared slightly brighter to them. In color discrimination tests (Farnsworth-Munsell 100-hue and Panel D-15 desaturated), maximum confusion followed protan rather than scotopic axes. Measurements of spectral sensitivity revealed action spectra exclusively of blue sensitive cones, even under conditions that should isolate green- or red-sensitive cones. After 20 minutes of dark adaptation, rods determined the spectral sensitivity function. Transient tritanopia, which in normals results from the interaction between cones sensitive to short and long wavelengths, was completely absent in blue cone monochromats. Visual acuity (Snellen charts and contrast gratings) revealed values between 20/200 and 20/60. Recognition of high-spatial low-contrast gratings was improved by blue cut-off filters (Schott BG 28) and considerably worsened by yellow cut-off filters (Schott OG 510). Since alteration of visual acuity induced by cut-off filters was not found in rod monochromats, this two-filter test is a means of differentiating quickly between rod achromats and blue cone monochromats. As the mode of inheritance is autosomal recessive in rod achromats and x-linked recessive in blue cone monochromats, differential diagnosis is important for correct genetic counseling.
Using the Farnsworth-Munsell 100-hue test, investigations were carried out in 14 patients with subtoxic to toxic serum concentrations of digoxin (greater than 2.0 ng/ml) and 13 patients with subtoxic to toxic serum concentrations of digitoxin (greater than 30 ng/ml), in order to detect color vision deficiencies related to serum levels of digitalis. As compared to the control group (n = 24) the total error scores were significantly increased for both glycosides and all serum level ranges. No evidence was found indicating that digoxin and digitoxin influence color vision differently. The FM 100-hue test indicated definite improvements in the digoxin group within one day of discontinuing the glycosides, while the digitoxin group only started to normalize a week later. The results are discussed, taking the different pharmacokinetics of the two digitalis glycosides into account.
A 65-year-old patient sustained a transient left-sided sensomotoric monoparesis with homonymous hemianopsia. One day later there was an acute deterioration in the patient's vision and he developed achromatopsia, prosopagnosia, disturbance of spatial orientation and a homonymous upper hemianopsia. Six months later the findings are about the same. The CT shows a bioccipital lesion with left-sided accentuation, extending dorsocaudally. The origin of the cerebral infarct is presumably a vertebrobasilar insufficiency due to congestive cardiomyopathy and atrial fibrillation.
Three variants of a new anomaloscope principle are described. This principle is distinguished by the fact that for generation of the mixed color and the reference color three interference filters with narrow band widths are used instead of an expensive dispersion prism. In the first variant the brightness of the mixed color field and the reference field is determined by three detectors (silicon diodes) and kept constant taking the relative spectral response into consideration. The degree of anomalous color vision present is indicated digitally by a microprocessor whose interface also permits data processing equipment to be connected. The second variant uses only one detector which sequentially pulses the three light sources and distributes the results to different signal channels for further processing. In the third variant, measurement is performed in the same way as in the second variant but with only one light source. Fiber optic bundles illuminate of the mixed color and reference fields and also permit adaptation of the eye to neutral. In this case additional optical attenuators are required to keep the luminance of the fields constant. An advantage shared by all three variants is that they have virtually no moving parts, employing monochromatic filters and cemented prism blocks with high-quality electronics. This has made it possible to produce a compact, rugged and efficient new-generation anomaloscope, which renders the considerable calibration and maintenance work previously necessary superfluous.
In the Federal Republic of Germany nearly 4 million patients receive cardiac glycosides. Intoxication rates of up to 20% have been reported. About 80% of digoxin-intoxicated patients show generalized color vision deficiencies. Ophthalmologists should pay more attention to color vision disturbances due to digitalis.
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