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Procedures for Testing Color Vision Report of Working Group 41 Committee on Vision Assembly of Behavioral and Social Sciences National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1981

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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn f ram the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The National Research Council was established by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and of advising the federal government. The Council operates in accordance with general policies determined by the Academy under the authority of its congressional charter of 1863, which establishes the Academy as a private, nonprofit, self-governing membership corporation. The Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in the conduct of their services to the government, the public, and the scientific and engineering communities. It is administered jointly by both Academies and the Institute of Medicine. The National Academy of Engineering and the Institute of Medicine were established in 1964 and 1970, respectively, under the charter of the National Academy of Sciences. This work relates to Department of the Navy Contract N00014-80-C-0159 issued by the Office of Naval Research under Contract Authority NR 201-124. However, the content does not necessarily reflect the position or the policy of the Department of the Navy or the Government, and no official endorsement should be inferred. The United States Government has at least a royalty-free, non-exclusive and irrevocable license throughout the world for goverment purposes to publish, translate, reproduce, deliver, perform, dispose of, and to authorize others so to do, all or any portion of this work.

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WORKING GROUP 41 JOEL POKORNY (Chair), Eye Research Laboratories, University of Chicago BILL COLLINS, Civil Aeromedical Institute, Aeronautical Center, Federal Aviation Administration GERALD HOWETT, National Bureau of Standards ROMUALD LAKOWSKI, Department of Psychology, University of British Columbia MARK LEWIS, Civil Aeromedical Institute, Aeronautic ~ Center, Federal Aviation Administration JACK MORELAND, University of Bradford, England HELEN PAULSON, Naval Submarine Medical Research Laboratory, Groton, Connect lout VIVIANNE C. SMITH, Eye Research Laboratories, University of Chicago STEVEN SHEVELL, Statistical Advisor, Department of Behavioral Sciences, University of Chicago ~

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COMMITTEE ON VISION . DEREK H. FENDER (Chair), Jorgensen Laboratory of Information Science, California Institute of Technology ANTHONY ADAMS, School of Optometry, University of California, Berkeley ELIOT L. BERSON, Harvard Medical School JOHN E. DOLLING, Department of Biology, Harvard University JULIAN HOCHBERG, Department of Psychology, Columbia University DOROTHEA JAMESON, Department of Psychology, University of Pennsylvania KEN NARAYAMA, Smith-Kettlewell Institute of Visual Sciences, San Francisco LUIS M. PROENZA, Department of Zoology, University of Georgia ROBERT SEKULER, Departments of Psychology, Ophthalmology, Neurobiology/Physiology, Northwestern University HARRY SNYDER, Department of Industrial Engineering and Operations Research, Virginia Polytechnic Institute and State University KEY DISMUKES, Study Director BARBARA BROWN, Research Assistant LLYN ELLISON, Administrative Secretary iv / 1

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CONTENTS PREFACE 1 INTRODUCTION Color Vision Requirements in Different Occupations, 1 Occupations Excluding Ma jor Color Vision Defects, 2 Occupations Requir ing Representative Color Vision, 2 Occupations Requiring Good Color Discrimination, 2 Selecting Color Vision Tests, 3 2 CLASSIFICATION OF COLOR VISION DEFECTS Normal Color Vision, 4 Colorimetric Def inition, 4 Chromatic Discriminative Ability, 8 Congenital Sex-Linked Color Vision Defects, 8 Anomalous Trichromats, 9 Dichromats, 10 Autosomal Dominant Tritan Defect, 11 Acquired Color Vision Defects, 12 Normal Color Vision Changes with Age, 12 Effect of Disease, Injury, and Drugs, 12 Physical Factors Affecting Color Vision, 13 Illumination, 13 Field Size, 13 3 COLOR VISION TESTS Historical Introduction, 14 General Description of Types of Color Vision Tests, 15 Anomaloscopes, 15 Plate Tests, 16 Arrangement Tests, 17 Lantern Tests, 18 How to Evaluate a Color Test, 18 Reliability and Validity, 18 v ~ V 1 1 1 4 14 e

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Specific Procedures for Calculating Different Types of Tests, 19 Illuminants, 20 Existing Tests: Availability, Practicality, and Procedures, 24 Anomaloscopes, 24 Pseudoisochromatic Plates, 40 Other Plate Tests, 53 Arrangement Tests, 57 Lantern Tests, 73 Other Tests, 78 4 USING COLOR VISION TESTS Evaluation of Congenital and Acquired Color Vision Defects, 81 Rapid Screening of Congenital Red-Green Color Defects, 81 Diagnosis of Red-Green Defects, 82 Recognition of Congenital Blue-Yellow Defects, and Achromatopsia, 83 Evaluation of Acquired Color Vision Defects, 83 Classification and Quantification of Chromatic Discriminative Ability, 83 Test Batteries, 83 Quantification of Chromatic Discriminative Ability, 85 Screening for Professional Purposes, 86 Test Administration: Training Personnel to Administer Tests, 87 Some Special Problems of Testing, 89 Testing Illiterates, 89 Language Problems, 90 Testing the Elderly, 90 Testing Children, 90 Malingering and Concealing, 93 Color Vision "Cures and "Remedies n ~ 93 5 RECOMMENDATIONS APPENDIX: UNDERSTANDING TEST DESIGN Color Matching, 97 Representation of Defective Color vision in the Chromaticity Diagram, 99 Theory of Test Construction, 101 Pseudoisochromatic Plate Tests, 101 Arrangement Tests, 105 Anomaloscope, 107 REFERENCES vi 81 95 97 111 , e

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PREFACE Color vision tests are used in selecting personnel for certain occupa- tions that require the use of color vision. These tests are also used clinically to identify and differentiate congenital and acquired disorders involving color vision. Several basic techniques are used for testing color vision and many different devices are available commercially. It is extremely important that color vision testing devices be validated before being adopted for screening; this requires demonstration that a test actually does identify and discriminate among color vision deficiencies as required for a particular occupational task. Some, but not all, commercially available tests have been adequately validated. This information, however, has not been available from any single source, making it difficult for users to decide what tests are most appropriate for their needs. Working Group 41 was established by the Committee on Vision to assemble information on existing color vision tests and to assess their utility and the extent to which they have been adequately validated. This report, which is derived from deliberations of the working group, describes the administration, scoring, and interpretation of various color vision tests and evaluates validation studies that have been performed on these tests. Additional material is included to make this report a self-contained reference source on procedures for testing color vision. Characterization of color vision and the classification of color vision defects are described. An appendix on the principles of test design is included for nonspecialists. Recommendations are made for the appropriate use of color vision tests in occupational screening. The report includes information on most of the more commonly used tests, but it was not possible to obtain complete descriptions of all tests. Readers are welcome to send to the study director of the Committee any supplementary information that might be used if this report were to be updated in the future. Members of Working Group 41 brought to this project great expertise in such areas as the nature of color vision defects, calorimetry, test design, and occupational uses of color vision tests. Individual members of the group contributed material, which was drafted by Joel Pokorny and Vivianne Smith into manuscript form and reviewed by the entire group. Preparation of the report was supported in part by grants EY 01876 (Smith) and EY 00901 (Pokorny) from the United States vii t

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Public Health Service and the National Eye Institute. Mary Jo Nissen provided technical editing. Several members of the Committee on Vision staff contributed to the preparation of this report: William Benson, Barbara Brown, Key Dismukes, Michelle Eabon, Llyn Ellison, and Luis Proenza. Robert M. Boynton, Ronald Ever son, Dorothea Jameson, and Whitman Richards also encouraged this work and commented helpfully on the manuscript. Some of the information herein is based on material prepared for Congenital and Acquired Color Vision Defects (Pokorny et al., 19791. 1 viii r