The influence of age on performance in the panel D-15 colour vision test

Comparison of panel D-15 tests in a large older population

PURPOSE

To determine the frequency and type of color vision defects in a large group of randomly selected older people using two versions of the D-15 and to examine the agreement between the two tests.

METHODS

The Adams desaturated D-15 test was administered under Illuminant C (MacBeth lamp, ∼ 100 lux) to a group of 865 individuals aged 58 to 102 years (mean, 75.2 ± 9.1 years). No exclusion criteria, other than the reported presence of a congenital color defect, were applied. Testing was binocular with habitual near correction. If any error was made on this test, the Farnsworth D-15 was administered under identical conditions. On both tests, a color confusion score of 30 or higher was considered failing, and for those failing the test, color defect type (blue-yellow, red-green, or nonselective) was determined using the method of Vingrys and King-Smith (1988).

RESULTS

The majority (60.8%) of the people tested passed both tests. For the sample as a whole, the failure rates of the Adams desaturated D-15 and the Farnsworth D-15 were 36.2% and 20.76%, respectively. As expected, for both tests, failure rate increased markedly with age. Among those who failed both tests, 17.5% of the population, the proportion of specific agreement for red-green and blue-yellow defects was high, 88%. The vast majority of those failing either or both tests had blue-yellow defects, in agreement with previous studies.

CONCLUSIONS

Blue-yellow defects were quite common among the aged, becoming increasingly prevalent with increasing age. More people failed the Adams desaturated D-15 than the Farnsworth D-15, but among those who failed, the proportion of blue-yellow defects was similar for the two tests, approximately 75%. The agreement between the two tests in identifying acquired red-green and blue-yellow errors was high.

[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.

Color vision and occupational chemical exposures. II. Visual functions in non-exposed subjects

This paper presents data on visual functions (visual acuity, contrast sensitivity, and several tests of color vision), in a group of 199 non-exposed healthy subjects with an even distribution over the age range 18-65 years, and sex. Although subjects with obvious congenital color vision deficiencies were removed from the analyses (four males), females were superior to males on several of the color vision tests applied. Age influenced visual acuity and contrast sensitivity, while color discrimination was less affected. Correlations between functions of the right and the left eye in the individual subjects were rather low, ranging from 0.40 to 0.73. Correlations between visual acuity and contrast sensitivity on the one hand and color discrimination ability on the other hand were still lower (r < 0.20). These low correlations between functions in the two eyes support the need for testing each eye separately.

Solvent related colour vision loss: an indicator of neural damage?

Previous studies have related colour vision loss to solvent exposure, raising the question as to its use as an indicator of solvent-related neurotoxic alterations. However, colour vision loss can likewise result from ocular damage. In the present study chromatic discrimination capacity and ocular integrity were examined among 23 workers of a paint manufacture plant exposed to solvent mixtures. Using industrial hygiene data, the workers were classified according to their exposure level: moderate (n = 13) and high (n = 10). Colour discrimination capacity was assessed using the Farnsworth-Munsell 100 Hue, a colour arrangement test, providing qualitative and quantitative data. Biomicroscopy, funduscopy and peripheral visual field tests were used to examine ocular integrity. The results showed a significantly higher prevalence (P less than 0.02) of chromatic discrimination loss among the highly exposed workers (80%), as compared to the moderately exposed (23.1%). Ocular examination revealed no apparent major damage, although slight posterior sub-capsular opacification, indicative of incipient cataract, and, diminished foveal reflex were observed among 1/3 of the workers. Lens opacification was related to age and exposure duration, but not to exposure level. Diminished foveal reflex was not related to either age, exposure duration or level. Neither observation was related to chromatic discrimination loss. These findings support the hypothesis that chromatic discrimination impairment, associated with solvent exposure, reflects neural, rather than ocular, damage. The authors propose that tests of acquired colour vision loss be included in field batteries to evaluate neurotoxic effects of solvent exposure.

Assessing color vision loss among solvent-exposed workers

Acquired color vision loss has been associated with exposure to organic solvents in the workplace. However, not all tests of chromatic discrimination loss are designed to detect acquired, as opposed to congenital, loss. The Lanthony D-15 desaturated panel (D-15-d), a simple 15 cap color arrangement test, designed to identify mild acquired dyschromatopsia, can be administered rapidly in the field, under standard conditions. The objective of the present study was to evaluate the D-15-d among 23 solvent-exposed workers of a paint manufacturing plant, by comparing the results obtained with the D-15-d to those obtained with the Farnsworth-Munsell 100 Hue (FM-100), a highly sensitive measure of color vision loss. The D-15-d revealed a significantly higher prevalence of dyschromatopsia among the ten highly exposed workers (80%) as compared to the 13 moderately exposed workers (30.8%); FM-100 results revealed one false positive. All dyschromatopic workers presented blue-yellow loss; the FM-100 detected eight complex patterns, while the D-15-d identified 5. Comparison of D-15-d and FM-100 scores were highly correlated (corr. coeff. 0.87; p less than 0.001). Multiple regression analyses showed both scores to be significantly related to age and exposure level. The findings of this study indicate that the D-15-d is an adequate instrument for field study batteries. However, the FM-100 should be used for more detailed assessment.

A method for quantitative scoring of the Farnsworth Panel D-15

The Farnsworth Dichotomous test or Panel D-15 is used extensively for the evaluation of colour discrimination in congenital and acquired colour vision defects. This qualitative assessment of colour vision defect type and severity is based on the hue confusions which are represented diagrammatically on the Panel D-15 score sheet. This paper presents a new proposal for quantitatively scoring the Panel D-15 based on those hue confusions made by the subject. Such a quantitative score can be used to establish relationships with other visual functions or experimental conditions. The application of the scoring technique to clinical results is illustrated.

The clinical assessment of colour discrimination in senile macular degeneration

The colour discrimination of 15 subjects manifesting senile macular degeneration was investigated, over a wide range of illuminances, using the Farnsworth-Munsell 100-Hue test and Panel D-15. Ten subjects of similar ages with normal colour vision were investigated concurrently to provide a control group. Colour discrimination was shown to deteriorate with decreasing illuminance this being more marked for the subjects with senile macular degeneration than for the normal subjects. It is demonstrated that the FM 100 is the preferred test for assessment of colour discrimination loss in senile macular degeneration with early visual acuity loss. The Panel D-15 is more useful as acuity loss becomes more marked.