Color Vision Deficiency Survey in Anatomic Pathology

OBJECTIVES

To learn what color vision-deficient pathologists and cytotechnologists consider their most significant problems and advantages as well as any accommodations.

METHODS

An anonymous online survey developed for practicing pathologists and cytotechnologists regarding their experiences with stains was sent to the members of 4 national societies.

RESULTS

We received 377 responses. Twenty-three people, all men, identified themselves as color vision deficient, with 22 reporting red-green color vision deficiency and 1 reporting uncertain type. Eight pathologists and cytotechnologists indicated that they thought that their color vision deficiency conferred advantages to them, including a greater appreciation of morphology, with less confusion resulting from variations in stain quality or intensity. Nineteen pathologists and cytotechnologists thought that their color vision deficiency conferred disadvantages; the most common disadvantages stated were the identification of eosinophils and acid-fast bacilli. Other difficulties included interpretation of RBCs and nucleoli and sometimes Alcian blue, Brown and Brenn, Congo red, crystal violet, Fite, Giemsa, mucicarmine, periodic acid-Schiff, and fluorescence in situ hybridization stains. Only 2 of the color vision-deficient pathologists and cytotechnologists found digital slides more difficult than glass slides.

CONCLUSIONS

Color vision-deficient pathologists and cytotechnologists report that they have developed approaches to viewing slides that do not compromise their interpretations. Digital pathology may provide several approaches for aiding color vision-deficient pathologists with the interpretation of certain stains.

Inverse-Designed Aid Lenses for Precise Correction of Color Vision Deficiency

Color vision deficiency (CVD) is a common ocular disorder affecting more than 300 million people on the earth. Although no clinical cure for the disorder currently exists, some specialized color filtering glasses/lenses based on dyes, metasurfaces, or nanocomposites have been employed for CVD management. However, as CVD patients usually diversify in their classification and severity, none of the current lenses provides a customized correction for various CVD patients, resulting in undesirable correction effects. Here, we present an inverse-designed approach for the precise correction of CVD. The wavelength shift of a patient's abnormal cone photoreceptors was measured to inversely design the best blocking wavelength and blocking rate of the lens. Then the customized aid lenses were fabricated using silica-coated gold nanoparticles with appropriate sizes and concentrations, verified by the simulated color vision and human tests. This study demonstrates the potential of the inverse-designed aid lenses in precise color filtering and customized CVD management.

ColourSpot, a novel gamified tablet-based test for accurate diagnosis of color vision deficiency in young children

There is a need for a straightforward, accessible and accurate pediatric test for color vision deficiency (CVD). We present and evaluate ColourSpot, a self-administered, gamified and color calibrated tablet-based app, which diagnoses CVD from age 4. Children tap colored targets with saturations that are altered adaptively along the three dichromatic confusion lines. Two cohorts (Total, N = 772; Discovery, N = 236; Validation, N = 536) of 4–7-year-old boys were screened using the Ishihara test for Unlettered Persons and the Neitz Test of Color Vision. ColourSpot was evaluated by testing any child who made an error on the Ishihara Unlettered test alongside a randomly selected control group who made no errors. Psychometric functions were fit to the data and “threshold ratios” were calculated as the ratio of tritan to protan or deutan thresholds. Based on the threshold ratios derived using an optimal fitting procedure that best categorized children in the discovery cohort, ColourSpot showed a sensitivity of 1.00 and a specificity of 0.97 for classifying CVD against the Ishihara Unlettered in the independent validation cohort. ColourSpot was also able to categorize individuals with ambiguous results on the Ishihara Unlettered. Compared to the Ishihara Unlettered, the Neitz Test generated an unacceptably high level of false positives. ColourSpot is an accurate test for CVD, which could be used by anyone to diagnose CVD in children from the start of their education. ColourSpot could also have a wider impact: its interface could be adapted for measuring other aspects of children’s visual performance.

Prevalence of color vision deficiency among school-going boys in South India

Purpose:

Impact of color vision deficiency (CVD) on activities at school and productivity at work and consequential psychosocial difficulties has been reported. Although early detection and awareness help in overcoming these difficulties, screening for CVD is not a part of the school eye-screening initiatives in many countries. This study aimed at reporting the prevalence of CVD among school-going boys in Kanchipuram district, South India.

Methods:

The study was carried out as part of a school eye-screening program (SES) conducted in Kanchipuram district, Tamil Nadu, India for children between 6 and 17 years. The SES followed a three-phased protocol, which also included screening for CVD for all the boys between 11 and 17 years. The boys underwent CVD screening with Dalton's pseudo isochromatic plates (PIPs) followed by confirmation with Ishihara's PIP. The data were analyzed and the proportion of CVD in boys among different class grades, type of schools, location of schools, blocks of the district, and other clinical characteristics are presented.

Results:

Totally 250,052 children were screened in 1047 schools of which 74986 (60.61%) were boys between 11 and 17 years (mean age: 13.75 ± 1.91). The overall prevalence of CVD was found to be 2.76% (n = 2073; 95% confidence interval [CI]: 2.65–2.88). CVD was associated with urban locations (3.17% odds ratio [OR]: 1.90 95%CI: 1.69–2.13 P < 0.05) and public schooling (2.87%) (OR: 1.29 95%CI: 1.17–1.43 P < 0.05). Boys with CVD were less likely to have vision impairment (P = 0.002) and myopia (P < 0.001) as compared with boys with normal color vision. There was no significant difference in the proportion of other ocular conditions between children with and without CVD (P > 0.05).

Conclusion:

The study shows a significant proportion of CVD among boys in Kanchipuram district, India and its association with various demographic and clinical characteristics. Identification of CVD and counseling the stakeholders earlier through school children screening is crucial.

Color discrimination in anomalous trichromacy: Experiment and theory

In anomalous trichromacy, the color signals available from comparing the activities of the two classes of cone sensitive in the medium and long wavelength parts of the spectrum are much reduced from those available in normal trichromacy, and color discrimination thresholds along the red-green axis are correspondingly elevated. Yet there is evidence that suprathreshold color perception is relatively preserved; this has led to the suggestion that anomalous trichromats post-receptorally amplify their impoverished red-green signals. To test this idea, we measured chromatic discrimination from white and from saturated red and green pedestals. If there is no post-receptoral compensation, the anomalous trichromat's loss of chromatic contrast will apply equally to the pedestal and to the test color. Coupled with a compressively nonlinear neural representation of saturation, this means that a given pedestal contrast will cause a smaller than normal modulation of discrimination sensitivity. We examined cases where chromatic pedestals impair the color discrimination of normal trichromatic observers. As predicted, anomalous observers experienced less impairment than normal trichromats, though they remained less sensitive than normal trichromats. Although the effectiveness of chromatic pedestals in impairing color discrimination was less for anomalous than for normal trichromats, the chromatic pedestals were more effective for anomalous observers than would be expected if the anomalous post-receptoral visual system were the same as in normal trichromacy; the hypothesis of zero compensation can be rejected. This might suggest that the effective contrast of the pedestal is post-receptorally amplified. But on closer analysis, the results do not support candidate simple models involving post-receptoral compensation either.

The prevalence of color vision deficiency in the northeast of Iran

PURPOSE

To determine the prevalence of color vision deficiency (CVD) in the northeast of Iran.

METHODS

This cross-sectional, population-based study was conducted in Mashhad, in the northeast of Iran. Multistage cluster sampling was used for selecting the participants. After preliminary screening, the subjects underwent a complete ophthalmic examination. The examination included the measurement of visual acuity, refraction, and slit-lamp biomicroscopy. The Farnsworth D-15 test was used to detect CVD. The color vision test was done with the best optical correction.

RESULTS

Of the 4453 invitees, 3132 participated in the study (response rate: 70.4%). The overall prevalence of CVD in this study was 13.93% [95% confidence interval (CI): 12.44-15.41]. The prevalence of CVD in males and females was 15.85% (95% CI: 13.26-18.44) and 12.96% (95% CI: 11.22-14.71), respectively. The most prevalent types of CVD were tritanopia (6.96%; 95% CI: 5.84-8.08), deuteranopia (3.92%; 95% CI: 3.14-4.70) and tritanomalous (2.21%; 95% CI: 1.55-2.86), respectively. According to the results of logistic regression, the odds of having protanopia were higher in females than males [Odds ratio (OR) = 4.80; 95% CI: 1.20-19.18]. The odds of having deuteranopia were lower in females than males (OR = 0.52; 95% CI: 0.35-0.76). The odds of having CVD were lower in 16-30 (OR = 0.52; 95% CI: 0.37-0.73) and higher in 46-60 (OR: 1.41; 95% CI: 1.01-1.97) year age groups compared to 7-15 year age group. The odds of having tritanopia in 16-30 and 46-60 year age groups was 0.56 (95% CI: 0.35-0.90) and 1.79 (95% CI: 1.19-2.67) compared to 7-15 year age groups, respectively.

CONCLUSION

The prevalence of CVD was high in this study, especially in males and people over 46 years of age. Planning for involvement of ocular disease control programs in health care systems can be helpful in the reduction of CVD and improving the quality of life in affected patients.

Discrimination of colors by red-green color vision-deficient observers through digitally generated red filter

Previous studies have shown that with the use of tinted lenses (or colored filters), individuals with red-green color vision deficiency (CVD) report an improvement in their performance on certain color vision tests. In this context, this study examines the effects of a digitally generated red-colored filter and identifies the mechanism mainly responsible for the changes in red-green CVD observers' performance on a D-15 arrangement test performed using the filter. We simulate the red filter digitally with the spectral transmittance similar to that of the X-Chrom, which is a red-tinted lens. Fourteen red-green CVD subjects are subjected to the D-15 test on a computer monitor under four filter conditions, consisting of one condition without the filter and three conditions with the filter, corresponding to the opacity of the red filter. The results show that while the simulated red filter improves the performance of deutans to arrange the caps in the D-15 test, this is not the case for protans. In addition, considerations based on the human cone-contrast model enable us to identify that the improvement in deutan observers largely results from the increase in the luminance contrast between stimuli and a background. To summarize, the red filter simulated in this study induces different changes in the red-green CVD observer luminance contrast between the protan and deutan types, with the result that the performance of deuteranopes improves while that of protanopes deteriorates.

Contrast sensitivity of patients with congenital color vision deficiency

PURPOSE

To investigate the static and dynamic contrast sensitivity (CS) of patients with congenital red-green color vision deficiency (CVD) and to compare these values with those of healthy control subjects.

METHODS

The study included 25 subjects with congenital CVD (10 with strong protan defect and 15 with strong deutan defect) and 20 age- and gender-matched healthy subjects. Following detailed ophthalmological examination, monocular static and dynamic CS measurements were taken with the Monpack3 device (Metrovision, Perenchies, France) on all subjects. The data from the right eyes of all the subjects were used for statistical analysis.

RESULTS

The mean age of the groups was similar (deutan group: 25.3 ± 11.3 years, protan group: 27.1 ± 12.2 years, control group: 26.7 ± 8.8 years, p = 0.98). The mean static and dynamic CS values in the protan and deutan groups were higher compared to those of the healthy control subjects, but not at a statistically significant level (all p > 0.017).

CONCLUSION

The static and dynamic CS values of patients with congenital red-green CVD were similar to those of healthy control subjects.

Frequency of color blindness in pre-employment screening in a tertiary health care center in Pakistan

Objective:

To describe the frequency of color vision deficiency among Pakistani adults presenting for pre-employment health screening in a tertiary care hospital.

Methods:

The cross-sectional study was carried out at the Aga Khan University Hospital, Karachi, and the data was collected for color vision deficiency, age, gender, and job applied for from pre-employment examination during 2013-2014. IBM SPSS 20 was used for statistical analysis.

Results:

Three thousand four hundred and thirty seven persons underwent pre-employment screening during 2013 and 2014; 1837 (53.44%) were males and 1600 (46.65%) females. The mean age was 29.01 (±6.53) years. A total of 0.9% (32/3437) persons had color vision deficiency with male being 1.4% and female 0.4%.

Conclusion:

Color vision deficiency was observed in 0.9% of candidates screened for pre-employment health check up in a tertiary care hospital. The color vision deficiency was predominantly present in male individuals.

Prevalence of color vision deficiency among arc welders

PURPOSE

This study was performed to investigate whether occupationally related color vision deficiency can occur from welding.

METHODS

A total of 50 male welders, who had been working as welders for at least 4 years, were randomly selected as case group, and 50 age matched non-welder men, who lived in the same area, were regarded as control group. Color vision was assessed using the Lanthony desatured panel D-15 test. The test was performed under the daylight fluorescent lamp with a spectral distribution of energy with a color temperature of 6500K and a color rendering index of 94 that provided 1000lx on the work plane. The test was carried out monocularly and no time limit was imposed. All data analysis were performed using SPSS, version 22.

RESULTS

The prevalence of dyschromatopsia among welders was 15% which was statistically higher than that of nonwelder group (2%) (p=0.001). Among welders with dyschromatopsia, color vision deficiency in 72.7% of cases was monocular. There was positive relationship between the employment length and color vision loss (p=0.04). Similarly, a significant correlation was found between the prevalence of color vision deficiency and average working hours of welding a day (p=0.025).

CONCLUSIONS

Chronic exposure to welding light may cause color vision deficiency. The damage depends on the exposure duration and the length of their employment as welders.

A method for identifying color vision deficiency malingering

PURPOSE

To propose a new test to identify color vision deficiency malingering.

METHODS

An online survey was distributed to 130 truly color vision deficient participants and 160 participants willing to simulate color vision deficiency. The survey contained three sets of six color-adjusted versions of the standard Ishihara color plates each, as well as one set of six control plates. The plates that best discriminated both participant groups were selected for a "balanced" test emphasizing both sensitivity and specificity. A "specific" test that prioritized high specificity was also created by selecting from these plates. Statistical measures of the test (sensitivity, specificity, and Youden index) were assessed at each possible cut-off threshold, and a receiver operating characteristic (ROC) function with its area under the curve (AUC) charted.

RESULTS

The redshift plate set was identified as having the highest difference of means between groups (-58%, CI: -64 to -52%), as well as the widest gap between group modes. Statistical measures of the "balanced" test show an optimal cut-off of at least two incorrectly identified plates to suggest malingering (Youden index: 0.773, sensitivity: 83.3%, specificity: 94.0%, AUC of ROC 0.918). The "specific" test was able to identify color vision deficiency simulators with a specificity of 100% when using a cut-off of at least two incorrectly identified plates (Youden index 0.599, sensitivity 59.9%, specificity 100%, AUC of ROC 0.881).

CONCLUSIONS

Our proposed test for identifying color vision deficiency malingering demonstrates a high degree of reliability with AUCs of 0.918 and 0.881 for the "balanced" and "specific" tests, respectively. A cut-off threshold of at least two missed plates on the "specific" test was able to identify color vision deficiency simulators with 100% specificity.

A validation study regarding a generative approach in choosing appropriate colors for impaired users

In many circumstances, concepts, ideas and emotions are mainly conveyed by colors. Color vision disorders can heavily limit the user experience in accessing Information Society. Therefore, color vision impairments should be taken into account in order to make information and services accessible to a broader audience. The task is not easy for designers that generally are not affected by any color vision disorder. In any case, the design of accessible user interfaces should not lead to to boring color schemes. The selection of appealing and harmonic color combinations should be preserved. In past research we investigated a generative approach led by evolutionary computing in supporting interface designers to make colors accessible to impaired users. This approach has also been followed by other authors. The contribution of this paper is to provide an experimental validation to the claim that this approach is actually beneficial to designers and users.

Prevalence and gene frequency of color vision impairments among children of six populations from North Indian region

X-linked red-green color blindness is the most widespread form of vision impairment. The study aimed to determine the prevalence and gene frequencies of red-green color vision impairments among children of six different human populations of Jammu province. A total of 1028 healthy subjects (6-15 years of age) were selected from five Muslim populations and the color vision impairments were determined using the Ishihara's test of color deficiency. The gene frequency was calculated using Hardy-Weinberg equilibrium method. The prevalence of color vision deficiency (CVD) ranged from 5.26% to 11.36% among males and 0.00%-3.03% among females of six different populations. The gender based differences in the frequency of CVD was found to be statistically significant (p < 0.0001), with a higher prevalence among male (7.52%) as compared to female (0.83%) children. We observed high frequency of deutan as compared to protan defects. The incidences of deuteranomaly (5.68%) and deuteranopia (2.27%) were higher among male children of Syed population while the frequencies of protanomaly (1.94%), protanopia (1.28%) and achromacy (2.27%) were the highest among male subjects of Khan, Malik and Syed populations, respectively. The allele and genotype frequencies showed cogent differences among six populations. The population based assessment of CVDs help patients to follow adaptive strategies that could minimize the risks of the disease.