Color vision screening for individuals with intellectual disabilities: a comparison between the Neitz Test of Color Vision and Color Vision Testing Made Easy.

BACKGROUND: The Neitz Test of Color Vision (Neitz) and Color Vision Testing Made Easy(trade mark) (CVTME) were compared to determine which test was more effective in evaluating patients with intellectual disability (i.e., mental retardation) and developmental delay. METHODS: Two hundred eight Special Olympics floor hockey athletes were screened in San Diego, California, and 93 athletes were screened in Long Beach, California for a total of 301 athletes. Each athlete was administered the CVTME and the Neitz tests. RESULTS: The pass rate for the CVTME was 94.6% (n = 93) at Long Beach and 96.2% (n = 208) at San Diego. Every athlete was able to complete the CVTME. The pass rate for the Neitz was 38.7% at Long Beach and 56.7% at San Diego. Additionally, 10.8% of the Long Beach athletes and 12.5% of the San Diego athletes were unable to understand the Neitz. In addition, there was a low level of agreement between the results from the 2 tests with kappa = 0.081 for the San Diego data and 0.028 for the Long Beach data. CONCLUSIONS: This study suggests that the CVTME continues to be the screening test of choice in evaluating color vision in individuals with intellectual disability. The Neitz had more failing scores on the first attempt and more total failing scores leading to over-referrals, making it an inappropriate screening test for individuals with intellectual disability and developmental delay.     

Color changes in the red-green plates of the 50-year-old AO HRR color vision test

The original AO HRR color vision test has been considered by many as one of the best plate tests. It is still accepted by many governmental agencies for color vision certification. In their 1954 publication, Hardy, Rand, and Rittler stated that specially compounded inks were used for printing to avoid color changes with time. Fifty years later, it is both important and interesting to determine whether the wear and tear cause significant color changes. The chance finding of a never-used second edition offers an opportunity to evaluate the color changes. A GretagMacbeth Spectrolino spectrophotometer was used to measure the chromaticities of the never-used book, and an extensively used book. Four plates (#4, 7, 13, 16), selected randomly from the four red-green sections, were analyzed. The colored dots from each of the eight plates were plotted on a CIE chromaticity diagram. Isocolor lines were drawn to evaluate chromatic alignment. Chromaticities for plates #4 and 7 are significantly different between the two books. With regard to alignment with isocolor lines, the extensively used book is better than the never-used book for plate #4. There is significant misalignment on plate #7 for both books. Chromaticities for plates #13 and 16 are essentially identical between books, all with good alignment with isocolor lines. The overall comparison shows that the chromatic alignment characteristics of the extensively used book are not worse than the never-used book. Since colors in these plates have to be aligned with both the protan and deutan axes, any significant color changes would have disturbed this delicate requirement. The findings of many plates with good alignment, and the lack of differences on plates #13 and 16 between books, suggest that there are no significant color changes over time. Differences between books on plates #4 and 7 were likely the result of the original printing process.     

Colour vision screening in glaucoma: the Tritan Album and other simple tests

Results from simple colour vision tests used for the detection of (he Type III colour vision deficiency in glaucoma and ocular hypertension are presented. We assessed 49 patients with primary open angle glaucoma. 16 ocular hypertensives, 54 age matched normals and 50 young normal observers using six established tests and the recently introduced Tritan Album. This lest was introduced specifically for acquired colour vision deficiencies. Results show in general that individual tests have low sensitivity and poor screening efficiency. The best screening efficiency was achieved by the City University Colour Vision Test and the AO HRR plate test, no acquired tritan defects were identified by the Farnsworth F2 plate, and the Tritan Album had very low sensitivity (the lowest excluding the F2 plate). Best results were obtained from a combination of City University and HRR test scores and this combination could provide useful additional data on colour vision in a glaucoma screening programme.     

Visual acuity assessment: a comparison of two tests for measuring children''s vision

PURPOSE: To compare the Kay Picture Test and the logMAR Crowded Test. METHODS: Monocular visual acuity measurement was attempted on 103 paediatric subjects (aged between 2.5 and 16 years) attending eye clinics, using each of the visual acuity tests. RESULTS: The results obtained with the two tests were found to be comparable as confirmed with the Intra-class Correlation Coefficient, which revealed good agreement between the two tests. There was significant correlation between the visual acuity results measured and high conformity in the results from the weaker eye. There was a statistical difference in acuity scores between the tests; the Kay Picture Test gave a lower logMAR score with a mean difference of 0.08 logMAR. This 0.08 difference represents an actual difference of less than one line of acuity measure which can be considered to be clinically insignificant. There was a significant difference in the ability to perform each of the tests under binocular conditions, with more of the 50 children, aged 5 and under, able to perform the Kay Picture Test than the logMAR Crowded Test. CONCLUSIONS: The results obtained with the two tests are comparable. Both tests can be considered to be appropriate for amblyopia detection and the use of picture-based logMAR tests should be considered for younger children.     

Colour vision screening in children: an evaluation of three pseudoisochromatic tests

We examined 513 children (258 boys and 255 girls), between 3 and It years of age, with three pseudoisochromatic tests which involve different visual tasks. These were a selection of numeral designs from the Ishihara test, the Ishihara test for Unlettered Persons and the Velhagen Pflügertrident test. Eighteen children were found to be colour deficient. The symbol designs of the Unlettered Persons test were found lo be the quickest and most effective method for examining children under 7 years of age. After 7 years of age the symbol designs of the Unlettered lest and the numeral designs of Ishihara lest were equally effective. The preferred numeral designs for screening children with the Ishihara plates are listed. Verbal identification always produced the most accurate results, Drawing over the figures or selecting replicas increased the viewing lime and assisted children with normal colour vision lo see both figures in transformation designs, especially pathway designs. The Velhagen Pflügertrident test was found to be unreliable for colour vision screening and younger children had difficulty performing the figure matching task.     

Relation between perceived driving disability and scores of vision screening tests

AIM: To determine the relation between perceived driving disability and vision screening tests. METHODS: 93 subjects, aged 50 years and over, with binocular visual acuity of at least 20/80. Perceived driving disability (PDD) was assessed by a questionnaire. Subtracting daytime from night-time driving question scores revealed PDD at night (PDDN), subtracting scores of questions for driving in familiar places from those in unfamiliar places revealed PDD at unfamiliar places (PDDU). RESULTS: PDD was strongly related to visual acuity, contrast sensitivity and useful field of view (UFOV). Specific relations existed between PDDN and Nyktotests and Mesotests and between PDDU and UFOV. These associations were enhanced in a subset of subjects with better visual acuities. CONCLUSIONS: Vision screening tests correlate well with perceived driving disabilities, especially when a subtraction method is used in the questionnaire to reveal condition dependent disabilities. Additional tests for visual acuity are useful, especially in subjects with better visual acuity.     

Diagnostic accuracy of vision screening tests for the detection of amblyopia and its risk factors: a systematic review

Aim

This systematic review evaluates the diagnostic accuracy of preschool vision screening tests for the detection of amblyopia and its risk factors.

Methods

The literature searches were conducted in nine bibliographic databases. No limitation to a specific study design, year of publication or language was applied. Studies were included if they compared a vision screening test with a reference test (gold standard) in children from the general population. In addition, the studies had to provide sufficient data to calculate diagnostic accuracy (sensitivity and specificity). Full-text articles were assessed for studies that satisfied the inclusion criteria using the “Quality of Diagnostic Accuracy Studies (QUADAS)” checklist.

Results

Two studies with a longitudinal design and 25 cross-sectional studies met the inclusion criteria. One of the longitudinal studies compared a screening programme in children between 1 and 2 years of age with a re-examination at the age of 8. The sensitivity for the screening programme was 86% (range: 64–97%) and the specificity 99% (range: 98–99%). The second longitudinal study compared screening examinations at 8, 12, 18, 25 and 31 months, with a re-examination at the age of 37 months. In this study, the sensitivity of the screening examination increased with age, while the specificity remained unchanged. The cross-sectional studies evaluated different screening settings, visual acuity tests, auto- or photorefractors and stereo tests. A large variety of reference tests, differing criteria for defining amblyopia and its risk factors and methodological limitations of the studies prevented a valid data interpretation.

Conclusion

Diagnostic test accuracy of preschool vision screening tests can only be sufficiently investigated after establishing age-related values defining amblyopia, refractive errors and binocular disorders. To address these questions, we recommend a controlled longitudinal study design.     

Color vision disturbance in laser operators and patients: comparison of argon and dye lasers

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.     

Diabetes and color vision disorder detected by the Farnsworth 100 Hue test. Diabetic dyschromatopsia

Farnsworth 100 Hue test was used to investigate color vision in 100 diabetic patients. Blue Yellow axis dyschromatopsia was found in 66.5% of patients. Such a dyschromatopsia precedes diabetic retinopathy in 55% of patients. Its frequency increased as a function of the increasing severity of diabetic retinopathy. On the other hand, 36% of the patients suffering from dyschromatopsia misinterpreted the self-monitoring (urine and blood) tests. These results suggest that the investigation of color vision may be a useful tool for the early screening of diabetic retinopathy particularly in self-monitoring patients.     

Sensitivity of screening tests for detecting vision in preschoolers-targeted vision disorders when specificity is 94%.

PURPOSE: To compare the sensitivity of 11 preschool vision screening tests administered by licensed eye care professionals for the detection of the 4 Vision in Preschoolers (VIP)-targeted vision disorders when specificity is 94%. METHODS: This study consisted of a sample (n = 2588) of 3- to 5-year-old children enrolled in Head Start programs, 57% of whom had failed an initial Head Start vision screening. Screening results from 11 tests were compared with results from a standardized comprehensive eye examination that was used to classify children with respect to the four VIP-targeted vision disorders: amblyopia, strabismus, significant refractive error, and unexplained reduced visual acuity (VA). With overall specificity set to 94%, we calculated the sensitivity for the detection of each targeted vision disorder. RESULTS: With the overall specificity set to 94%, the most accurate tests for detection of amblyopia were noncycloplegic retinoscopy (NCR) (88% sensitivity), the SureSight Vision Screener (80%), and the Retinomax Autorefractor (78%). For detection of strabismus, the most accurate tests were the MTI Photoscreener (65%), the cover-uncover test (60%), the Stereo Smile II stereoacuity test (58%), the SureSight Vision Screener (54%), and the Retinomax Autorefractor (54% in year 1, 53% in year 2). The most accurate tests for detection of significant refractive error were NCR (74%), the Retinomax Autorefractor (66%), the SureSight Vision Screener (63%), and the Lea Symbols VA test (58%). For detection of reduced VA, the most accurate tests were the Lea Symbols Distance VA test (48%), the Retinomax Autorefractor (39%), and NCR (38%). CONCLUSIONS: Similar to the previously reported results at 90% specificity, the screening tests vary widely in sensitivity with specificity set at 94%. The rankings of the sensitivities for detection of the 4 VIP-targeted vision disorders are similar to those with specificity set to 90%.     

Color vision in children and the Lanthony New Color Test

Much is known about color vision in infants, adolescents, and adults, but very few studies report the changes, which occur in color perception of children in their early schooling years. There is also a shortage of suitable color vision tests for children. This study investigated the changes in color vision of school students between 5-12 years old using the Lanthony New Color Test (NCT). Subjects of all ages were able to complete a shortened form of this test adequately. The Vingrys and King-Smith (1988) method of panel test analysis and Adams and Rodic (1982) color confusion score were adapted to analyze their performance of the test. This study confirmed that there are changes in color perception occurring in this age group. Color perception abilities increased as a function of age and there was also an improvement in the performance on the NCT with age. This can be attributed to both cognitive development and changes occurring to the color vision system.