Evaluating the level of visual acuity to minimise false-positives in different colour vision tests.

CLINICAL RELEVANCE: Accurate colour vision assessment is important in clinical settings to minimise false-positive errors and enhance the reliability of diagnoses outcomes. BACKGROUND: Colour vision testing is valuable in assessing the visual system, particularly given the high proportion of individuals with poor vision. This study aimed to determine the minimum visual acuity level required to perform a colour-vision test without errors. METHODS: After fogging the right eyes of 52 healthy participants using plus lenses to 1.60 logMAR, vision was evaluated using Ishihara, Hardy - Rand - Rittler Standard Isochromatic, Waggoner Pseudo-isochromatic, City University, Waggoner Computerised, and Farnsworth D-15 tests. Participants then completed these tests at lower fogging degrees (in 0.1-logMAR intervals). The acuity at which 5% of the tested population was considered abnormal was determined. RESULTS: Significant differences were found in the average visual acuity required to perform colour vision tests without errors (p < 0.05). The Waggoner Computerized test required the highest average visual acuity among the tests utilised. The Farnsworth D-15 test yielded the highest logMAR values. No significant differences were observed between the Waggoner Pseudo-isochromatic test and Hardy - Rand - Rittler Standard Isochromatic, Ishihara, and Farnsworth D-15 tests (p > 0.05). Additionally, no significant differences were found between the Ishihara and Hardy - Rand - Rittler tests (p > 0.1) or between the Waggoner Computerized and City University tests (p = 0.11). Colour vision testing maintained an accuracy ≤ 1.0 logMAR with the Ishihara and Hardy - Rand - Rittler tests, 1.1 logMAR with the Waggoner Pseudo-isochromatic and Farnsworth D-15 tests, and 0.9 logMAR with the Waggoner Computerized and City University tests. CONCLUSIONS: Insights are provided into the visual acuity thresholds required for accurate colour vision testing, which can serve as a basis for future research and provide a reference for clinical practice in this field.

Assessment of tear film parameters post-treatment with commercial eyelid cleaning wipes: a pilot study.

AIM: To investigate the short-term effects of commercially available eyelid-cleaning wipes on film parameters. METHODS: This study enrolled 48 healthy participants aged 20-35y (both males and females). Clinical assessment included the Ocular Surface Disease Index (OSDI) questionnaire, non-invasive tear break-up time (NITBUT), tear meniscus height (TMH), and lipid layer pattern (LLP). Based on these initial results, participants were categorized as either non-dry eye or dry eye. Participants in each group were randomly allocated to either Blephaclean® or Systane® treatments. Changes in NITBUT, TMH, and LLP levels before and after lid wipe treatment were assessed. RESULTS: The dry eye group exhibited significantly higher OSDI scores and lower NITBUT and TMH levels than in the non-dry eye group (P<0.001). Following the application of eyelid wipes (Systane® wipes), dry eye subjects experienced a significant improvement in NITBUT levels (P=0.0014) compared to the non-dry eye individuals. Although the remaining participants showed a marginal increase in TMH and NITBUT levels, these changes did not achieve statistical significance (P>0.05). Similarly, the LLP levels were significantly improved with Systane® (P<0.001) post-treatment compared to individuals in the non-dry eye group. However, the dry eye subjects showed higher post-treatment LLP levels than the untreated group (P<0.02). CONCLUSION: The short-term effects of Systane® eyelid wipes on tear film parameters suggest their effectiveness in dry eye disease. Nonetheless, further exploration of their long-term impact is essential to justify their cost effectiveness and efficacy in treating both aqueous deficiency and evaporative dryness.

Age-related changes in reading performance in normally sighted Arabic-speaking adults.

CLINICAL RELEVANCE: Reading performance is important for evaluating near vision and predicting and prescribing near-vision correction. There is a significant gap in the literature on Arabic reading performance and its associated effects. BACKGROUND: Normative data from control participants serve as the baseline for future studies involving groups with specific characteristics. This study aimed to assess baseline measures of Arabic reading performance. METHODS: In total, 428 normally sighted adults aged 19-83 years read the Balsam Alabdulkader - Leat chart to measure their reading performance. The participants were divided into five age groups. The outcome measures were the maximum reading speed in standard-length words per minute, critical print size, reading acuity, and reading accessibility index. RESULTS: The average reading performance measures were as follows: 171 ± 27 standard-length words per minute for maximum reading speed, 0.01 logarithm of the minimum angle of resolution for critical print size, -0.17 logarithm of the minimum angle of resolution for reading acuity, and 1.02 for the accessibility index. There were significant differences among the age groups, indicating a dependency on age and showing a plateau for the young adult group and a decline with age. The accessibility index had an almost perfect correlation with maximum reading speed and a weak but significant relationship with reading acuity and critical print size. CONCLUSION: Arabic exhibits an age-dependent trend in reading speed. However, owing to differences in orthography, visual demands, and reading strategies, the magnitude of the decrease and increase differs, potentially accounting for the variations between languages, especially when compared to English. This study serves as a foundation for future studies on Arabic reading performance. Future studies should examine the reading performance in patients with low vision, study the effects of common diseases on reading ability, evaluate the effectiveness of reading devices, and assess improvements in vision rehabilitation.

Can chromatic text/background improve Arabic reading performance?

PURPOSE: Colors have been shown to improve reading performance; however, the effect of colors on Arabic orthography has not been studied. This study aimed to design and create a chromatic acuity chart to evaluate the effect of chromatic contrast on Arabic reading performance. METHODS: Color selection for the newly developed chromatic acuity chart was based on the contrast between the L, M, and S cones. The colors were chosen to have a luminance of approximately 13.6 cd/m2 with red text on a green background. A Pantone color guide set was used to choose the colors. Fifteen healthy individuals aged 19-27 years were recruited. Reading performance was measured using the newly developed red-green (R-G) chart and compared with the original achromatic Balsam Alabdulkader-Leat (BAL) chart with a luminance of 95 cd/m2. The outcomes were maximum reading speed in standard-length words per minute (SLWPM), reading acuity (RA), and critical print size (CPS). RESULTS: The mean R-G SLWPM of 201 wpm was similar to that of the BAL chart (P < 0.05). The mean RA for the R-G chart was - 0.05 logMAR and - 0.20 logMAR for the BAL chart (P < 0.05). The CPS for the R-G chart was 0.36 logMAR, significantly higher than the original chart of 0.17 logMAR (P < 0.05). CONCLUSION: This study showed that the reading performance for a text that varies only in chromatic contrast along the R-G axis reduces the reading performance for CPS and RA. Individuals showed an approximate decline of two lines on an Arabic continuous text chart compared with a high-contrast achromatic chart. This information can be used to further develop a set of near-reading charts that can efficiently determine whether there is a differential loss in chromatic and achromatic sensitivity in patients with various vision disorders.

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.

Visual resolution under photopic and mesopic conditions in patients with Sjögren's syndrome.

AIM: To focus on different visual resolution tasks under photopic and mesopic conditions in Sjögren's syndrome patients compared to age-matched healthy controls. METHODS: The visual resolution measurements included high and low visual acuities and contrast sensitivity functions. These tests were conducted under photopic and then mesopic conditions. Twenty-one Sjögren's syndrome patients and 21 aged-matched healthy volunteers completed all the measurements in this study. RESULTS: Sjögren's syndrome patients have greater impairment in contrast sensitivity than standardized visual acuity. This reduction was significant under the mesopic condition. Also, Sjögren's syndrome patients treated with pilocarpine suffer more than patients without pilocarpine treatment under low light conditions. CONCLUSION: Sjögren's syndrome patients shows greater impairment in different visual resolution tasks due to dry eye symptoms.

Clinical analysis of the Konan-Waggoner D15 color vision test using the Surface-Pro display.

This work expands on our previous comparison of the Konan-Waggoner D15 (KW-D15) and Farnsworth D15 (F-D15). Sixty subjects with normal color vision and 68 subjects with a red-green color vision defect participated in the study. The KW-D15 had good agreement with the F-D15 for both pass/fail and classification across all failure criteria. The agreement was slightly better if subjects had to pass on 2/3 trials compared with just the first trial. The KW-D15 is an adequate substitute for the F-D15, with the caveat that the KW-D15 might be slightly easier to pass than the F-D15 for deutans.

Knowledge of Saudi Patients with Autoimmune Diseases about Hydroxychloroquine Toxicity: The Role of Physician-Patient Communication.

This cross-sectional internet-based questionnaire aimed to assess the knowledge and experience of autoimmune disease patients in Saudi Arabia of the ocular effects of hydroxychloroquine (HCQ). Among the 245 respondents, discontinuation of the drug was linked to its ocular toxicity in approximately 7.3%. Most patients had taken HCQ for a period longer than five years, exceeding a dose of 5 mg/Kg. A lack of education and physician communication about medication toxicity was reported by approximately 40.8% of the participants. Despite the knowledge about HCQ retinopathy, the drug is prescribed to autoimmune disease patients at an inappropriate dosage. Knowledge obtained from physicians' communication may improve the health outcomes of chronically ill patients. Rheumatologists and ophthalmologists should work together to recognize patients at risk of hydroxychloroquine toxicity and ensure they receive proper education and adhere to periodic follow-up.

Self-Efficacy of Saudi Patients with Autoimmune Diseases in Managing Hydroxychloroquine-Induced Ocular Complications: A Cross-Sectional Survey.

Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are common autoimmune diseases (AD) that affect joints and have multi-organ involvement that results in disability, morbidity, and increased mortality. Both conditions are known to cause a wide range of ocular manifestations. Antimalarial drugs, mainly hydroxychloroquine (HCQ), are among the treatment options for AD that is uniquely characterized by retinopathy as a main side effect. This study examines self-efficacy levels in autoimmune disease patients who were or are currently treated with HCQ and related factors such as patient education, communication with the physician, self-education, and ability to cope with the disease.

Evaluation of the Third edition of the City University Colour Vision Test.

INTRODUCTION: The 3rd edition of the City University Colour Vision Test (CUT) was originally based on the Farnsworth-Munsell D-15 test (D15). The first part of the test is for detecting a defect, and the second part is used to diagnose the type and severity of the defect. This study evaluates the CUT 3rd edition relative to the Ishihara and the D15 colour vision tests. METHODS: Fifty nine colour vision normal subjects and 60 subjects with a congenital red-green colour vision defect were recruited. Subjects were tested with the Ishihara and CUT tests. Subjects who failed the Ishihara also performed the D15 test. RESULTS: The agreement between the Ishihara and CUT screening plates was marginally higher when using the CUT failure criterion of >1 error compared with using >2 errors. If the diagnostic plates were included with the screening plates in determining the pass/fail outcomes, the agreement between the Ishihara and CUT was high, with a first-order agreement coefficient (AC1) of 0.90. The AC1 coefficient agreement between the D15 and CUT diagnostic plates in terms of pass/fail was 0.81 when using the D15 failure criteria of >1 or >0 crossing. CONCLUSION: The level of agreement between the 3rd edition of the CUT and D15 was lower than the 2nd edition of the CUT. The primary reason for the lower agreement of the 3rd edition of the CUT was that it had a lower specificity relative to the D15 compared to the 2nd edition. Although the CUT predictive value for failing the D15 is over 90%, the predictive value for passing shows that 19%-25% of patients who pass the 3rd edition of the CUT test will fail the D15. The 3rd edition tends to misclassify protans as deutans or cannot classify the type of defect relative to the D15 and Ishihara.

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.

Predicting the Farnsworth-Munsell D15 and Holmes-Wright-A lantern outcomes with computer-based color vision tests.

This study determined the AC1 agreement values between computer-based color vision tests and the Farnworth-Munsell D-15 (F-D15) and the Holmes-Wright Type A lantern (HWA). The computer-based tests were the United States Air Force Cone Contrast Test (OCCT), Cambridge Color Test, Innova Rabin Cone Contrast, Konan-Waggoner D15 (KWC-D15), and Color Assessment and Diagnosis (CAD). Sixty-eight color-vision-defective persons participated. The KWC-D15 had the highest AC1 with the F-D15 (${\rm AC1} = {0.88}$AC1=0.88). Both the CAD and OCCT had the highest values with the HWA (${\rm AC1} \gt {0.96}$AC1>0.96). The KWC-D15 would be the best substitute for the F-D15. Either the CAD or OCCT would be appropriate substitutes for the HWA.

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.

Military Research ColorDx and Printed Color Vision Tests.

PURPOSE: To determine the equivalence of the ColorDx Military Research version (mColorDx) test and three printed pseudoisochromatic tests (HRR, Ishihara, and PIPIC) for color vision testing. METHODS: Participating in the study were 75 color-normals and 47 subjects with red-green color vision defects. Color vision was classified by an anomaloscope. The HRR (4(th) edition), Ishihara 38-plate edition, and PIPIC tests are printed color vision tests, whereas mColorDx test figures were displayed on a calibrated computer desktop monitor. All tests were repeated in about 1 wk. RESULTS: The kappa level of agreement (κ) values with the anomaloscope for screening for each test was 0.96 or greater. The values were statistically identical. Specificity for each test was at least 0.99 and sensitivity was at least 0.95. The repeatability of the screening sections for all tests was very good with κ values greater than 0.95. Deutans tended to miss the tritan screening plates on the HRR and mColorDx tests. The Spearman rank correlation coefficients between the severity of the defect and anomaloscope range was moderate with r = 0.45 for the mColorDx and r = 0.6 for the HRR. Both the mColorDx and HRR had perfect agreement with the anomaloscope in classifying the defects as either protan or deutan. CONCLUSION: The validity of the four tests for color vision screening was statistically identical; however, the HRR may be preferred because it had the highest sensitivity of 0.99, a specificity of 1.0, and a reasonable correlation between the severity rating of the defect and the anomaloscope range.