Discriminative Validity of Color Vision Tests in Young Children: Comparison of Normal and Impaired Vision Subjects
Oliver A. Pfaeffli; Christina Gerth-Kahlert
University Hospital of Zurich
Introduction: To investigate the diagnostic ability of pseudoisochromatic plate-based color vision tests (Ishihara and Matsubara), the Mollon-Reffin-Minimalist (MRM) color vision test and the Cambridge Color Test (CCT) to compare the performance of young children with reduced visual acuity to children without visual impairment.
Methods: Data of 23 children with reduced visual acuity (mean logMAR 0.19) and 37 children with age-related normal visual acuity (mean logMAR -0.01), both groups aged 3-10 years were included in a prospective study. The Cambridge Color Test is a computer assisted test on static screens resembling pseudoisochromatic plates. The discriminative chromaticity threshold is adjusted according to the subject’s performance.
Results: All children successfully completed the Pseudoisochromatic and MRM test, CI[87%,100%] for patients and CI[91% ,100%] for probands. The success rate for the CCT was 89%, CI[71%,98%] for patients and 89%, CI[75%,97%] for the control group. No significant difference in the rate of correct answers could be found between groups for the Matsubara/Ishihara test and the MRM. Mean discrimination levels for the protan/deutan/tritan confusion axes in the CCT trivector test were 168/169/231, CI[125,211]/[118,221]/[136,326] for patients and 117/116/137, CI [99,134]/[95,137]/[121,153] for probands, with a tendency towards higher discriminative levels in children with reduced visual acuity. A portion of 50% of all amblyopic patients had a tritan discrimination level beyond the 95% confidence interval for the mean of controls.
Discussion: Color vision is one of the earliest developed visual function in children. Pseudoisochromatic plate-based color vision tests and MRM are of widespread use in clinical routine. However, preliminary data suggest that the discriminative validity of the CCT is higher compared to former tests. Reduced success rate occurred in the subgroup of 3-5y old children most probably due to difficulties in the handling of the adult adapted CCT equipment and limited attentiveness.
Conclusion: The CCT test can be performed by children with reduced visual acuity and could be useful for detecting, grading and monitoring those patients.
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