The reliability of the Lanthony Desaturated D-15 test

The complex relation between visual complaints and decline in visual, visuoperceptual and cognitive functions in people with multiple sclerosis

People with multiple sclerosis (pwMS) report many different visual complaints, but not all of them are well understood. Decline in visual, visuoperceptual and cognitive functions do occur in pwMS, but it is unclear to what extend those help us understand visual complaints. The purpose of this cross-sectional study was to explore the relation between visual complaints and decline in visual, visuoperceptual and cognitive functions, to optimize care for pwMS. Visual, visuoperceptual and cognitive functions of 68 pwMS with visual complaints and 37 pwMS with no or minimal visual complaints were assessed. The frequency of functional decline was compared between the two groups and correlations were calculated between visual complaints and the assessed functions. Decline in several functions occurred more frequently in pwMS with visual complaints. Visual complaints may be an indication of declined visual or cognitive functioning. However, as most correlations were not significant or weak, we cannot infer that visual complaints are directly related to functions. The relationship may be indirect and more complex. Future research could focus on the overarching cognitive capacity that may contribute to visual complaints. Further research into these and other explanations for visual complaints could help us to provide appropriate care for pwMS.

Lanthony D15 for Occupational Testing: Short-term Repeatability

SIGNIFICANCE

The Lanthony D15 has been reported to have poorer repeatability than the Farnsworth D15. This study found that two trials of the test provide high short-term repeatability and can be administered this way for occupational testing.

PURPOSE

This study aimed to determine the short-term repeatability of the Lanthony D15 in patients with color vision deficiency. Repeated trials were used to examine if learning effects occur and to determine how many trials would be necessary to ensure the highest short-term repeatability for occupational testing.

METHODS

Twenty male subjects (mean [standard deviation] age, 27.2 [4.3] years) with congenital color vision deficiency, ranging from mild to severe, participated in this single-visit study. Visual acuity, color vision book screening, Farnsworth D15, and anomaloscope testing were performed for classification purposes. Ten trials of the Lanthony D15 were performed. Color confusion index scores from each trial were determined, and a repeated-measures analysis of variance was used to compare the scores across trials. Orthogonal polynomial analysis was performed to detect any trends across trials through the third order. The intraclass correlation coefficient was calculated.

RESULTS

No differences in color confusion index (mean [standard error of the mean], 3.57 [0.04]) were found across the 10 trials ( P = .18). Legendre polynomials showed no statistical significance (all P > .39). The intraclass correlation coefficient was 0.81 (95% confidence interval, 0.70 to 0.90). Based on the method of Shrout and Fleiss, intraclass correlation coefficients of 0.7, 0.8, and 0.9 could be achieved with an average of one, two, and four trials of the test, respectively. However, empirically, 0.9 was not achievable.

CONCLUSIONS

The Lanthony D15 test has fairly high short-term repeatability. Thus, although more trials would likely improve clinical certainty, the mean result of two trials appears sufficient for occupational testing.

Color Vision and Microperimetry Changes in Nonexudative Age-Related Macular Degeneration After Risuteganib Treatment: Exploratory Endpoints in a Multicenter Phase 2a Double-Masked, Randomized, Sham-Controlled, Crossover Clinical Trial

BACKGROUND AND OBJECTIVE

To explore the association between best-corrected visual acuity (BCVA) improvement and changes in microperimetry (MP) and color vision in patients with nonexudative age-related macular degeneration following administration of two 1.0-mg intravitreal doses of risuteganib.

PATIENTS AND METHODS

In a phase 2a, prospective, double-masked, sham-controlled study, eyes with nonexudative age-related macular degeneration and Early Treatment Diabetic Retinopathy Study BCVA between 20/40 and 20/200 were randomized to intravitreal risuteganib (1.0 mg) or sham injection. The risuteganib group received a second 1.0-mg dose, and patients in the sham group crossed over to receive 1.0 mg of risuteganib at week 16. Exploratory endpoints included changes in color vision and mesopic MP.

RESULTS

Thirty-nine patients (risuteganib, n = 25; sham, n = 14) completed the study. There was a significant (P < .05) correlation between BCVA and the total error score (TES) for both Lanthony and Hue Style. Confusion index was close to the criterion for significance (P = .056) in the risuteganib group. All color vision metrics demonstrated a trend toward improvement in risuteganib responders (BCVA letter gain ≥8 letters) and no change in the nonresponders, with significant differences seen in confusion index between the risuteganib and control group (P = .0493) and between responders and nonresponders (P = .0478). MP showed that risuteganib responders improved in mean sensitivity and change in number of loci ≤11 dB and ≤0 dB, whereas nonresponders worsened.

CONCLUSION

All color vision and MP parameters tested trended toward improvement in risuteganib-treated patients and risuteganib responders. Statistically significant improvement was evident in two metrics: confusion index (in risuteganib-treated patients and responders) and number of loci with decreased sensitivity (in responders). A significant correlation between BCVA and both TES Lanthony and TES Hue Style in risuteganib patients provides concurrent evidence of objective and subjective improvement of retinal function. [Ophthalmic Surg Lasers Imaging Retina 2022;53:430-438.].

VISUAL FUNCTION AND RETINAL CHANGES IN PATIENTS WITH BIPOLAR DISORDER

PURPOSE

To evaluate visual and retinal changes in patients with bipolar disorder. To analyze the correlation between structural changes and visual function parameters.

METHODS

Thirty patients with bipolar disorder and 80 healthy controls underwent visual function evaluation with Early Treatment Diabetic Retinopathy Study charts at 100%, 2.50%, and 1.25% contrast, Pelli-Robson chart, and color vision Farnsworth and Lanthony tests. Analysis of the different retinal layers was performed using Spectralis optical coherence tomography with automated segmentation software. Correlation analysis between structural and functional parameters was conducted.

RESULTS

Patients with bipolar disorder presented worse color vision compared with controls (Lanthony's index, P = 0.002). Full macular thickness, the retinal nerve fiber layer (RNFL), ganglion cell layer, and inner plexiform layer were reduced in patients compared with healthy individuals (P < 0.005). The inner nuclear layer was significantly thickened in patients (P < 0.005). Peripapillary RNFL thickness was reduced in all temporal sectors (P < 0.005). Significant correlations were found between visual acuity and the RNFL thickness, the Pelli-Robson score and the inner plexiform layer, and between the Lanthony's color index and the ganglion cell layer thickness.

CONCLUSION

Patients with bipolar disorder present quantifiable thinning of the macular RNFL, ganglion cell layer, and inner plexiform layer, as well as in the peripapillary RNFL thickness, and increasing thinning in the inner nuclear layer.

Functional retinal outcomes in patients with prediabetes and type 2 diabetes

PURPOSE

Type 2 diabetes (T2DM) is a leading cause of visual impairment. Its precursor, prediabetes (preDM), is growing in numbers every year. While it is well known that T2DM causes changes in retinal function early in the disease process, it is likely that some of these changes emerge during the preDM stage. This study evaluates retinal function measures in patients with preDM to determine if there are differences in colour vision, contrast sensitivity (CS), and multifocal electroretinogram (mfERG) measures present before T2DM is diagnosed.

METHODS

The L'Anthony desaturated D-15 test, Mars Chart CS test, and mfERG were administered on the right eye of 43 participants; 15 controls (HbA1c ≤ 5.6%), 17 with preDM (HbA1c 5.7%-6.4%), and 11 with T2DM (either physician diagnosed or with untreated HbA1c ≥ 6.5%). HbA1c values were measured at the time of the other tests. Colour vision confusion scores (CVCS) were calculated from the D-15 using the method developed by Torok. Multivariate regression (which controlled for age differences) was used to evaluate the relationship of HbA1c and functional measures. Kruskal-Wallis tests were also used to evaluate differences between groups with post-hoc analysis.

RESULTS

CVCSs were significantly different between the three groups (p = 0.009). There was an association between higher CVCS and higher HbA1c values across all groups as well as specifically within the preDM group when controlling for age (R2  = 0.29, p = 0.01 and R2  = 0.39, p = 0.02 respectively). Multivariate regression of all of the functional tests together and HbA1c found only colour vision remained significant, indicating that the functional examination metrics may provide redundant data, with similar changes in prediabetes where colour vision may be the strongest indicator early in the process.

CONCLUSIONS

Patients with prediabetes have functional changes that can be measured in the retina before the diagnosis of diabetes, with the L'Anthony D-15 colour vision test providing the strongest association with glucose dysregulation in this population. This has important implications for follow up and screening for diabetes within optometric practices. Further studies are needed to follow these patients over time to see how and when these metrics change.

Cambridge Colour Test: reproducibility in normal trichromats

This study evaluated reproducibility of the Trivector subtest of the Cambridge Colour Test. Data for normal trichromats were obtained in Brazil ($ N = 111 $N=111) at T0, six months (T1), and 12 months later (T2), and in the United Kingdom (${ N}={79}$N=79), with the test directly followed by a retest. Coefficients of repeatability-Bland-Altman indices-for Protan, Deutan, and Tritan vectors were similar for both datasets. Intraclass correlation coefficients (ICCs)-measures of reliability-were low or moderate for these relatively homogeneous datasets; for a heterogeneous dataset, comprising color-normal and abnormal observers, ICCs were 0.80-0.98, indicating the high discriminative accuracy of the Trivector subtest.

Spatial contrast sensitivity: effects of reliability, test-retest repeatability and sample size using the Metropsis software

PURPOSE

The goals of the study were to further assess contrast sensitivity to (1) investigate the existence of monocular vs. binocular differences; (2) observe possible differences between sample sizes; (3) investigate the effects of test-retest repeatability.

METHODS

Contrast sensitivity measurements were obtained by presenting eight horizontal sine-wave gratings (ranging from 0.2 to 20 cycles per degree). A three-up-one-down method was used to obtain thresholds with a criterion of 79.4% correct responses for each spatial frequency. The mean of 12 reversals was used for obtaining thresholds, and the two-alternative forced-choice method was used. Data were recorded in 55 naive observers from 20 to 45 years. All participants were free from identifiable ocular disease and had normal visual acuity.

RESULTS

We observed the absence of differences on CSF for both monocular and binocular observers, as well as the absence of differences between large sample sizes. The latter investigation revealed a high degree of repeatability across time (baseline to 6 months later) with the higher test-retest for low and high spatial frequencies.

CONCLUSIONS

Our results indicated that spatial contrast sensitivity measurements were little influenced by variables, such as binocular summation, eye dominance, sample size and time using the Metropsis test. The results obtained here have significance for basic and clinical vision science.

Color vision impairments in schizophrenia and the role of antipsychotic medication type

Schizophrenia patients (SCZ) demonstrate deficits in many domains of mental functioning, including visual perception. An issue that has been relatively unexplored, in terms of explaining variation in visual function in SCZ, however, is medication use. The present study explored potential medication effects on color vision in SCZ, a process that is strongly linked to dopaminergic function in the retina. SCZ patients who had clear-cut either typical (n = 29) or atypical (n = 29) monotherapy, without any other concurrent medication, and a group of age- and gender-matched healthy controls participated in the study. Color vision was assessed by the Cambridge Colour Test, using the Trivector and Ellipse subtests. The results demonstrated impaired color perception in patients with schizophrenia, especially in those receiving typical antipsychotics, but these deficits were subtle and not generalized to all parameters. Our findings are consistent with the known neurophysiology of the retina and visual pathways, and with the effects of dopamine blocking medications, but the results should be carefully interpreted.

Preliminary data for performance in hue ordering tests during pregnancy

The visual system of women changes during pregnancy. Few reports have addressed the effects of pregnancy on color vision. We aimed to compare the color vision of women in the first, second, and third trimesters of pregnancy. Fifty women were divided into first (n=10), second (n=10), third trimester pregnancy groups (n=10), and non-pregnant group (n=20). We used the Farnsworth D15 and Lanthony desaturated D15 (D15d) tests. The hue ordering quantified the amount of error (C-index) and the chromatic selectivity of the errors (S-index). Bland-Altman analysis was applied to the hue ordering data. No difference was found for Farnsworth D15 test results obtained from the pregnant groups and the non-pregnant group (P<0.0083). For the Lanthony D15 desaturated test, the third trimester pregnant group had higher C-index and S-index than non-pregnant women and first-trimester pregnant women (P<0.0083). The Bland-Altman analysis showed that the limits of agreement increased as pregnancy advanced, and the errors were biased to the D15d test. In this study, color vision was impaired during pregnancy. Color vision evaluation could be used as an indicator of the functional status of the central vision during pregnancy.

Can the Farnsworth D15 Color Vision Test Be Defeated through Practice?

SIGNIFICANCE

This study suggests that it is possible for some patients with severe red-green color vision deficiency to do perfectly on the Farnsworth D15 test after practicing it.

PURPOSE

The Farnsworth D15 is a commonly used test to qualify people for certain occupations. For patients with color vision deficiency, there may be high motivation to try to pass the test through practice to gain entry into a particular occupation. There is no evidence in the literature on whether it is possible for patients to learn to pass the D15 test through practice.

METHODS

Ten subjects with inherited red-green color vision deficiency and 15 color-normal subjects enrolled in the study. All subjects had anomaloscope testing, color vision book tests, and a Farnsworth D15 at an initial visit. For the D15, the number of major crossovers was determined for each subject. Failing the D15 was determined as greater than 1 major crossover. Subjects with color vision deficiency practiced the D15 as long as desired to achieve a perfect score and then returned for a second visit for D15 testing. A paired t test was used to analyze the number of major crossovers at visit 1 versus visit 2.

RESULTS

Color-normal subjects did not have any major crossovers. Subjects with color vision deficiency had significantly (P < .001) fewer major crossovers on the D15 test at visit 2 (mean/SD = 2.5/3.0), including five subjects with dichromacy that achieved perfect D15 performance, compared to visit 1 (mean/SD = 8.7/1.3).

CONCLUSIONS

Practice of the Farnsworth D15 test can lead to perfect performance for some patients with color vision deficiency, and this should be considered in certain cases where occupational entry is dependent on D15 testing.

Colour discrimination thresholds in type 1 Bipolar Disorder: a pilot study

Although some studies have reported perceptual changes in psychosis, no definitive conclusions have been drawn about visual disturbances that are related to bipolar disorder (BPD). The purpose of the present study was to evaluate colour vision in BPD patients. Data were recorded from 24 participants: healthy control group (n = 12) and type 1 BPD group (n = 12). The participants were 20-45 years old and they were free from neurological disorders and identifiable ocular disease and had normal or corrected-to-normal visual acuity. Colour discrimination was evaluated using the Lanthony D-15d, Trivector and Ellipse tests, using a psychophysical forced-choice method. The relationship of visual measures to mood state and cognitive function was also investigated. The results showed that BPD patients had higher colour discrimination thresholds in the D15d (p < 0.001), Trivector (p < 0.001) and Ellipse (p < 0.01) tests compared with healthy controls. Linear regression analysis showed that mood state was related to colour discrimination. BPD individuals were not impaired in cognitive tasks. The present study provided new evidence of potential links between type 1 BPD and visual processing impairments. This research suggests a new direction for studies and the need for research in this field of study.

A simple modification of the Farnsworth-Munsell 100-hue test for much faster assessment of color vision

Purpose:

The Farnsworth-Munsell (FM) 100-hue test is well known but is also time consuming, especially its analytical component. To reduce this needless time-waste during precious working hours, a simple modification was devised.

Design:

Prospective, comparative, observational study.

Materials and Methods:

A transparent clear plastic carrier box replaced the opaque one, allowing ready digital photodocumentation of top and bottom without even opening the box, or handling/inverting the caps -200 reportedly normals and 50 known color vision defectives could be easily tested on this modified-FM and results stored, allowing rapid turnover. The captured scores with patient ID were analyzed, at leisure, outside hospital time, saving 45-60 minutes/patient. After recording, the box was promptly handed over to the next subject for rearrangement. Times taken for test/patient were recorded.

Results:

Running time was reduced from 60-75 min to ~15 min/patient with no waste of invaluable lab hours. Turnover time is limited to capturing two photographs (~60 sec). The box is relatively cheap and easy to maintain.

Conclusions:

Our simplified FM 100-hue test allowed rapid assessment of color visions with easy data storage of both top and bottom.

Association between retinal nerve fiber layer thickness and abnormalities of vision in people with human immunodeficiency virus infection

PURPOSE

To investigate relationships between contrast sensitivity (CS), color vision, and retinal nerve fiber layer (RNFL) among people with human immunodeficiency virus (HIV) infection; to evaluate the effect of time since diagnosis of HIV infection on RNFL thickness.

DESIGN

Noninterventional cross-sectional study.

METHODS

We evaluated 102 eyes of 57 HIV-infected individuals without ocular opportunistic infections. Peripapillary RNFL thickness was determined with spectral-domain optical coherence tomography in 4 quadrants. CS was measured with the Pelli-Robson technique (expressed as logCS); color vision was measured with the Lanthony desaturated 15-hue technique (expressed as color confusion index [C-index], with higher scores indicating worse color vision). Correlations between values were assessed using Spearman correlation coefficients.

RESULTS

Median RNFL thickness (average of 4 quadrants) was 102.9 μm (range, 75.0-134.7 μm). Median logCS was 1.90 (range, 1.25-1.95). Median C-index was 1.58 (range, 0.96-4.07). Temporal RNFL thickness was correlated with logCS (r=0.295, P=.003) and C-index (r=-0.338, P=.0005). Time since diagnosis of HIV infection was shorter for those with thick average RNFL than for those with thin average RNFL (P=.18).

CONCLUSIONS

Both worse CS and worse color vision are correlated with thinning of the temporal RNFL, with possible threshold effects. Increased prevalences of abnormal CS and abnormal color vision in this population are therefore likely attributable to neuroretinal compromise. This pattern of structural and functional losses may reflect preferential damage to small-caliber axons in the maculopapillary bundle, possibly associated with mitochondrial dysfunction, providing a potential disease mechanism for HIV-associated "neuroretinal disorder."

Cone function in children with a history of preterm birth

Color vision was examined by psychophysical tests and photopic color full-field electroretinography (ERG) in formerly preterm children, and compared with those of full-term children. In a prospective case-control study, 25 patients with a history of preterm birth 7-14 years of age were divided into three groups: group I, laser-treated retinopathy of prematurity [ROP] (n = 7); group II, spontaneously regressed ROP (n = 8); group III, no ROP (n = 10). Age-matched full-term born children comprised the control group (n = 8). Color vision was assessed by Fansworth D15 and Lanthony desaturated D15 tests. The cone function was tested using photopic full-field ERG. Besides the ISCEV standard stimuli, blue light on amber background was also used (S-cone ERG). The correlation between ERG parameters and prematurity or ROP was determined. We found no significant differences between any patient group and the control group in the results of the psychophysical tests, and implicit times of the ERG responses. The ERG b-wave amplitudes were significantly lower in group I (laser-treated ROP) compared to controls, for 2 of 4 stimulus conditions i.e. the standard (P = 0.028) and S-cone (P = 0.017) single flash ERGs. The general estimating equation model statistics found a significant effect of prematurity on the b-wave amplitudes (P = 0.025, standard, P = 0.014, S-cone ERG). A slightly reduced photopic ERG b-wave amplitude may be associated with prematurity.

Occupational styrene exposure, colour vision and contrast sensitivity: a cohort study with repeated measurements

OBJECTIVE

Associations between occupational styrene exposures and impairment of visual functions were investigated with a view to answering three questions: (1) are the published findings for colour vision deficiencies and impaired contrast sensitivity to reproduce in a new study approach, (2) if such effects exist, are they related to current or chronic exposures and (3) if effects exist, are there reductions in the effects during an exposure-free period?

METHODS

Workers from a boat building plant were examined in groups of current low [n = 97, mean mandelic acid (MA) + phenylglyoxylic acid (PGA) = 51 mg/g creatinine], medium (n = 115, mean = 229 mg/g creatinine) and high (n = 30, mean = 977 mg/g creatinine) level exposure to styrene. Job tenure was about 6 years. In addition, subgroups chronically exposed to low-short (n = 34, lifetime weighted mean 200 mg/g creatinine for 6 years) and high-long (n = 17, mean = 660 mg/g creatinine, 15 years) styrene levels were analysed. The examinations were carried out during normal working days and during the company holidays. Colour vision was investigated with the Lanthony desaturated panel D-15d using the colour confusion index (CCI) as a relevant variable. Contrast sensitivity was investigated with the Vistech charts VCTS 6500 using frequency-related results as well as total scores as variables. Co-variance analyses with repeated measurements and multiple linear regressions were used for statistical analysis.

RESULTS

There was no evidence of significant associations between exposure parameters and CCI. This is true for the analyses with all participants as well as for those with the subgroups with high-long versus low-short exposure. Thus, no exposure related changes in the relevant variables were found during the exposure-free period. The analyses for contrast sensitivity show similar results. The largest portions of the variances in both tests were explained by age. German as mother tongue covered a considerable portion of the CCI variances. Education, long-term alcohol use and job tenure explain only partly significant portions of the test variances exhibited.

CONCLUSION

Both acute styrene exposure levels of 40 ppm (range of standard deviation up to 54 ppm) and long term exposures to 27 ppm (range of standard deviation up to 44 ppm with higher exposure levels in the past) for a period of about 15 years were not identified as causing elevated risks for the investigated parameters of colour vision and contrast sensitivity. This statement contradicts the published results for styrene-related colour vision deficiencies but it seems to be compatible with published results for contrast sensitivity due to styrene exposure.

[Usefulness of color vision test for early detection of neurological damages by neurotoxic substances]

This paper reviews the published literature that is concerned with color vision impairment from industrial and environmental exposure to neurotoxic substances, and we evaluated whether testing for color vision impairment could be an affordable procedure for assessing these neurotoxic effects. In general, most cases of congenital color vision impairment are red-green, and blue-yellow impairment is extremely rare. However, most of the acquired color vision impairment that is related to age, alcohol or environmental factors is blue-yellow impairment. Therefore, many studies have been performed to identify this relationship between exposure to neurotoxic substances, such as organic solvents and heavy metals, and the prevalence of blue-yellow color vision impairment. The test for color vision impairment is known to be very sensitive to the early signs of nervous system dysfunction and this can be useful for making the early diagnosis of neurotoxic effects from exposure to very low concentrations of toxic substances.

Reference intervals and discrimination values of the Lanthony desaturated D-15 panel test in young to middle-aged Japanese army officials: the Okubo Color Study Report 1

PURPOSE

To better understand the reference values and adequate discrimination values of colour vision function with described quantitative systems for the Lanthony desaturated D-15 panel (D-15DS).

METHODS

A total of 1042 Japanese male officials were interviewed and underwent testing using Ishihara pseudoisochromatic plates, standard pseudoisochromatic plates part 2, and the D-15DS. The Farnsworth-Munsell (F-M) 100-hue test and the criteria of Verriest et al were used as definitive tests. Outcomes of the D-15DS were calculated using Bowman's Colour Confusion Index (CCI). The study design included two criteria. In criterion A, subjects with current or past ocular disease and a best-corrected visual acuity less than 0.7 on a decimal visual acuity chart were excluded. In criterion B, among subjects who satisfied criterion A, those who had a congenital colour sense anomaly were excluded.

RESULTS

Overall, the 90th percentile (95th percentile) CCI values for criteria A and B in the worse eye were 1.70 (1.95) and 1.59 (1.73), respectively. In subjects satisfying criterion B, the area under the receiver operating characteristic curve was 0.951 (95% confidence interval, 0.931-0.971). The CCI discrimination values of 1.52 or 1.63 showed 90.3% sensitivity and 90% specificity, or 71.5% sensitivity and 95% specificity, respectively, for discriminating acquired colour vision impairment (ACVI).

CONCLUSION

We provided the 90th and 95th percentiles in a young to middle-aged healthy population. The CCI is in good agreement with the diagnosis of ACVI. Our results could be helpful for using D-15DS for screening purposes.