Colorimetric evaluation of iPhone apps for colour vision tests based on the Ishihara test

Assessment of visual function using mobile Apps

With the advances in smartphone and tablet screens, as well as their processing power and software, mobile apps have been developed reporting to assess visual function. This review assessed those mobile apps that have been evaluated in the scientific literature to measure visual acuity, reading metrics, contrast sensitivity, stereoacuity, colour vision and visual fields; these constitute just a small percentage of the total number of mobile apps reporting to measure these metrics available for tablets and smartphones. In general, research suggests that most of the mobile apps evaluated can accurately mimic most traditionally paper-based tests of visual function, benefitting from more even illumination from the backlit screen and aspects such as multiple tests and versions (to minimise memorisation) being available on the same equipment. Some also utilise the in-built device sensors to monitor aspects such as working distance and screen tilt. As the consequences of incorrectly recording visual function and using this to inform clinical management are serious, clinicians must check on the validity of a mobile app before adopting it as part of clinical practice.

Screening for mild anomalous trichromacy using the Ishihara plates test

The Ishihara plates test is one of the most established and widely used means of identifying color vision deficiencies. However, literature examining the effectiveness of the Ishihara plates test has identified weaknesses, particularly when screening for milder anomalous trichromacy. We constructed a model of the chromatic signals expected to contribute to false negative readings by calculating, for particular anomalous trichromatic observers, the differences in chromaticity between the ground and pseudoisochromatic portions of plates. Predicted signals from five plates were compared for seven editions of the Ishihara plates test, for six observers with three severities of anomalous trichromacy, under eight illuminants. We found significant effects of variation in all of these factors other than edition on the predicted color signals available to read the plates. The impact of edition was tested behaviorally with 35 observers with color vision deficiency and 26 normal trichromats, which corroborated the minimal effect of edition predicted by the model. We found a significant negative relationship between predicted color signals for anomalous trichromats and behavioral false negative plate readings (ρ=-0.46, p=0.005 for deuteranomals, ρ=-0.42, p=0.01 for protanomals), suggesting that residual observer-specific color signals in portions of plates designed to be isochromatic may be contributing to false negative readings, and validating our modeling approach.

Effect of Luminance and Contrast Variation on Stereoacuity Measurements Using Smartphone Technology

Owing to the limitations of printed stereoacuity tests, the effects of luminance and contrast on stereopsis have not yet been sufficiently investigated, despite its important implications in designing stereoacuity measuring instruments, particularly for electronic devices. A stereopsis measurement system was established using two 4 K smartphones and a phoropter to evaluate the effects of luminance and contrast variations on the stereoacuity test. Seventeen young subjects with normal visual acuity and stereopsis were recruited. Two types of test symbols, contour-based and random-dot-based, were used in the experiment. Four series tests were established with different maximum brightness values, including 240 lux, 120 lux, 60 lux, and 30 lux. Each series test contained 19 pages with different contrasts between 95% and 5% and was calculated using the Michelson contrast formula. No significant difference was found for both contour-based and random-dot-based stereograms in any of the contrast groups with different maximum brightness. Similarly, no significant difference was found between contour-based and random-dot-based patterns under different contrasts of above 35%. As the contrast decreased below 30%, the stereopsis was significantly better in the contour-based pattern than in the random-dot-based pattern for some degrees of contrast. The luminance and contrast of the digital display are not critical factors for stereoacuity under normal circumstances. This implies that a standard monitor with a certain 3D technology can be used to measure the stereoacuity threshold without calibrating the luminance and contrast.

Evaluation of the Waggoner computerized D15 color vision test using an iPad device

The W-D15 test, a computerized variant of the F-D15 test, is used to determine whether an individual with a color vision defect can safely perform color-related tasks. This study evaluated the performance of the W-D15 test using an iPad. Fifty-nine color normal and 61 color vision defect subjects participated. Participants were screened based on the Ishihara, City University Test, and Waggoner PIP24 tests. Different failure criteria of the D15 tests were considered. The pass/failure agreement between the two tests was relatively appropriate, with a κ-coefficient ≥0.8, for all failure criteria. The W-D15 could be an appropriate substitute for F-D15 using an iPad.

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.

Testing a Popular Smartphone Application for Colour Vision Assessment in Healthy Volunteer Subjects

We aimed to compare the Ishihara pseudoisochromatic colour vision test with a colour vision test from a popular smartphone application (EyeHandBook [EHB]) using digital image processing to simulate colour vision deficiencies. Three digital versions of the Ishihara and EHB slides were created: full colour; 32 bit- greyscale (removing all colour information); and blue channel (to simulate red-green colour vision deficiencies). Twenty healthy volunteers were shown each colour-edited plate. The answers they reported were compared with what would be expected for that colour-simulation scenario based on the answer key provided in the Ishihara booklet ("expected" answer). There were nine plates that had comparable patterns between the EHB and Ishihara test. We found no significant difference in the overall proportion of "expected" answers for the full colour (p = .35), 32 bit-greyscale (p = .39) and blue channel (p = .22) conditions. There were significant differences between the proportion of "expected" answers among six individual colour- edited plates (p < .05 for each). Colour vision assessment from the EHB is distinct from comparable Ishihara plates. Clinical scenarios that require serial assessment of colour vision may benefit from using the same modality consistently rather than exchanging between the two tests with the assumption of equivalence. Refinement of digital colour editing techniques beyond 32-bit greyscale and RGB channel splitting is necessary in order to accurately simulate colour vision deficiency.

Tele-Neuro-Ophthalmology During the Age of COVID-19

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Screening for Stereopsis of Children Using an Autostereoscopic Smartphone

Background

The advantage of using an autostereoscopic smartphone is that it can achieve 3D effects without the need for glasses. The purpose of this study was to evaluate whether this technology could be utilized to detect stereoacuity.

Methods

An autostereoscopic smartphone was used to imitate Lang stereotest I & II, Pass Test 3, Dinosaur Stereoacuity Test, and the Random Dot Stereo Acuity Test to screen the stereopsis of children from 3–6 years old.

Results

No significant difference was found between each pair of groups (autostereoscopic smartphone vs. Lang stereotest I, Lang stereotest II, Pass Test 3, Dinosaur Stereoacuity Test, and Random Dot Stereo Acuity Test, respectively; Wilcoxon signed-rank test, P value all >0.05). All of the weighted kappa were higher than 0.84. Therefore, all of the comparisons between measurements showed a high level of agreement.

Conclusions

The autostereoscopic smartphone is an effective tool when used for the screening of deficiency in stereopsis.

Evaluation of tablet computers for visual function assessment

Recent advances in technology and the increased use of tablet computers for mobile health applications such as vision testing necessitate an understanding of the behavior of the displays of such devices, to facilitate the reproduction of existing or the development of new vision assessment tests. The purpose of this study was to investigate the physical characteristics of one model of tablet computer (iPad mini Retina display) with regard to display consistency across a set of devices (15) and their potential application as clinical vision assessment tools. Once the tablet computer was switched on, it required about 13 min to reach luminance stability, while chromaticity remained constant. The luminance output of the device remained stable until a battery level of 5%. Luminance varied from center to peripheral locations of the display and with viewing angle, whereas the chromaticity did not vary. A minimal (1%) variation in luminance was observed due to temperature, and once again chromaticity remained constant. Also, these devices showed good temporal stability of luminance and chromaticity. All 15 tablet computers showed gamma functions approximating the standard gamma (2.20) and showed similar color gamut sizes, except for the blue primary, which displayed minimal variations. The physical characteristics across the 15 devices were similar and are known, thereby facilitating the use of this model of tablet computer as visual stimulus displays.