Ultraviolet protection in eye and face protection against biological hazards.

BACKGROUND: In the development of eye and face protection standards against biological hazards, it is important to consider that the eye and face protectors may be used in the outdoor environment, where ultraviolet (UV) exposure from the sun is much higher than indoors. Workers affected include paramedics, ambulance officers and clinical testing personnel. METHODS: Spectral transmittances (280-780 nm) were measured on eight face shields and one goggle of the types used in hospital and clinical environments, three overhead projector sheets and an occupational impact protective goggle. The UV and luminous transmittances were calculated according to the international and two national sunglass standards, and compared with the compliance requirements. RESULTS: All the face shields and goggle lenses were made of variants of the same material. All the samples, including the overhead projector sheets, complied with the requirements of the sunglass standards (for normal conditions, in the case of the American standard). CONCLUSION: Since all the lenses complied with the sunglass standards for UV protection, and there appears to be uniformity in the choice of materials in this product type, there is no need to make provision, as is the case for occupational eye and face protection standards, for protectors that do not provide UV protection. This makes labelling and advice to end users from eyecare and safety professionals much simpler.

Difficult at dusk? Illuminating the debate on cricket ball visibility.

OBJECTIVES: Investigate the visibility of new and old red, white and pink cricket balls under lighting and background conditions experienced during a day-night cricket match. DESIGN: We modelled the luminance contrast signals available for a typical observer for a ball against backgrounds in a professional cricket ground, at different times of day. METHODS: Spectral reflectance (light reflected as a function of wavelength) was derived from laboratory measurements of new and old red, white and pink balls. We also gathered spectral measurements from backgrounds (pitch, grass, sightscreens, crowd, sky) and spectral illuminance during a day-night match (natural afternoon light, through dusk to night under floodlights) from Lord's Cricket Ground (London, UK). The luminance contrast of the ball relative to the background was calculated for each combination of ball, time of day, and background surface. RESULTS: Old red and old pink balls may offer little or no contrast against the grass, pitch and crowd. New pink balls can also be of low contrast against the crowd at dusk, as can pink and white balls (of any age) against the sky at dusk. CONCLUSIONS: Reports of difficulties with visibility of the pink ball are supported by our data. However, our modelling also shows that difficulties with visibility may also be expected under certain circumstances for red and white balls. The variable conditions in a cricket ground and the changing colour of an ageing ball make maintaining good visibility of the ball a challenge when playing day-night matches.

Visual function and retinal thickness in children with type 1 diabetes mellitus.

CLINICAL RELEVANCE: The possibility that changes in blue-yellow visual thresholds and some retinal thickness measures in children with diabetes mellitus may be observed before any visible fundus changes points to the possibility of these measures being a useful predictor that the risks of diabetic retinopathy are higher in some children than in others. INTRODUCTION: Previous studies showed mixed results on chromatic and achromatic contrast sensitivity early in the course of diabetes mellitus, and the findings of these studies may have been influenced by a lack of experimental sensitivity to visual deficits, a bias towards tritan-like errors or the cognitive demands of the tests and variations in sample composition. The purpose of this study was to evaluate colour and contrast thresholds and retinal thickness in children with type 1 diabetes mellitus compared with age-matched controls. METHODS: A prospective case-control study was carried out on 9-14-year-old children with type 1 diabetes mellitus (49 cases) and age matched controls (49) in which isoluminant red-green and blue-yellow and achromatic luminance contrast thresholds were measured. Fundus photography was used to grade diabetic retinopathy. Retinal thickness parameters were measured using optical coherence tomography. Data on the duration of diabetes mellitus, glycaemic control (HbA1c), blood glucose level, body mass index, blood pressure and blood oxygenation at the time of testing were obtained. RESULTS: The cases mostly had poorly controlled diabetes, HbA1c 8.6% (6.4-12.8%), for an average (range) duration of 5 (0.4-12) years. The cases had significantly higher blue-yellow thresholds (p = 0.02) and greater total retinal and inner retinal thickness (p < 0.05) than controls. No cases had diabetic retinopathy. Within the cases, poorer visual function and systemic health measures were associated with thinner retinal structures and greater global loss volume percentage in the ganglion cell complex. CONCLUSION: Blue-yellow thresholds of cases were raised compared to normal. Within the cases, higher luminance contrast thresholds were also associated with, mostly, ganglion cell complex reductions.

Recommendations and requirements for the wavelengths in Rayleigh equation anomaloscopes.

DIN 6160:2019 is a technical standard that sets requirements for Rayleigh equation anomaloscopes. Table 1 of the standard contains the limits for centroid wavelengths and spectral half power bandwidths (SHBW). The centroid limits are more restrictive than dominant wavelength recommendations. The SHBW limits have no known evidence base and are inconsistent between colors. The spectral characteristics of three commercial anomaloscopes brands were measured using a telespectroradiometer. Only the oculus instruments complied with DIN 6160 Table 1, but all the anomaloscopes complied with published recommendations. All complied with the DIN 6160 bandwidth requirements. This highlights the need to provide an evidence base for such requirements.

A model for assessing the efficacy of colour vision aids.

Optical filter aids are marketed which claim to improve colour discrimination in red-green colour vision defectives. An earlier model has been revised and used to assess 9 currently available aids. Spectral reflectances (400-700 nm) for 80 colours equally spaced in hue angle at four equally spaced saturations were synthesised from chromatically adjacent Munsell colours. Aid induced chromaticity changes for Protanomals and Deuteranomals were calculated. Five aids enhanced red-green discrimination significantly for Protanomals and six for Deuteranomals and one aid reduced it significantly for both defectives. Five aids enhanced blue-yellow discrimination in Protanomals and Deuteranomals for whom it is not needed.

Luminance contrast preferences of people with a vision impairment for elements in the built environment.

BACKGROUND: Standards for building elements recommend a minimum luminance contrast of 30%. The basis of this value and the metric originally used is not known. OBJECTIVE: To begin to provide an evidence base for the specification of minimum contrast in building elements. METHODS: Subjects with and without a vision impairment were characterized by visual acuity, contrast sensitivity, visual fields and color vision. On an iPad they rated the visibility, as a function of contrast, of simulated door frames, door handles, light switches and stair nosings as "not visible at all", "poorly visible", "easily visible" and "extremely easily visible". RESULTS: The contrasts for each level of visibility were highly correlated with visual acuity and contrast sensitivity. A principal component analysis also verified the importance of visual acuity, contrast sensitivity and visual fields in rating visibility of simulations of building elements. The required contrast for door handles, light switches and stair nosings to attain the same ratings of visibility were very similar but less contrast was required for door frames. CONCLUSIONS: 30% Michelson contrast for building elements renders building elements only poorly visible for those with severe vision impairments. 65% luminance contrast is necessary for all elements to be "easily visible". Some increase (not a decrease) on the present 30% requirement and encouragement to exceed this requirement would seem appropriate. The use of simulated objects facilitates a systematic examination of the effect of contrast, but the applicability of the results to real-life remains to be demonstrated.

How practitioners say they answer the questions of patients about ultraviolet protection.

Patients should be able to rely on optometrists and optical dispensers to provide evidence-based answers to their questions on eye protection, including against ultraviolet radiation. Surveys indicate that there is public concern about the need for protection against ultraviolet radiation, particularly in sunlight. This investigation aimed to evaluate the quality of information provided by practitioners in response to typical questions to which they might reasonably be expected to have ready answers. A cross-sectional study was conducted of on-site responses from attendees of a 3 day optical fair, in Sydney, Australia, in 2017. Subjects were not forewarned about the study. The portion of the questionnaire reported here comprised open answers to four questions intended to represent typical enquiries of patients. The questions were about recommendations for ultraviolet protection in the context of 1) computer use, 2) outdoor use, 3) driving and 4) under office lighting. Eighty-three participants returned completed questionnaires out of 140 issued (61% response). The open-answer question responses were grouped into appropriate, borderline (mostly appropriate but mixed with non-UVR related recommendations) and others (mostly non-UVR related recommendations) and by job title. The proportion of appropriate answers to the four questions were 20%, 30%, 12% and 15%, respectively, which did not differ by job title. A significantly higher proportion of optical dispensers than optometrists selected 'Don't know/no answer' for all questions except office use. Eyecare professionals need to be educated on eye protection against UV radiation to improve the quality of information to be given to the public.

Optical performance of welding curtains and existing standards.

Welding curtains and screens are intended to protect workers, other than the welder, from the effects of optical radiation generated by the welding process. The national and international standards for welding screens and curtains have different requirements. The aim is to compare the protection requirements of examples of welding curtain material and to assess compliance with the international and national standards. Spectral transmittance values (ultraviolet, visible, and infrared) of 21 samples were obtained from the records of an ISO/IES 17025 accredited test laboratory and performance/compliance was assessed according to each of the standards. In the ultraviolet, 10 samples passed and seven failed all standards. In the visible/infrared region, four samples passed and 10 failed all standards. Four samples passed the U.S. and international standards but failed the Australian/New Zealand standard in the blue-light transmittance requirement. One sample failed both the U.S. and Australian/New Zealand standards but the result for the international standard was borderline, one sample passed ISO but failed the blue-light requirements, and one failed ISO but passed the blue-light requirements. The derivations of the various requirements are not well documented. The Australia/New Zealand standard is significantly more stringent in the ultraviolet and blue-light regions. A review of the optical radiation hazards and revision of the standards are indicated. It is possible that curtains, other than those tested, that comply with the international standard might transmit hazardous levels of blue light and, conversely, adequate ultraviolet and blue-light protection is available with curtains that do not comply with the international standard.

Ultraviolet radiation transmission of soft disposable contact lenses and ISO 18369: claims and compliance.

CLINICAL RELEVANCE: This study was carried out to provide advice to eye care practitioners on those soft disposable contact lenses that comply with the Class 1 or Class 2 requirements of the international standard ISO 18369 for ultraviolet radiation protection. BACKGROUND: This study was carried out to provide advice to eye care practitioners on those soft disposable contact lenses that comply with the Class 1 or Class 2 requirements of the international standard ISO 18369 for ultraviolet radiation (UVR) protection and to validate any claims made. It is intended to be used when a patient needs or requests UVR protection. A revised ISO 18369-3 was published in 2017. There is no Australian adoption nor equivalent. METHODS: The direct spectral transmittance of three specimens of each of the twenty soft disposable contact lens types available in Australia in 2018 was measured in saline in a quartz cuvette with a dual beam spectrophotometer from 200-780 nm. Transmittance values for each material were averaged and scaled according to a single measurement of its transmittance in the visible spectrum (380-780 nm). Based on the ISO 18369-3:2017 criteria, lens materials were denoted as Class 1, Class 2 or non-UVR protectors. This classification was compared with any claim made by the manufacturer. RESULTS: All claims of the manufacturers for Class 1 or Class 2 were valid. There were no examples of any missed opportunity to make a claim. Some claims were so general as to be untestable. Some numerical claims appeared to hide that only a Class 2 claim could be made. CONCLUSIONS: Claims of Class 1 or Class 2 were found to be appropriate. There were no missed opportunities to claim. UV protection claims that were not in the ISO 18369-3 format may be taken as Class 2 compliance but not Class 1 compliance. A two-class system of UV protectors and non-UV protectors may serve practitioners and their patients better.

Effect of blue-blocking lenses on colour discrimination.

CLINICAL RELEVANCE: Tinted lenses may adversely affect colour discrimination. Before recommending tinted lenses to patients, practitioners should bear in mind any effects on colour discrimination. The effects of 'blue-blocking' spectacle lenses with high luminous transmittance on colour vision is not a concern. BACKGROUND: Blue-blocking lenses have been widely promoted by manufacturers and practitioners. The more blue-blocking lenses are known to affect colour vision significantly but there has been no study of the effects of 'blue-blocking' spectacle lenses. METHODS: The transmittances of commercially available lenses were measured and the three lenses with the lowest blue light transmittance were selected. Subjects undertook the following computer-based colour vision tests: Colour Assessment and Diagnosis; the Cambridge Colour Test; and the Farnsworth-Munsell 100 Hue Test. RESULTS: Blue and luminous transmittances of lenses were documented. The reduction in blue transmittance varied from 12 to 40 per cent (two to 30 per cent compared with an untinted lens). The lenses were found to have no significant, statistical or possibly practical, effect on the results of the three colour vision tests (t-test, analysis of variance, Mann-Whitney, Kruskal-Wallis). CONCLUSION: The modest blue light transmittance reduction of the 'blue-blocking' spectacle lenses examined was not sufficient to have a statistically significant effect on colour vision.

The blue light dose from white light emitting diodes (LEDs) and other white light sources.

PURPOSE: This study was carried out to determine if light emitting diodes (LEDs) represented a special case in exposing the retina to blue light, when compared with other methods of backlighting television and computer screens and with fluorescent tube lighting. METHOD: The spectral distribution of light from computer and television screens (cathode ray tube, plasma screen, organic LEDs, and screens backlit by cold cathode tubes and/or LEDs), domestic type spotlights (LED and fluorescent tube) and objects in the outdoor sunlit environment were measured with a telespectroradiometer. The spectral data were analysed for the proportion of blue light and luminance. The results were also presented as time to reach the occupational safety limit, without regard to the normal 10 000 s time limit by which time there is no summation of exposure. RESULTS: The amount of blue light in a source is essentially independent of the technology of the light source, but closely related to the correlated colour temperature. CONCLUSIONS: Fluorescent lamps show essentially the same proportions of blue light and LEDs do not represent a special case, given the same correlated colour temperature. Blue-blocking lenses are no more needed with LED sources than with other screen illumination methods or with fluorescent lighting. There is no evidence base on which to recommend blue-blocking lenses for indoor applications.

Lighting for color vision examination in the era of LEDs: the FM100Hue Test.

Lighting conditions nominated for color vision testing are many and varied. The recommendation of CIE color rendering index (CIE CRI) ≥90 and correlated color temperature of close to 6500 K is widely made for color vision testing generally. With the demise of incandescent and fluorescent lighting and their replacement by light-emitting diodes (LEDs), this is an opportune time to revisit the recommendation. In this paper, we consider the current sources, acceptable and unacceptable, and improvements to the recommendation as it applies to the Farnsworth-Munsell 100 Hue Test (FM100Hue Test). We conclude that there is no need to treat LEDs as a special case but propose a modified CRI measure.

Limitations and Precautions in the Use of the Farnsworth-Munsell Dichotomous D-15 Test.

SIGNIFICANCE: Clinicians who administer the Farnsworth-Munsell D-15 test need to pay attention to the quality and quantity of lighting and the time that they allow for completion of the test, and all repeat attempts need to be included in reports on compliance with color vision standards. PURPOSE: The validity of the Farnsworth-Munsell D-15 has been questioned because practice may allow significantly color vision-deficient subjects to pass. In this article, we review the influence of practice and other factors that may affect the performance. These relate to both the design and the administration of the test. METHODS: We review the literature and present some calculations on limitations in the colorimetric design of the test, quantity and quality of lighting, time taken, and repeat attempts. RESULTS: In addition to the review of the literature, color differences and luminance differences under selected sources are calculated, and the increases in luminance clues under some sources and for protanopes are illustrated. CONCLUSIONS: All these factors affect the outcome of the test and need specification and implementation if the test is to be applied consistently and equitably. We recommend the following: practitioners should never rely on a single color vision test regardless of the color vision standard; lighting should be Tcp '' 6500 K and Ra > 90; illuminance levels should be between 200 and 300 lux if detection of color vision deficiency is a priority or between 300 and 1000 lux if the need is to test at the level where illuminance has minimal influence on performance; illuminance should be reported; time limits should be set between 1 and 2 minutes; repeat testing (beyond the specified test and one retest) should be carried out only with authorization; and initial and repeated results should be reported. A set of test instructions to assist in the consistent application of the test is provided in the Appendix.

Development of color vision discrimination during childhood: differences between Blue-Yellow, Red-Green, and achromatic thresholds.

Nonvisual demands of tests affect vision test results in children. 150 children (79 females and 71 males, 5.3-12.7 years of age) were examined. Isoluminant Blue, Yellow, Red, Green, and Black and White thresholds were established with a four-alternative forced-choice and pseudo-10-bit system with adaptive staircase and gaming elements. Where Threshold=b0+b1*age-1, b1 for RG=6.26±1.90 (95% confidence limits), Achr=3.96±1.07 and BY=12.48±2.76 were significantly different. The noncolor demands of the test are the same for RG, BY, and Achr, so the later development of BY discrimination is not an artifact of the test.

Normative values for a tablet computer-based application to assess chromatic contrast sensitivity.

Tablet computer displays are amenable for the development of vision tests in a portable form. Assessing color vision using an easily accessible and portable test may help in the self-monitoring of vision-related changes in ocular/systemic conditions and assist in the early detection of disease processes. Tablet computer-based games were developed with different levels of gamification as a more portable option to assess chromatic contrast sensitivity. Game 1 was designed as a clinical version with no gaming elements. Game 2 was a gamified version of game 1 (added fun elements: feedback, scores, and sounds) and game 3 was a complete game with vision task nested within. The current study aimed to determine the normative values and evaluate repeatability of the tablet computer-based games in comparison with an established test, the Cambridge Colour Test (CCT) Trivector test. Normally sighted individuals [N = 100, median (range) age 19.0 years (18-56 years)] had their chromatic contrast sensitivity evaluated binocularly using the three games and the CCT. Games 1 and 2 and the CCT showed similar absolute thresholds and tolerance intervals, and game 3 had significantly lower values than games 1, 2, and the CCT, due to visual task differences. With the exception of game 3 for blue-yellow, the CCT and tablet computer-based games showed similar repeatability with comparable 95% limits of agreement. The custom-designed games are portable, rapid, and may find application in routine clinical practice, especially for testing younger populations.

When is protection from impact needed for the face as well as the eyes in occupational environments?

BACKGROUND: The most commonly identified reason for requiring or using occupational eye and face protection is for protection against flying objects. Standards vary on what risk may require protection of the eyes alone and what requires protection for the whole face. Information on the minimum energy transfer for face damage to occur is not well-established. METHODS: The heads of pigs were used as the common model for human skin. A 6 mm steel ball projected at velocities between 45 and 135 m/s was directed at the face area. Examples of impacts were filmed with a high-speed camera and the resulting damage was rated visually on a scale from 1 (no visible damage) to 5 (penetrated the skin and embedded in the flesh). RESULTS: The results for the cheek area indicate that 85 m/s is the velocity above which damage is more likely to occur unless the skin near the lip is included. For damage to the lip area to be avoided, the velocity needs to be 60 m/s or less. CONCLUSION: The present data support a maximum impact velocity of 85 m/s, provided the thinner and more vulnerable skin of the lids and orbital adnexa is protected. If the coverage area does not extend to the orbital adnexa, then the absolute upper limit for the velocity is 60 m/s. At this stage, eye-only protection, as represented by the lowest level of impact test in the standards in the form of a drop ball test, is not in question.

Impact of Gamification of Vision Tests on the User Experience.

OBJECTIVE: Gamification has been incorporated into vision tests and vision therapies in the expectation that it may increase the user experience and engagement with the task. The current study aimed to understand how gamification affects the user experience, specifically during the undertaking of psychophysical tasks designed to estimate vision thresholds (chromatic and achromatic contrast sensitivity). METHODS: Three tablet computer-based games were developed with three levels of gaming elements. Game 1 was designed to be a simple clinical test (no gaming elements), game 2 was similar to game 1 but with added gaming elements (i.e., feedback, scores, and sounds), and game 3 was a complete game. Participants (N = 144, age: 9.9-42 years) played three games in random order. The user experience for each game was assessed using a Short Feedback Questionnaire. RESULTS: The median (interquartile range) fun level for the three games was 2.5 (1.6), 3.9 (1.7), and 2.5 (2.8), respectively. Overall, participants reported greater fun level and higher preparedness to play the game again for game 2 than games 1 and 3 (P < 0.05). There were significant positive correlations observed between fun level and preparedness to play the game again for all the games (p < 0.05). Engagement (assessed as completion rates) did not differ between the games. CONCLUSION: Gamified version (game 2) was preferred to the other two versions. Over the short term, the careful application of gaming elements to vision tests was found to increase the fun level of users, without affecting engagement with the vision test.

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.

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

Given the versatility of smart phone displays, it was inevitable that applications (apps) providing colour vision testing would appear as an option. In this study, the colorimetric characteristics of five available iPhone apps for colour vision testing are assessed as a prequel to possible clinical evaluation. The colours of the displays produced by the apps are assessed with reference to the colours of a printed Ishihara test. The visual task is assessed on the basis of the colour differences and the alignment to the dichromatic confusion lines. The apps vary in quality and while some are colorimetrically acceptable, there are also some problems with their construction in making them a clinically useful app rather than curiosity driven self-testing. There is no reason why, in principle, a suitable test cannot be designed for smart phones.