COLOUR VISION

DEFICIENCIES
 TODAY’S SESSION

1.Colour Defect & Classification

2.Colour Vision Testing
3.Management & Consultation
INTRODUCTION
• Colour vision is the ability to discriminate a
light stimulus as a function of its wavelength
• Human eye can recognize 150 colours in the
visible spectrum (400-700nm)
• Can detect differences of less than 3nm in
wavelength
 DEFINITION

• Most colour blind people are able to see things as

clearly as other people but they unable to fully
‘see’ red, green or blue light.

• A condition in which certain colors cannot be

distinguished.

• Confuse between Red-Green or Blue-Yellow.

 Review…
RETINA
(photoreceptors)

RODS CONES
(photopigment) (photopigments)

Rhodopsin Cyanolabe Chlorolabe Erythrolabe

430 nm 535 nm 565 nm
S-cone M-cone L-cone

RODS ~operate under CONES ~ sensitive under

dim lighting bright conditions
RETINA
RETINAL
LAYERS
COLOUR VISION DEFECTS
& CLASSIFICATION
1. CONGENITAL COLOUR VISION DEFECTS (CCVD)
2. ACQUIRED COLOUR VISION DEFECT (ACVD)
 TYPES

CONGENITAL ACQUIRED

•Defects in X chromosome
•Drugs effects
•X linked recessive
•Lesions in brain
•Male 8%
•Signs of systemic/ocular disease
•Female 0.5%
1. CONGENITAL COLOUR
VISION DEFECT
 CONGENITAL

ANOMALOUS
DICHROMACY ACHROMATOPSIA
TRICHROMACY

PROTANOMALY PROTANOPIA RODS

DEUTRANOMALY DEUTRANOPIA CONES

TRITANOMALY TRITANOPIA
 INTRODUCTION
• Normal Color Vision - Normal Trichromat
• Has 3 different cone receptors, each with a
different photopigments.
• Photopigments responds to light over a spectral
regions :
L cones - long wavelength : red
M cones - middle wavelength : green
S cones - short wavelength : blue
• Signals from photopigments will directed to
different channel for colour processing.
• Optic nerve sends signals to brain for colour
understanding.
 CONGENITAL COLOUR
VISION DEFECT
• Predictable and classical
• Affect the whole eye
• Both eyes equally (very few exceptions)
• Condition is stable
• Genetically determined
• All other visual functions are totally
normal
STEPHEN J. DAIN
1. Anomalous Trichromacy
• Have 3 photo pigments,
• BUT the absorption spectrum of 1 of these photo pigments
is displaced to an abnormal position

TYPES OF SPECTRUM DISPLACED

DEFECT INVOLVED TOWARDS

Erythrolabe
Shorter λ
Protanomaly (L-Cone)

Chlorolabe
Deutranomaly
(M-Cone) Longer λ

Cyanolabe
Tritanomaly Slightly to
(S-Cone)
medium λ
 Normal Protanomaly

Deuteranomaly Tritanomaly
 2. Dichromacy
• Inherit only 2 types of photo pigments

MISSING
TYPES OF
PHOTO REPLACED BY
DEFECT
PIGMENTS

Erythrolabe Chlorolabe
Protanopia (L-Cone) (M-Cone)

Chlorolabe
Deutranopia (M-Cone)
Erythrolabe
(L-Cone)

Cyanolabe
Tritanopia (S-Cone)
 NORMAL PROTANOPIA

DEUTRANOPIA TRITANOPIA
 3. Monochromacy
• Achromatopsia –absence of colour vision
• True colour blind –see only lightness
difference
• Very rare
• Types
–Typical rod monochromats
–Atypical cone monochromats
NORMAL MONOCHROMACY
 Terminologies
• Protan, deutan, tritan referring to the
photopigment affected
–Subject may either dichromat or
anomalous trichromat

PROTANOMALY/
PROTANOPIA

DEUTRANOMALY/
DEOTRANOPIA

TRITANOMALY/
TRITANOPIA
2.ACQUIRED COLOUR
VISION DEFECT
 ACQUIRED COLOUR
VISION DEFECTS (ACVD)
• Developed secondary to disease processes
• May be R-G or B-Y, but mostly B-Y
• Often present in only one eye in their
presentation
–Important to perform CV test monocularly
–Any difference in CV test demonstrate
possibility of pathological condition one of the
eye
 ACQUIRED COLOUR
VISION DEFECTS (ACVD)
• Severity changes over time
–Need to check monocularly when
ACVD is suspected

• Visual acuity and visual field defects

frequently involved
 ACQUIRED COLOUR
VISION DEFECTS (ACVD)
• As a result of

a) ocular general pathology

b) prolonged used of therapeutic drugs

c) intracranial injury
 CSR
BLUE-YELLOW MACULAR EDEMA
IMPAIRMENT SHALLOW RD
RETINAL LESIONS

ACQUIRED

OPTIC NERVE
OPTIC NEURITIS
LESIONS RED-GREEN LEBER’S OPTIC ATROPHY
IMPAIRMENT COMPRESSION OF
OPTIC NERVE
Systemic diseases which causes
color vision disturbances.

Systemic disease Color vision changes

•Diabetes mellitus •Blue defect

•Multiple sclerosis •Red-yellow defect
•Pernicious anemia •Red-green defect
•Congenital jaundice •Blue and green defect
•Stroke •Various
•Cerebral cortex disease •Blue defect
•Alcoholism and cirrhosis of the •Blue defect
liver
Ocular diseases which causes colour
vision disturbances

Ocular disease Colour vision changes

Aged related maculopathy BY defect

Retinal detechment BY defect
Pigmentary degeneration of retina BY defect
Myopic retinal degeneration BY defect
Chorioretinitis BY defect
Retinal vascular occlusion BY defect
Diabetic retinopathy BY defect
Hypertensive retinopathy BY defect
Papilledema BY defect
Central serous retinopathy BY defect
Optic neuritis RG defect
Tobacco or toxic amblyopia BY defect
Laber’s optic atrophy RG defect
Lesion of optic nerve and pathway RG defect
Papillitis RG defect
Glaucoma BY defect
 Commonly used group of drug which can
cause color disturbances
Group Drug Color defect

Cardiac Digitalis, digitoxin BY & RG

Antimalarial Quinine & deviatives (eg chloroquine) BY & RG
Anti-athritic Hydroxychloroquine, Plaquenyl, BY
Indomethacine. BY
Antituberculosis Etharnbutol, Myambutol BY & RG
Isoniazid BY
Ovulation inhibitors Anovlar, Lyndiol, Ovulen. BY
Antibacterial Erythromycin, BY
Streptomycin BY & RG
Anticonvulsant Trimethadione BY
Antiepileptic Paramethadione BY
Antidepressants Hydrazines RG
Antidiabetic Chlorpropamide, Tolbutamide RG
Antipyretic Ibuprofen, phenylbutazone, Salicylates RG
 A selection of toxin which can cause
color disturbances
Likely color
Toxin and use
defect

Carbon disulphide (rubber, rayon, explosives industries) RG

Carbon monoxide R
Carbon tetrachloride (fire extinguishers, drycleaning G
agent)
Chlorodinitrobenzene G
Dinitrobenzene (explosives) RG
Chlorodinitrotoluene (dry cleaning fluid) RG
Ethylene glycol (antifreeze) RG
Lead & lead compounds (petrol) G
Mangenese R
Methyl alcohol (methylated spirit) RG
Methylbromide (fire extinguishers, fumigant) G
Thallium (rodent poison) RG
 Congenital ‘vs’ acquired
color vision deficiency
Congenital
Typically red-green
More prevalent in males
Present from birth and
have genetic basis, not
assoc. with disease or
toxicity
Stable throughout the life
span
Symmetric : same in each
eye
Easily classified with
standard clinical color tests
Acquired
Often blue-yellow
Equally prevalent in males
and females
Normally secondary to
pathological state, assoc
with ocular or systemic
disease or toxicity
Unstable and changes over
time
Asymmetric : often a
difference in severity
between the eyes
Classification often not
straightforward with
standard clinical color tests
COLOUR VISION TESTS
 How to assess colour
vision?
• Detect
• Classify
• Quantify severity of defect

One test insufficient to test colour

vision deficiencies
Why should colour vision be
done as a routine test?

• To evaluate status of normality of eye

• Provide vocational advice
• Aid in diagnosing any ocular disease, in
which color vision is the earliest
symptom, e.g. retinal disease, optic
nerve disease,systemic disease
 Tests of Color
Deficiency
• Color vision tests generally fall into
two categories : test of matching and
test of discrimination
• Clinically at least, the latter are
divided into plate tests and colour
ordering tests
 A.Plate Tests
• Ishihara plates
• SPP vol 1 & vol 2
• AO Hardy, Rand and Rittler (HRR)
plates
• Farnsworth Plate
 Ishihara Plates
• Used as a screening test for red-
green defect only
• 2 editions : 24 plates or 38 plates
• Uses one or two numbers, designed on
the confusion principle
• Tracing paths included for children and
illiterates
• During test, subject required to read
number or trace the path on the plate
• If subject fails to identify 4 plates or
more correctly, then subject FAILS
test – subject has red-green defect
• If subject can identify all correctly –
he could be having normal color vision
or he may have blue-yellow defect
B. COLOUR ORDERING TESTS

• These are tests in which the subject must

order a series of colors in a gradual
progression
• These rely on the fact that most people with
color vision deficiencies have reduced color
discrimination
• The most popular tests are the Farnsworth
Munsell D-15 and the Farnsworth Munsell
100Hue
Farnsworth Standard D15 Test
• Consists of 15 loose caps and
one fixed cap (the reference
cap) in one box
• The hue of each cap has been
chosen so that adjacent caps
have approximately equal hue
differences
• When the cap are arranged in
order out of their box, they
form a hue circle
• As a result, errors can be made
across the hue circle
 Farnsworth Standard D 15 Test
• NOT design for screening but for
diagnosis
• Typical result are obtained in congenital
protan, deutan, and tritan color
deficiency.
• Does not detect minor defects
• Patient with minimal defects(some
anomalous trichromats) may pass this
test
• Advantage : able to detect tritan defects
Farnsworth Standard D15 Test
Look at the LARGEST cross-over, compare the axis to
diagnos
 Farnsworth-Munsell
100 Hue Test
• Designed to detect all types
of CV abnormality from the
mildest red-green defect to
total achromatopsia.
• Separates persons with
normal CV into classess of
superior, average and low
color discrimination
• Measures the axes or zones
of color confusion in those
with defective CV
Normal

PROTANS : have a mid point

between 62 and 70
Deutan ~ 10 & 4 o’clock

DEUTANS : have a mid point

Normal between 56 and 61
~11 & 5 0’clock

TRITANS : have a mid point

between 46 and 52
Tritan
~12 & 6 0’clock

Protan
 COLOUR ORDERING
TESTS
Others….
• Lantern Test
• City University Test
• Farnsworth and Anthony’s Color
Vision Testing
• Nagel Anomaloscope
 MANAGEMENT
&
CONSULTATION
• No medical approach available for congenital color deficient
types.

• Colored Filters (X-chrom lens, Solarchromic lens)

-Colour filters or contact lenses can be used in some situations
to enhance the brightness between some colours and these are
occasionally used in the workplace, but many colour blind people
find these actually confuse them further rather than help.
Solarchromic Lens

X- Chrom Contact Lens

• Counseling
• Re-assurance
• Modified eg labelling, high luminance
contrast.
• For acquired colour vision deficiency, once
the cause has been established and
treated, your vision may return to normal
• http://www.colourblindawareness.org
Secondary School & Higher Education

IN CLASSROOM

NORMAL CV DEUTRANOPIA
Secondary School & Higher Education

SCIENCE LAB

NORMAL CV DEUTRANOPIA
Secondary School & Higher Education

SPORT

NORMAL CV DEUTRANOPIA
Secondary School & Higher Education

GEOGRAPHY

NORMAL CV DEUTRANOPIA
 Careers And Vocational
Courses
• Colour blind children about to make choices regarding
their future careers and vocational courses must be
properly advised on careers which they will find it
difficult or impossible to pursue.

• Most people know that a colour blind person is

unlikely to be able to become a pilot but there are
many other careers which are unsuitable for colour
blind people and numerous jobs where the colour blind
will find it difficult to function as good as their
colleagues whom colour vision is normal
• The most common industries where colour blind
people are likely to be excluded are those where
colour vision is critical to safety especially where
coloured lights are used and a mistake could lead
to a fatality.

• Most transport industries exclude colour blind

people from most roles

• Most uniformed services and a large number of

disciplines in the Armed Forces.
 CAREER OCCUPATIONAL STANDARDS SUGGESTIONS

GENERAL It is possible that at the point of choosing his
future career a colour blind secondary school
student might not be even aware of his colour
vision deficiency.
Statistics show that up to 40% of children with
colour defective vision were not aware of their
problem before they left secondary school.
It is important that a student be tested to
confirm a colour defective vision.
Use some form of preliminary colour
testing.
Suggest professional testing / diagnoses to
the type and strength of colour defective
vision.
Consult with student on colour diagnoses.
Consult with student on possible career
choice
Counsel student on the colour challenges
that may be ahead in chosen career path.
# Almost every occupation will involve
colour in some way.

ARMED SERVICES These careers have strict colour vision tests. Student to check for colour entrance
POLICE requirements.
AIR TRAFFIC CONTROLER Some potential entrants have taken these
FIRE SERVICES occupations to court on discrimination grounds
and lost.
Check to see that if some of these careers have
a division (Administration etc;) within the
chosen career that does not need strict colour
entrance test.
# In the Colour Radar set up for Air Traffic
Controllers was changed to accommodate
Colour Defective Vision

COMMERCIAL AEROPLANE PILOT
MARINE and MARINE PILOT etc;
TRAIN DRIVER
ELECTRICIAL ENGINERING
ELECTRICAL TRADES
COMMERCIAL ARTIST, HOSPITAL
LABORATORY TECHNICIANS
etc;
Most of these careers have strict colour vision Student to check for colour entrance
tests. requirements.
Check to see that if some of these careers have
a division (Administration etc.) within the
chosen career that does not need strict colour
entrance test.
There may be some restrictions on non-
commercial Australian licences for pilots with
 CAREER
PROFFESSIONAL TRANSPORT DRIVER
COLOUR DEPENDENT OCCUPATIONS
FASHION INDUSTRY, HOSPITALITY INDUSTRY
INTERIOR DECORATORS, FURNISHINGS,
PAINTING, SPRAY PAINTING, CHEMIST
ETC;
NON- COLOUR
DEPENDENT OCCUPATIONS
BUT REQUIRE DESIRABLE COLOUR
RECOGNITION
MEDICINE, ARCHITECTURE, BUILDING
INDUSTRY, TRADES,
NURSES, FLORIST, HAIRDRESSER,
HORTICULTURALIST ETC;
ALL OTHER OCCUPATIONS
OCCUPATIONAL STANDARDS
A strict colour vision test.
Some states Applicants diagnosed with
PROTANOMALY -RED colour defective vision may be
excluded.
It would be up to the individual employer to decide the
extent in which the prospective applicant will be affected
by his or her colour defective vision.
Some employers may insist on some form colour testing.
It would be up to the individual employer to decide the
extent in which the prospective applicant will be affected
by his or her colour defective vision.
Some employers may insist on some form colour testing.
All other occupations will at some time require some
form of colour recognition.
NOTE
THE OCCUPATIONAL LISTS AND SUGGESTIONS
GIVEN ARE A GUIDE ONLY- THE INDIVIDUAL
STUDENT SHOULD ASCERTAIN COLOUR
OCCUPATIONAL REQUIREMENTS AND THEIR
OWN CONFIDENCE IN COLOUR RECOGNITION
FOR EACH OCCUPATION.
SUGGESTIONS
Check to see that if some of these careers have a division
(Administration etc.) within the chosen career that does
not need strict colour entrance test.
Applicants with DEUTERANOMALY RED GREEN
colour defective vision MAY BE ACCEPTED check
with R.T.A.
Prospective applicants in these areas would be certainly
colour challenged to correctly fulfil their job.
Students should be strongly advised of the colour
challengers that lay ahead, but not DISCOURAGED.
Remember there are different types and levels of colour
blindness.
Prospective applicants in these areas would be certainly
colour challenged and would require close attention to
overcome colour requirements.
Students should be strongly advised of the colour
challengers that lay ahead, but not DISCOURAGED.
Remember there are different types and levels of colour
blindness.
Prospective applicants in these areas will be certainly
colour challenged and would require close attention to
overcome some colour requirements.
# EMPLOYERS SHOULD NOT RELY ON ONE
FORM OF COLOUR TESTING (ISHIHARA TEST)
BUT EMPLOYMENT TASK ORIENTATED.
# There may be limits for Dalton's and just how far they
are prepared to challenge the standard but it should not
alter the pursuit of our there dreams
 JPJ LICENSE????
WITH COLOUR VISION
DEFECT
Color Vision Standard for Drivers in

Standard. Visual Visual Color vision

acuity fields
•Vision Standard 1 6/12 in both 170° horizontal Ability to identify
-driver of large public services eyes visual field red, green and
vehicles (buses), heavy good amber lights
vehicles and other professional
drivers)

•Vision Standard 2 6/12 one eye, 130° with both Not required to be
(commercial vehicles – small 6/60 second eye eye (horizontal tested
truck, van, taxis, emergency VF)
vehicles and majority private
vehicles drivers)

•Vision Standard 3 6/12 in one eye 130° with one eye Not required to be
Driver who are effectively one- or only eye or both eye tested
eye, who qualify as private (horizontal VF)
drivers)

Guidelines to Medical Practioner for the certification of motor vehicles.

Dr. Alias Dahalan, Secretary Society of MMA
Thank you and have a
colourful day ahead!!!