Predicted effectiveness of EnChroma multi-notch filters for enhancing color perception in anomalous trichromats.

EnChroma filters are aids designed to improve color vision for anomalous trichromats. Their use is controversial because the results of lab-based assessments of their effectiveness have so far largely failed to agree with positive anecdotal reports. However, the effectiveness of EnChroma filters will vary depending on the conditions of viewing, including whether the stimuli are broadband reflective surfaces or colors presented on RGB displays, whether illumination spectra are broadband or narrowband, the transmission spectra of particular filters, and the cone spectral sensitivity functions of the observer. We created a model of anomalous trichromatic color vision to predict the effects of EnChroma filters on the color signals impaired in anomalous trichromacy. Using the model we varied illumination, filter type and observer cone sensitivity functions, and tested the effect of presenting colors as broadband reflective surfaces or on RGB displays. We also used hyperspectral images to assess the impact of the filters on anomalous trichromats' color vision for natural scenes. Model results predicted that the filters should be broadly effective at enhancing anomalous trichromats' equivalent to L/(L + M) chromatic contrasts under a range of viewing conditions, but are substantially more effective for deuteranomals than for protanomals. The filters are predicted to be more effective for broadband reflective surfaces presented under broadband illuminants than for surfaces presented under narrowband illuminants or for colors presented on RGB displays. Since the potential impacts of contrast adaptation and perceptual learning are not considered in the model, it needs to be empirically validated. Results of empirical tests of the effects of EnChroma filters on deuteranomalous color vision in comparison with model predictions are presented in an accompanying paper (Somers et al., in prep.).

Empirical tests of the effectiveness of EnChroma multi-notch filters for enhancing color vision in deuteranomaly.

Manufacturers of notch filter-based aids for color vision claim that their products can enhance color perception for people with anomalous trichromacy, a form of color vision deficiency (CVD). Anecdotal reports imply that people with CVD can have radically enhanced color vision when using the filters. However, existing empirical research largely focussed on the effect of notch filters on performance on diagnostic tests for CVD has not found that they have any substantial effect. Informed by a model of anomalous trichromatic color vision, we selected stimuli predicted to reveal the effects of EnChroma filters. Using these stimuli, we tested the ability of EnChroma filters to enhance color vision for 10 deuteranomalous trichromats in three experiments: 1. asymmetric color matching between test and control filter conditions, 2. color discrimination measured using four alternative forced-choice, and 3. color appearance measured using dissimilarity ratings to reconstruct subjective color spaces using multidimensional scaling. To investigate potential effects of long-term adaptation or perceptual learning, participants completed all three experiments at two time points, on first exposure to the filters, and after a week of regular use. We found a significant effect of the filters on color matches in the direction predicted by the model at both time points, implying that the filters can enhance the anomalous trichromatic color gamut. However, we found minimal effect of the filters on color discrimination at threshold. We found a significant effect of the filters in enhancing the appearance of colors along the red-green axis at the first time point, and a trend in the same direction at the second time point. Our results provide the first quantitative experimental evidence that notch filters can enhance color perception for anomalous trichromats.

Comparison of Two Printed Pseudoisochromatic Tests for Color Vision Assessment.

SIGNIFICANCE: The Waggoner PIP24 is a pseudoisochromatic test with a pattern similar to the Ishihara test. This study determined that the W-PIP24 can be used clinically to yield screening results (or sensitivity and specificity) comparable with the Ishihara. PURPOSE: This study aimed to determine whether the W-PIP24 is equivalent to the Ishihara 38 edition pseudoisochromatic test in detecting red-green color vision defects. Also, the performance of each plate of the W-PIP24 in detecting the color vision defects relative to the Ishihara test was determined. METHODS: Sixty-three individuals with congenital red-green color vision defects and 57 with normal trichromacy were recruited. Participants were tested with both the Ishihara and W-PIP24. The first-order agreement coefficients were calculated for the Ishihara and W-PIP24. The results were also analyzed using specificity, sensitivity, efficiency, and predictive pass and fail values. RESULTS: The agreement between the W-PIP24 and Ishihara test using the recommended criterion of using all plates was perfect. The sensitivity, specificity, predictive pass, and predictive fail were 1.00 (95% confidence interval, 0.94 to 1.00). CONCLUSIONS: This study showed that the W-PIP24 using a failure criterion of three or more errors on screening plates 1 to 15 is equivalent to the Ishihara test while screening for red-green color vision deficiency using a failure criterion of three or more errors on screening plates 1 to 17 of the Ishihara 38 edition.

Elimination of the color discrimination impairment along the blue-yellow axis in patients with hypothyroidism after treatment with levothyroxine as assessed by the Farnsworth-Munsell 100 hue test.

Our previous study has shown that individuals with untreated hypothyroidism display significantly higher partial error scores (P E S) along the blue-yellow axis compared to the red-green axis than normal individuals using the Farnsworth-Munsell 100 hue test [J. Opt. Soc. Am. A37, A18 (2020)JOAOD60740-323210.1364/JOSAA.382390]. We wished to determine how color discrimination may change when hypothyroidism has been treated to the point of euthyroidism. Color discrimination was reassessed for 17 female individuals who had undergone treatment for hypothyroidism, and the results were compared with 22 female individuals without thyroid dysfunction. No statistically significant difference was found in the total error score (T E S) for the first and second measurements for both groups (p>0.45). The P E S for the hypothyroid group improved significantly in the previously impaired color regions after the treatment. Color discrimination defects found in untreated hypothyroidism can be negated with treatment of the condition over an appropriate time period.

Evaluation of color vision related quality of life changes due to cataract surgery.

Questionnaires have been used as research tools to provide a standardized approach to assess quality of life at various time periods and populations. However, literature shows only a few articles about self-reported color vision changes. Our aim was to evaluate the subjective patient feelings before and after cataract surgery and compare the results with a color vision test result. Our method was as follows: 80 cataract patients filled out a modified color vision questionnaire and performed the Farnsworth-Munsell 100 Hue Color Vision Test (FM100) before, two weeks, and six months after cataract surgery. We analyzed the correlations between these two types of results, which reveal that FM100 hue performance and subjective perception improved after surgery. Additionally, subjective patient questionnaire scores correlate well with the FM100 test results before and two weeks after the cataract surgery, but this effect decreased with longer follow-up times. We conclude that subjective color vision changes can only be noticed at longer periods after the cataract surgery. Health care professionals can use this questionnaire to better understand the subjective feelings of patients and monitor their color vision sensitivity changes.

A diagnostic model based on color vision examination for dysthyroid optic neuropathy using Hardy-Rand-Rittler color plates.

PURPOSE: To investigate color vision deficiency and the value of Hardy-Rand-Rittler (HRR) color plates in monitoring dysthyroid optic neuropathy (DON) to improve the diagnosis of DON. METHODS: The participants were divided into DON and non-DON (mild and moderate-to-severe) groups. All the subjects underwent HRR color examination and comprehensive ophthalmic examinations. The random forest and decision tree models based on the HRR score were constructed by R software. The ROC curve and accuracy of different models in diagnosing DON were calculated and compared. RESULTS: Thirty DON patients (57 eyes) and sixty non-DON patients (120 eyes) were enrolled. The HRR score was lower in DON patients than in non-DON patients (12.1 ± 6.2 versus 18.7 ± 1.8, p < 0.001). The major color deficiency was red-green deficiency in DON using HRR test. The HRR score, CAS, RNFL, and AP100 were found to be important factors in predicting DON from random forest and selected by decision tree to construct the multifactor model. The sensitivity, specificity, and the area under the curve (AUC) of the HRR score were 86%, 72%, and 0.87, respectively. The HRR score decision tree had a sensitivity, specificity, and AUC of 93%, 57%, and 0.75, respectively, with an accuracy of 82%. The data of the multifactor decision tree were 90%, 89%, and 0.93 for sensitivity, specificity, and AUC, respectively, with an accuracy of 91%. CONCLUSION: The HRR test was valid as screening method for DON. The multifactor decision tree based on the HRR test improved the diagnostic efficacy for DON. An HRR score of less than 12 and red-green deficiency may be characteristic of DON.

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.

Information gains from commercial spectral filters in anomalous trichromacy.

Red-green color discrimination is compromised in anomalous trichromacy, the most common inherited color vision deficiency. This computational analysis tested whether three commercial optical filters with medium-to-long-wavelength stop bands increased information about colored surfaces. The surfaces were sampled from 50 hyperspectral images of outdoor scenes. At best, potential gains in the effective number of surfaces discriminable solely by color reached 9% in protanomaly and 15% in deuteranomaly, much less than with normal trichromacy. Gains were still less with lower scene illumination and more severe color vision deficiency. Stop-band filters may offer little improvement in objective real-world color discrimination.

Coloured filters can simulate colour deficiency in normal vision but cannot compensate for congenital colour vision deficiency.

Red-green colour vision deficiency (CVD) affects ~ 4% of Caucasians. Notch filters exist to simulate CVD when worn by colour vision normal (CVN) observers (simulation tools), or to improve colour discrimination when worn by CVD observers (compensation tools). The current study assesses effects of simulation (Variantor) and compensation (EnChroma) filters on performance in a variety of tasks. Experiments were conducted on 20 CVN and 16 CVD participants under no-filter and filter conditions (5 CVN used Variantor; 15 CVN and 16 CVD used EnChroma). Participants were tested on Ishihara and Farnsworth-Munsell 100 hue tests, CVA-UMinho colour discrimination and colour naming tasks and a board-game colour-sorting task. Repeated-measures ANOVAs found Variantor filters to significantly worsen CVN performance, mimicking protanopia. Mixed-model and repeated-measures ANOVAs demonstrate that EnChroma filters do not significantly enhance performance in CVD observers. Key EnChroma results were replicated in 8 CVD children (Ishihara test) and a sub-sample of 6 CVD adults (CVA-UMinho colour discrimination and colour naming tasks) for a smaller stimulus size. Pattern similarity exists across hue for discrimination thresholds and naming errors. Variantor filters are effective at mimicking congenital colour vision defects in CVN observers for all tasks, however EnChroma filters do not significantly compensate for CVD in any.

Chromatic discrimination measures in mature observers depend on the response window.

Our past anecdotal evidence prompted that a longer response window (RW) in the Trivector test (Cambridge Colour Test) improved mature observers' estimates of chromatic discrimination. Here, we systematically explored whether RW variation affects chromatic discrimination thresholds measured by the length of Protan, Deutan and Tritan vectors. We employed the Trivector test with three RWs: 3 s, 5 s, and 8 s. Data of 30 healthy normal trichromats were stratified as age groups: 'young' (20-29 years), 'middle-aged' (31-48 years), and 'mature' (57-64 years). We found that for the 'young' and 'middle-aged', the thresholds were comparable at all tested RWs. However, the RW effect was apparent for the 'mature' observers: their Protan and Tritan thresholds decreased at 8-s RW compared to 3-s RW; moreover, their Tritan threshold decreased at 5-s RW compared to 3-s RW. Elevated discrimination thresholds at shorter RWs imply that for accurate performance, older observers require longer stimulus exposure and are indicative of ageing effects manifested by an increase in critical processing duration. Acknowledging low numbers in our 'middle-aged' and 'mature' samples, we consider our study as pilot. Nonetheless, our findings encourage us to advocate a RW extension in the Trivector protocol for testing mature observers, to ensure veridical measures of their chromatic discrimination by disentangling these from other ageing effects-slowing down of both motor responses and visual processing.

Extending the color discrimination metric with consideration of illuminance level.

Color discrimination is a crucial dimension for the visual assessment of white light sources. In this Letter, we took full advantage of data comparability among Farnsworth-Munsell 100 Hue (FM-100) color vision tests and modified our recent proposed color discrimination metric [Opt. Lett.45, 6062 (2020)10.1364/OL.400422] to make it effective in quantifying the color discrimination capability of lighting under multiple illuminance levels. The updated metric was developed based on a meta-analysis of 100 sets of combined visual data derived from three groups of visual studies containing 29 FM-100 trials and its superiority was comprehensively validated by 140 sets of combined data from five groups of studies with 42 FM-100 trials.

A Computer-Based Farnsworth-Munsell 100-Hue (CFM-100) Test in Pilots' Medical Assessments.

OBJECTIVES: This study investigated the effectiveness and identified the cutoff values of the computer-based Farnsworth-Munsell 100-Hue (CFM-100) test for screening color vision deficiencies in the pre-employment examination of civil aviators in China.METHODS: Firstly, subjects were stratified into normal, color weakness, and color blindness with the Ishihara pseudoisochromatic plate test (IPPT) by two ophthalmologists. Then they randomly completed CFM-100 and Farnsworth-Munsell 100-Hue (FM-100) tests. Total error scores (TES) and the time taken for the CFM-100 and FM-100 were analyzed and the cutoff values for the CFM-100 were determined.RESULTS: Of 218 subjects, 159 were normal while 59 were diagnosed with dyschromatopsia. The TES of the CFM-100 were congruent with those of the FM-100 (20.0 ± 18.8 vs. 20.6 ± 17.7, 160.9 ± 66.0 vs. 151.1 ± 66.4). The testing time for the CFM-100, however, was less than the FM-100 (10.3 ± 2.8 min vs. 12.9 ± 2.9 min, 7.8 ± 2.5 min vs. 12.6 ± 3.3 min). The correlation coefficient R was 0.93 and Cohen's kappa was 0.89 for the two methods. Further analyses defined 34 as the cutoff value to differentiate excellent from fair color discrimination (sensitivity 58.0%, specificity 94.7%) and 101 as the cutoff value to judge fair vs. poor (sensitivity and specificity both 98.8%) for the CFM-100. The cut-off value was 72 for distinguishing normal from defective color vision (sensitivity 96.6%, specificity 98.7%) and 110 was for distinguishing color weakness from color blindness (sensitivity 97.6%, specificity 97.7%) for the CFM-100.CONCLUSIONS: The CFM-100 is an effective method for the diagnosis of dyschromatopsia with high sensitivity in screening airline pilots.Zhang Y, Ma J, Cheng S, Hu W. A computer-based Farnsworth-Munsell 100-Hue (CFM-100) test in pilots' medical assessments. Aerosp Med Hum Perform. 2022; 93(4):362-367.

Limitation of standard pseudoisochromatic plates in identifying colour vision deficiencies when compared with genetic testing.

PURPOSE: The Ishihara pseudoisochromatic (PIC) plate test is the most used test for identifying red-green colour-deficient individuals, but it is not known how the Ishihara results compare with that of genetics testing. Here, the outcome of genotype analysis of OPN1LW and OPN1MW was compared with that of the Ishihara (24-plate ed., 1964) and the Hardy-Rand-Rittler (4th ed. 2002) PIC plate tests. METHODS: Healthy participants with normal habitual visual acuity (n = 454, 16-24 years; 193 males; logMAR ≤ 0.00) gave saliva samples for opsin gene analysis and performed the two PIC plate tests as part of a cross-sectional study. The criteria for failing the PIC tests were according to manufacturers' instructions. DNA was extracted and used in genotyping assays of OPN1LW and OPN1MW genes from each participant using the Agena MassArray genotyping system. RESULTS: Ten male (5.2%) and 3 (1.1%) female participants were identified as red-green colour deficient based on PIC tests alone. The combination of MassArray and PIC test results identified 10.4% of male and 0.8% of female participants to be colour deficient (males: 0.5% protan and 9.9% deutan; females: 0.8% deutan). Hardy-Weinberg calculations based on male frequencies from combining the MassArray and the PIC test results gave female frequency estimates of colour deficiency and carriers closely matching measured frequencies. CONCLUSIONS: MassArray identified twice as many colour-deficient males as identified from PIC tests alone. Combining results from MassArray and the PIC tests proves to be more reliable than any single test at correctly identifying red-green colour-deficient individuals and carriers.

Heavy and light smokers have slight differences in chromatic discrimination.

Objectives: The effects of smoking on color vision have been scarcely studied. To bridge such gap, this study examined if there were differences in chromatic discrimination between heavy and light smokers. Methods: The psychophysical Trivector test was used to evaluate chromatic discrimination in healthy controls (n = 36), heavy smokers (n = 29), and light smokers (n = 32). The subject's task was to identify the orientation of the Landolt C ring gap - presented and randomized in one of the four positions (e.g., up, down, right, and left). Results: The thresholds for Protan (red), Deutan (green) and Tritan (blue) were higher in heavy smokers compared to nonsmokers but not to light smokers. Conclusions: The results confirm that heavy smoking and chronic exposure to its harmful compounds affect color discrimination when compared to light smoking; and this is more pronounced in heavy smokers than light smokers. This is particularly important to understand the differences among smokers on visual and multisensory processing.

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.

Influence of aging on the color visual field in humans: A cross-sectional study.

ABSTRACT: Age-related narrowing of the visual field is observed in the elderly, which leads to reduced cognitive and psychomotor functions. The aim of the present cross-sectional study was to determine the influence of aging on the visual field for color vision in humans, with respect to angular thresholds for object detection and color detection.The subjects were divided into the elderly group (mean 76.1-year-old [70-89]) and the control group (25.2 [18-47]). Visual fields for different colors (blue, green, yellow, and red) were measured by manual kinetic perimetry and evaluated in terms of 2 measures of visual-field width: angular thresholds for object detection and those for color detection.While angular thresholds for object detection were significantly wider than those for color detection in the control group (P < .001), there was no difference in the elderly group (P = .06). Moreover, angular thresholds for object detection were significantly wider in the control group than in the elderly group (P = .019), but angular thresholds for color detection were not significantly different between the 2 groups (P = .903).The observed age-related changes in angular thresholds for object detection in color vision may reflect an age-related reduction in rod function. Stable cone function might explain the preserved angular thresholds for color detection in the elderly.

The Change in Color Vision with Normal Aging Evaluated on Standard Pseudoisochromatic Plates Part-3.

Purpose: To evaluate the influence of aging on color vision in a large normal population using Standard Pseudoisochromatic Plates part-3 (SPP-3), which is a pseudoisochromatic plate test used to detect congenital or acquired color vision deficiency (CVD).Materials and methods: We retrospectively reviewed SPP-3 test results of 23,565 normal eyes of 23,565 subjects (women: 12,035; men: 11,530), who were examined between July 1993 and December 2010. The subjects had a mean age of 46.9 ± 18.5 years, ranging from 5 to 89 years, and they were evaluated following categorization into age groups with five-year increments. Subjects whose best-corrected visual acuity (BCVA) was 20/20 or better, with no history of ocular diseases, were included. Subjects with congenital CVD were excluded.Results: We found a negative correlation between age and the total number of correct answers in SPP-3 (Spearman's correlation coefficient, r = -0.5743; p < .0001). The total number of correct answers was the highest in subjects aged 10-14, 15-19, and 20-24 years (17.2 ± 0.9 [mean ±SD]). The total number of correct answers of these groups had significant differences from those in the 5-9 years age group and those aged >30 years (Dunn's post-hoc test: p < .0001). Among the 19 detection numerals in SPP-3, we found that the correct answer rates of six numerals decreased with aging, and the colors of the numerals and their backgrounds all located parallel to the tritanopic confusion line.Conclusions: Using SPP-3, we confirmed that aging influenced color vision, even in normal eyes with a good BCVA (20/20 or better). The total number of correct answers of SPP-3 was the highest in subjects aged 10-24 years and had already begun to decline in those in their 30s.

Evaluation of a New Test for the Diagnosis of Congenital Dyschromatopsia in Children: the Color Vision Evaluation Test.

PURPOSE: To evaluate the validity, reproducibility, and feasibility of the "Color Vision Evaluation Test" (CVET) for the diagnosis of congenital dyschromatopsia. DESIGN: Prospective, monocentric, sensitivity, and specificity analysis study comparing the CVET with the Farnsworth 15 Hue standard test (15 Hue STF). METHODS: A total of 155 children from the Paediatric University Hospital of Nice were screened (both eyes) using Ishihara's pseudoisochromatic cards, which allowed dividing them into a dyschromatic group and a control group. All children underwent twice the 15 Hue STF and the CVET with at least 7 days between both series of tests. RESULTS: Patients' mean age was 7.56 ± 3.51 years in the dyschromatic group and 8.92 ± 2.9 years in the control group. At the first evaluation, the sensitivity and specificity were 95.7% and 96.4%, respectively, for the CVET and 75% and 58.9%, respectively, for the 15 Hue STF (P < .001). The reproducibility of the CVET was 100%, whereas that of the 15 Hue STF was 88.4% (P = .01). The mean test explanation duration was 18.8 seconds for the CVET and 17.7 seconds for the 15 Hue STF (P = .3). In the dyschromatic group, the mean duration of the CVET was always significantly longer than that of the 15 Hue STF (P < .001). The children subjectively preferred to undergo the CVET rather than the 15 Hue STF in 84.6% of cases (P < .001). CONCLUSIONS: The CVET is a rapid, reliable, and reproducible test for the diagnosis of congenital dyschromatopsia. It is accessible to young children.

Predicting the CN Lantern Test for Railways with Clinical Color-vision Tests.

SIGNIFICANCE: This research will help clinicians in advising their color-vision-defective patients regarding their career options. PURPOSE: In Canadian railways, individuals with a color-vision-defect (CVD) may qualify for positions at shorter sighting distance from signal lights. The railway companies' medical units use the CN Lantern (CNLan) test, and there is little information available as to whether clinical color-vision tests (CCVTs) can predict the CNLan results. This study determines the ability of some CCVTs to predict the CNLan performance to assist clinicians in advising their CVD patients regarding career options. METHODS: The CNLan viewing distance was varied between 4.6 and 0.57 m using a geometric progression. The CCVTs were the Hardy, Rand, and Rittler; Ishihara; ColorDx pseudoisochromatic plate (PIP); the Rabin Cone Contrast Test; Color Assessment and Diagnosis; Cambridge Color Vision Test; U.S. Air Force Operational Based Vision Assessment Cone Contrast Test; Farnsworth Munsell D15; and ColorDx D15. Fifty-six normal-color-vision and 63 CVD subjects participated in this study. RESULTS: Failure of either the Farnsworth Munsell D15 or ColorDx D15 essentially guarantees failure on the CNLan at the 4.6-m distance. The agreement values decreased as the viewing distance decreased. CONCLUSIONS: To counsel patients regarding a career as a locomotive engineer, clinicians should have either the Hardy, Rand, and Rittler or ColorDx PIP and a D15 test. For patients applying for a position in the yard, a mild-to-moderate classification CVD on HRR or ColorDx PIP indicates a high probability of passing CNLan.

The CN Lantern Test and Different Viewing Distances.

SIGNIFICANCE: This research shows that some color-vision-defective patients could identify railway signal lights correctly if they are working in the yard where sighting distances for signal lights are shorter. PURPOSE: When interpreting railway signal lights, sighting distance can vary depending on the employee's location and job requirements. Individuals with a color-vision-defect may pass railroad employment color vision testing for positions with shorter sighting distances, despite failing to qualify for positions with longer sighting distances. The CN Lantern (CNLan) simulates railway signal lights. We evaluated performance and repeatability on CNLan at different viewing distances in color-normal and color-deficient individuals. METHODS: Fifty-six subjects with normal color vision and 63 subjects with a red-green color-vision-defect participated. The CNLan test was performed at 4.6-, 2.3-, 1.15-, and 0.57-m viewing distance. The test was repeated after 10 days. RESULTS: All individuals with normal color vision passed the CNLan at all distances at both visits without errors. For the group with a color-vision-defect, the pass rate increased from 12% at 4.6 m to 62% at 0.57 m. The repeatability of the CNLan between visits for the color-vision-defective group was very good with AC1 agreement values greater than 0.85. CONCLUSIONS: An increase in retinal illumination was likely responsible for the improved performance as the test distance was decreased. Typical sighting distances in railway yards correspond to the 0.57-m test distance in our study. The results of this study suggest that 62% of the individuals with a red-green color-vision-defect may correctly identify colored signal lights in a railway yard where sighting distances are less than 100 m.