All right, my iPhone says it's 10.15, so I'm going to get started. I've got a lot of stuff to cover here. My name is Jeff Weaver. Thank you for coming this morning. Hope you have your red and green tomatoes at the ready. We can use that sort of an ancillary color test. Disclosure, nothing to disclose. Today we'll be talking about color vision in a number of different ways. Actually after having some conversations at this meeting and finding out, I mean, this is why we come to meetings like this, is to talk to people. I almost went to my slide deck this morning and changed everything and just wanted to start over almost based on some of the questions and issues that I heard coming up. But we'll look back over them. I'll just probably emphasize things a little differently on each one, especially getting through this history pretty quickly because we need to get to the meat of the color vision things other than the history. These are things we're going to cover. But I love history, so I wanted to talk a little bit about history and kind of how we got ... And I am an optometrist, so you guys maybe know some of these things, but I'm closing in on a PhD in industrial organizational psychology, so maybe I'm kind of learning some of these things that you guys already knew. But when did we start testing for occupational purposes? It goes all the way back to the Chinese civil service examinations back as early as 2200 BC. Initially examinations were conducted only for the purpose of evaluating civil servants to determine whether they should continue in office, something that happened every three years, almost as a re-election to office. But at some point, the Chinese rulers decided that the examination should also be used to choose the candidates for the civil service positions. It seems like they had the chicken or the cart before the horse there. But early research in experimental psychology was focused on the study of physical sensation. And German psychophysical laboratories in the early 1800s, such as that as Wilhelm Wundt, were concerned with obtaining precise estimates of reaction time, visual and auditory perception, and other physical sensations under various conditions. And Wundt was kind of interesting to me because he learned under Hermann von Helmholtz, who was an ophthalmologist who's actually known as the father of physiological optics, so well known in vision circles. But a major influence on the research at this time was the publication of Darwin's Origin of Species in 1859. There was Darwin's cousin, Francis Galton, who wrote several works on hereditability of scientific aptitude. And Galton is well known for the establishment of laboratories, starting at the 1884 International Health Exhibition in London, for the collection of physical measurements such as height, weight, strength of pull, and discrimination of colors. So here was Galton's recording form from 1884. So it's not so different from some of the occupational medical exam forms you might use today. But notice there, second one down under eyesight, is color sense, goodness of. And here is Galton's color vision test. It used wound colored wool. I mean, we still have some of those wool thread tests around, don't we? The drawing is a schematic showing the test cut open, but the person being tested was instructed to place a peg in the hole in front of any wool that contained any shade of green. In our roles, we're looking for physical competence for a position. And in the position competency model, it's based on the determining of knowledge, skills, and abilities, and other attributes needed for functioning in a particular role. And you know that. What we now refer to as job task analysis may be attributed to Munsterberg in his studies from the early 1900s that started with his examination of sea captains. In his text, he argued the best way to improve efficiency and productivity is to match the character and the physical abilities of an individual to the right job. And why I end up keeping these history things in here today was realizing that on this one in our occupational vision testing today, the top bullet is I think the thing we need to think about. Our primary concern is safety. And Munsterberg's early application of his theories were prompted by safety concerns. Train workers, fatality rates had skyrocketed near the turn of the 20th century, but it seems to be coming around again here with all these train accidents we're having. And you know, safety is also the primary reason for today's vision standards, as I'm sure it is many other physical standards that you guys deal with. The typical vision categories for employees of all types, as you know, are visual acuity, visual field, depth perception, and color vision. And this holds true for employees of the Department of Homeland Security, for whom I'm most frequently reviewing applications on an ongoing basis. So in terms of our safety issues, our safety concerns, especially in law enforcement, is not just to the employee, but for the public. So for each of these important attributes, if they're going to require a standard, it's important that they're evaluated in relation to essential job function. So I'm just going to get into some of these attributes real quickly before we get into the meat of color vision. So visual acuity is the best known measure that we have to measure a person's ability to see fine detail. So that's why it's assessed for many occupations. Unfortunately, in occupational medical settings, we often use one of the worst devices to assess it, the chart within these occupational vision testers. And I won't get into why it's problematic, but it can affect particularly younger individuals in terms of their accommodation and how they perceive this, even though it's optically set for optical infinity inside it. Better assessment these days can be obtained with the logMAR charts, the log at the minimum angle resolution that are standard for the measurement in clinical trials, as you see there in the lower right. One of the ways to kind of double check whether our visual acuity is accurate is think about the correlation with refractive error. Refractive error is a means of indirectly determining visual acuity. So this is a box and whisker plot of refractive error as a function of visual acuity. And I've added a couple of visual acuity lines that can be used for comparison. An important one up here is the 2100, which is common uncorrected visual acuity used in law enforcement. So if we look at myopia, it's unlikely that a person worse than about a minus three or three diopters of myopia is going to have 2100 or better visual acuity. And if you're looking over, you know, some of the results you might have or that someone has taken other than yourself, hopefully, and you look at their refractive error and their minus eight, very highly myopic, and they come in as 2070, no, it's not going to happen. That's not their uncorrected visual acuity. And it happens both directions. So if you look at that as a correlation, that's a good way to determine whether something is awry. Depth perception, similarly, true depth perception or stereopsis is the elegant sense of relative depth that allows us to see fine bulges or irregularities in surfaces, particularly in inspection tasks. And that's due to retinal disparity between the two eyes. So when the eyes are aligned, you can see detail from two different directions at the same time. And this is really important for inspecting in law enforcement, using to see hidden weapons or contraband, helpfully to sort out fine detail, discriminating a weapon from a distractor, for instance. And there are two main types, global and local stereo acuity. The circles on the left there, which are most commonly used in some of the occupational vision testers, are local stereo acuity. It's derived from very small images, the central retina and the macula. Global stereo acuity is larger areas. And they do measure two different things. So local may be perhaps more useful for some of the inspection tasks, but both can be very important. And if somebody has strabismus or exotropia, esotropia, and they come in with 20 seconds of stereopsis, something's awry there, too. So watch out for these kind of things. And visual field, the human eye can see temporally 100 degrees and nasally 60 degrees if looking straight ahead. Mom's much, much further. But this does yield a binocular visual field of 200 degrees with 120 degrees of overlap. Our vision screening testers in some of the occupational health centers are not the best. The TITMUS, I think, is probably about the worst. It has just three flashing lights on each side that only test at 70, 85, and 55, whatever. So it doesn't give us a very wide range of knowledge of the person's visual field test. So there are some better. Some of the other vision testers have much more wider range of the light flashings from the side. Fortunately, you can use an arc perimeter if you can find one of those dinosaurs around anymore. Or fortunately, Brunel has come out with a, I guess, a modern-day version of the arc perimeter called a hand-disc perimeter. They're only about $50, but you can test that horizontal visual field to the one-degree increment if necessary. Okay, so that was just a brief synopsis of both history and other vision attributes. But I really do want to get into color vision deficiency. That's why you're here. So let's talk about that. So color deficiencies can be categorized in numerous ways. One way is differentiating congenital versus acquired deficiencies. Congenital color deficiencies are typically, as the bullets show, they're present from the earth. They're stable. They typically are bilaterally symmetrical, and they do affect the entire field of vision, the entire retina. All the photoreceptors are the same because it's a congenital issue, X-linked. Acquired, to contrast that, they can progress and regress. They are typically asymmetrical, though they can appear very, very symmetrical at times, may affect only a portion of the visual field, typically the macula, and it can be caused by a number of conditions and medications. Another way of categorizing color deficiency is by the number of cone receptors. Normally individuals have three cone types, and having fewer or an anomalous cone type causes a deficiency. So this list is an order of worse to better color discrimination ability, and it should make sense. Those with the worst color deficiency are monochromats because they have either no cones or only one cone type. These are very rare, fortunately, and nobody's going to be applying for the jobs that we're looking at with monochromatism of any type. Those with two cone types, dichromats, are more common, still relatively severe. And those with milder color deficiencies have three cone types, but the cones have properties different than normal, so they're called anomalous trichromats. So one question here, which of the following color deficiencies is most likely to be encountered? It's deuteranomaly, and it's not even close, five times more deuteranomalous individuals than any other category, and that deuteranomaly is where the M cone, the green cone, is shifted to some extent, or it's anomalous in some way, and we'll get into more detail on that. In the Caucasian population, for which there are larger studies and more studies, 8 percent of males and about half percent of females are color deficient. Shouldn't be surprising. Color deficiency is on the X chromosome, so females must have two defective X chromosomes to be deficient. Other races do seem to have lower prevalence of color deficiency, and there are some smaller studies out there, too, that are pretty, making that pretty evident. So this graph shows the peak absorption of each of the four receptor types, the S, M, and L cones, blue, green, and red, if you will, with the S cone peaking at 437 nanometers, S at 498, M cones at 533, and L cones at 564. So I want to show you a simplified demonstration of what we classically understood to explain the variations in the degree of color deficiencies that we see out there in the world. So here we have the short, middle, and long wavelength cone absorption cones of a normal trichromat. So if any of the curve's peak absorption in an individual would be shifted, then that would signify an anomalous trichromat. If it was shifted just slightly, then there would only be a mild defect. If it shifted further, the color discrimination would get worse and worse and worse until we no longer what? We don't have an anomalous trichromat. We have a dichromat, or in that case, since it was the M cone that was deficient, it's now a deuteronome. So this has been a classic explanation, but now we have research that's refuted this understanding. If you look into the color vision genetics as the mapping of genetics has really changed our outlook on a lot of different things, there's not really a single normal absorption curve in any of us. There are classes of L and M photopigments that have normal variability. The L class, in fact, the red cone, has more variability than the M class, even though there are more deuteronomous problems out there in the individuals. So there's considerable normal variability in the amino acid sequences of both the L and M pigments, which in turn produce variability in the absorption spectra that defines color vision. An exciting development in research is there may be a treatment for color vision deficiency in the future. If you think there's treatment right now, like some of the glasses you hear on changing people's lives, it changes the way they perceive the world a bit, but it doesn't change their color vision deficiency, nor make them more safe on the job. But in the future, it may be coming, they've done some primate studies, and when genetic material was injected into monkeys missing the L genes, so protanopes, they were able to discriminate colors in the red and green range from each other, and as different from gray. So there is some hope on the way. So as we move forward in the discussion of function particularly, I'd like to remind everyone that individuals are not color blind. Well, maybe a rod monochromat is color blind from the bottom left there, but the vast majority of color vision deficient are that. They're color deficient, and we should use that terminology, otherwise I think it's kind of misleading as to what they're dealing with out there. So any of those rare individuals who are rod monochromats really can be considered color blind. So in terms of specific function, each cone can detect 100 gradations of color. So even a cone monochromat, just one cone type, can distinguish 100 shades of color, and it's multiplicative, so a dichromat can see 100 times 100, or 10,000 shades of color. And a trichromat, the majority of us in this room, can distinguish 1 million colors. That's a lot of crayons. I do want to mention an interesting variation in the other direction. There are a few individuals out there who in our simplistic explanation have four cone types, so they have the ability to distinguish 100 million colors. Interestingly, one of them happens to be an artist, so she really paints the world differently than anyone else that I know, so you might want to check out her very fascinating website here. If you look at her artwork across the board, it's like, okay, you either have something going on with your color vision, or you're using LSD. Okay, so thinking back to safety, what is the importance of color vision as a vision standard as a physical attribute that's needed for a particular job? Three main areas. Why is color vision important to us for occupational testing? So the first and perhaps one of the more important ones is that it codes and transmits a message. It's become innate for us when we look at a traffic light to know red means stop, green means go, yellow means go real fast or perhaps caution depending on whether or not you're late for work. And arguably just as important is that it organizes complex visual displays. It'd be very hard for like a professional athlete, if you look at these professional basketball players, hockey players making these blind passes, to be able to do such things that they are able to do if everyone were wearing the same clothing. So as it is, we know whether the player is friend or foe or referee depending on the color of their jersey. And we can code a person that without knowing exactly who that person is. And that will come into play on the job here as well. It does also evoke an appropriate mood or emotion, probably less important for occupational things, but it certainly explains why only teenagers have bedrooms that are painted black or purple. But relating to both coding and organizing complex visual displays, there may not, see if I see any Navy uniforms in the place, there may not be a more hectic place than on the deck of a U.S. Navy aircraft carrier. So on deck, each job has a specific color code that's especially important in an environment where it's not just visually demanding, but where noise makes verbal communication impossible, where you're relying more on the visual sense than you would otherwise. So back by popular demand, anybody here last year talk to me, so don't tell the answers here. So I do want to do a demonstration to prove that coding by color is beneficial. So I'm going to show you a slide here, and don't look ahead in your notes either. So there's a slide here with four bullets, there were four types of bullets here, lucky charms almost, squares, circles, diamonds, and triangles. So when the slide is shown, I want you to count the number of triangles that you see, and if you get those done, see if you can count the number of circles. So we're looking here for triangles first, and then circles, and you're going to have a full second to count. Ready? Here we go. Okay. That was a second, according to PowerPoint. Bill Gates wouldn't lie. So how many triangles? Any circles? Well, you guys are worse than usual. I'm not telling. So let's try example number two. This one, they're all diamonds, the four colored diamonds, they're red, green, blue, and yellow. So when the slide's shown, I want you to count the red diamonds, we're looking for red first, and then yellow. So stop, followed by, go real fast. You're going to give that full second again. Here we go. Okay. Wait, we got some answers this time. What's going on? Well, let me show you what I did. So here's the answers to the first one. Six and two, right? Watch what we did. Same location and everything. So even if you got them all in the first one, and I don't think there was very many in the crowd that did, certainly the second was easier, and we're coding there for color versus coding for shape. So if you're trying to make that, you know, whatever it is, that split second decision as a law enforcement officer perhaps, you need to have normal color vision, or at least nothing worse than a mild deficiency. So how do we do color vision testing? And hopefully this will be somewhat of a review, but let's talk about some things. So several different types of color discrimination testing we have out there available to us. And the three categories, really, color plates, color arrangement tests, and then the others. So color plates have very high sensitivity and specificity, perhaps as good as any screening test we have out there. It's really pretty close. If you're doing them right, administering them properly, and that includes appropriate lighting, which is real important, and making sure you have a reasonably new test book that hasn't been fingerprinted up and has oil stains where all the markings are so you don't need any color sensitivity at all to be able to see what the marks are. But it's pretty close to 100 percent of sensitivity and specificity. So they're designed that 100 percent of color vision normals are going to pass, 100 percent of color vision deficients are going to fail. So this is our cutoff test for knowing normal versus deficient. That may not be all we need to know, though, for a particular job because you may not need perfect color vision to do a job safely and efficiently. But again, for this initial test, you really need to have the appropriate lighting with a corrected color temperature greater than 5,000 Kelvin and a color rendering index greater than 90. And there's a number of these out there that are available. The Macbeth easel lamp on the upper left, which you may have seen, is kind of the classic one that was used back 50 years ago. More currently, there's a lot more appropriate lighting that's out there. You can get one of these color hoods that's shown there or just have appropriate lighting overhead. A 40-watt incandescent bulb is not going to cut it. You need to find something at your friendly Lowe's or Home Depot, if nothing else, that has these attributes of color temperature and color rendering index. Otherwise, it's not going to be appropriate. Does that pass more or fail more? I don't know. It's wrong. It doesn't really matter. It just needs to be done correctly. So color plates, you're probably holding them a little bit too closely. If you're doing color plates, they're really supposed to be held at a distance of 30 inches, which also helps them from reaching out and touching them. And a patient is allowed three seconds to respond. You don't want to let them hem and haw all day on it. So the Ishihara is probably the most common pseudo-isochromatic plate to be used to test red-green color vision that's changing. But included in the 14-plate edition is a demonstration plate, the number one there, which even a rod monochromat should be able to see. It's used for demonstration that they can actually, they're playing the game here. They're not intentionally trying to fail for some reason, which isn't the case in occupational testing, but it's sometimes in clinical testing. For us, people are trying to prove that they're blind. Maybe they are in your case because they are trying to get disability. But if they don't see the demo plate, something is awry and the person is either malingering or certainly not understanding what you're trying to do here. Plates two through ten are the basic test plates to be used to see who is failing the initial test. And then those beyond that, you can look at kind of defining whether it's a PROTAN or a DUTAN defect. In the 14-plate edition, there's also this illiterate plate that, for people who can't identify numbers, that can trace the lines that they see. And if you are having them trace that, again, don't let them use their finger, their oily finger, let them use a Q-tip, cotton tip applicator, if you're using that particular slide. Notice that there are different shades there, so you can differentiate between a PROTAN or DUTAN if they can only see one or the other, or see one of them more clearly than the other. But I said the Ishihara is probably number one. Coming up on their tail is the HRR fourth edition plate. So in my experience, which recently has been with Homeland Security, HRR fourth edition are becoming the standard over Ishihara. One disclaimer on that bullet, except for the FAA and similar, we'll talk about that in a minute. I don't have a slide for it, but we need to address that. So in the HRR fourth edition, the general recommendation for organizations is testing it, not how we would do it clinically. So if I'm doing this test in my office for a child, any kids coming in for their first eye examination, they're going to get a color test, just so at age, well, I won't do it so my six-month exams where I usually start them, but the first time I can get them to do this test at age five or six or whatever, let them know that don't have your heart set on being an astronaut or flying for the Air Force if you have a color deficiency at this age. It's good to identify color deficiencies early. So I would do up to plate 10 and stop, because that's the pass fail on it. And then if I do want to differentiate, I can do it all. However, how they're doing it and how you guys are maybe instructed to do it is, by the agencies, is do all 24 plates and then look at what's happened there. So somebody who has normal color vision is going to get all 24 plates correct. It's just that everything beyond plate 10, which are the pass fail criteria ones, everything beyond that is just for categorization. It's not particularly useful. So one to four demonstration plates, like the first plate on the Ishihara, five to 10 are test plates, and then you can go into then plates 11 through 15 are mild, 16 through 18 are moderate, 19 to 24 severe, and within those, mild, moderate, and severe, you can differentiate whether it's a pro-TAN, do-TAN, or tri-TAN deficiency. So that's why it has become popular. Another advantage of it is you can reduce the likelihood of memorization by the fact that it's not just a number on the plate. They're not memorizing the numbers, they are shapes. So in addition to just changing the order of presentation of the plates, you can rotate that plate all four directions to present it a different way. So that definitely cuts down on the likelihood of them guessing correctly. Okay, color arrangement tests. Some occupations still have these as more of determining individuals that have mild deficiencies versus whether they are truly color deficient or not. So if you see anything that somebody comes back, here's a D15 test, and they pass color vision normal, no, you can't say that. If you pass a color vision, a D15 test, all you can say is they do not have a severe deficiency. They're not standalone screening tests because passing doesn't mean that color vision is normal. A Farnsworth D15 will actually pass about 50% of defectives. What's the D mean in D15? Dichotomize. So it separates the individuals by degree of color deficiency, separating the mild and moderate from the severe. So you can do it after a person has failed color plate, so you know they're deficient. You can just determine how deficient they are. So if they pass, if they fail color plates and then fail a D15, they have pretty severe color deficiency. If they fail plates but then pass a D15, you know at least that they are, have a mild to moderate deficiency, and if you want to use the desaturated D15 called the Lanthony D15, you can even determine a mild from a moderate on that. These seem to be going away. Harder to find individuals that have these. Another one that you may have come across is the Farnsworth-Munsell FM100 hue test. Trivia, how many caps in an FM100? Now it's not 100, it's 85. I don't know why. But 85 loose caps, and it's very much like a D15, but with much smaller color differences between caps. Very challenging even for color normals. And it's used for specialized roles where color assessment is most critical, like the painting industry. Jewelry appraisers is one. A jewelry appraiser, if anybody's bought diamonds lately, a master gemologist appraiser must have an FM100 score of 25 or better. And typically, just to a normal person that has normal color vision should definitely be somewhere not too much worse than that. No more than, say, 75, or certainly not more than 100 error score. And it is a very difficult test, especially if the lighting is not perfect. You really definitely need critical lighting control on this one. Which brings up another problem with color vision testing. These are available either online or for purchase. So you can go to Amazon. There's just a screenshot of Amazon. And I want this job. I'm going to buy an Ishihara plate set and memorize it, and I'm good. Or I'm going to take the online version of this on my non-color-controlled computer monitor and pass that. Or worse, you go to some practitioner's office, and they don't have a particular test. Oh, let's find one online, see if you can pass it. I've had, you know, things to look for, for things being awry. Somebody failed their plates, failed a D15, went to their optometrist's office, oh, you need a 100 hue. Let's do a 100 hue. Find the online 100 hue test. Guess how many they missed? Zero. It's like, oh, not only are you qualified for this job you're trying to get into, you can be a master gemologist. So look for things that are awry. And I know somebody in this room has a question, what do we do in these cases where we find this? But we'll get to that at the end. So let's look at practical application of color vision. So pilot is certainly one occupation for which good color vision is important. So here's the trivia. Is this a modern aircraft or an older aircraft? Yeah, it's sort of a trick question. It is older because looking at it, you can see a lot of white on black gauges, not a lot of color tests in the cockpit. This is a Concorde, which you think is a pretty sophisticated aircraft, right? I mean, it has problems or it would be still flying, but it, crashing is a problem. But the, and I know it wasn't good for the environment either, but certainly very sophisticated, but not as sophisticated as maybe even a modern day Cessna or something, because the modern glass cockpits of today are using a lot more color and it's becoming even more important for pilots to have good color vision. So let's talk about the Farnsworth Lantern. One of the acceptable alternate tests for the FAA color vision testing to date is still the Farnsworth Lantern, Phalanx. And what, how the Farnsworth Lantern came about was it simulates the signal light gun that's used to signal planes from the control tower. So that makes sense, right? Very practical application of it. And the presentation is a series of two lights that are red, green, or white. So you show them these two, two lights and they, nine of them, and hopefully they can get them correct. The more modern version of that, even though this is becoming harder to get and no longer serviced, the Optec 900 color tester, which looks less like a Navy boat anchor, but it's, it worked the same way. The presentation's the same. So if anybody's kind of an aviation geek on the side, or maybe you're pilots in the room, if you're coming in for a landing and you look off to the side, you're going to see a series of lights that are, there's four lights across that are red and white. It's called a precision approach path indicator. So obviously a pilot, as they're coming in for landing, have to come in at appropriate glide angle, glide path, and pilots look at the incremental guide to determine whether they're on the correct glide path or not. So four white lights are too high, they need to go lower. Four reds are too low, okay, it makes, it's worse to be low than high, right? So four reds are low. But in an ideal, since they're incremental here, on glide path, two whites and two reds. Well, back in 2002, a long time ago now, right? A FedEx plane crashed upon landing in Tallahassee, Florida. And the story is that the first officer told the captain that the PAPI lights were four white, so it was too high. So upon adjusting and going lower, the plane crashed short of the runway. Why didn't the pilot, if I were the pilot, I'm going to say, I kind of disagree with you here, I can see myself, but he didn't. And he crashed the plane, and both individuals lived, and it was FedEx, so there weren't any passengers on board, so they got to do aftermath testing by the NTSB. And it revealed that the first officer had a severe deuteranomaly, not a deuteranote, but a very severe deuteranomaly, so color vision testing failed every test except for the Farnsworth Lantern and the signal light gun. So at that point, the National Transportation Safety Board recommended research on the effectiveness of the FAA color test, and what is it as of today, right now, Farnsworth Lantern is still on the Aviation Medical Examiner Guide as appropriate, that is changing, rumor has it that I found at this meeting, should have found out earlier perhaps, but you guys are more in the know than I am in many cases, that the FAA is moving towards precision color vision tests only, so that will be limited, all the plates will be gone, all the vision testers will be gone, phalant will be gone, and it's the computerized, not just online where you can dial it up on a website, but computer-based precision tests such as the Rabin contrast test that will be much more effective and appropriate determination on whether an individual has normal color vision or not. So they're moving that way, I don't know when it is, but it took them 21 years to get to that point. So conclusions, testing to a standard is far from new, it went back from our historical review there a long, long time back to the Chinese two centuries ago, color vision deficiency is certainly much more common in males, almost 1 out of 10 Caucasians, and it's certainly important on the job with the two big reasons of coding and transmitting messages and organizing complex visual displays which you saw from the demonstration. And it has to be done properly for high accuracy, particularly appropriate lighting, and standards must be based on essential job function because the one thing I wanted to splash all over the slide here that I should have is safety. It's there for safety, we're not trying to get people the job to pass the test, we don't want to let them wear their Enchroma lenses to pass the color vision test and they get the job and then people die because of it. So I did get through as fast as I had hoped to because I really want to open it to questions, I know last year we didn't have enough time for that, so let's go to that now and happy to answer any other thing that I might be able to. Yes ma'am, why don't you go to the mic so people can hear you on the recording and everything. Thank you. Is there a test for blue deficiency? We got a very interesting question from one of our nurses, I work in a medical center, and she had seen on the Hemocolt package insert that if somebody has blue color blind deficiency they shouldn't be interpreting Hemocolt tests and we routinely use Ishihara testing which doesn't distinguish any type of blue deficiency. Okay, good question, so if anyone didn't hear that, what do you use for blue deficient testing, so that's a Tritan defect that is testable with the HRR 4th edition. So that's probably, again, one of the reasons that has, another reason that has become more popular in the Ishihara because it will test Tritan or blue deficiency. You bring up maybe even a greater question there is, and I mean really controversial, do physicians need to have normal color vision? If you look at some of the, and I'm coming across this more in my psychology studies where they've really looked at this and there have been a lot of medical errors certainly made from just the inappropriate recognition or diagnosis based on color vision deficiency, so my answer to that would be no, we can't really tell everybody you have to be color normal to be a physician, but choose your specialty appropriately so you don't, less likelihood of medical errors. Yes, sir? Thank you so much for the interesting talk. I have a couple of questions. The first question is about standardized practical tests. I work in the healthcare industry, similar to the previous person, and we also, sometimes we send them when they fail their color vision testing as a nurse for colorimetric testing like urine dipstick, what else, probably that's the main one, we send them for a practical test. If they pass, they pass. Is there any standardized test we can use, we can use for practical test? Well, you mean more practical than color plates? Well, what we do, we actually look at the machine and their interpretation of the urine dipstick, so if they have it correct, then they actually can do the job. But I don't know if this method has been standardized. You know, yeah, it's validation of the testing is what you're going to need, and there have been some tests out there that have been very specific, electricians often for, or avionics even had to actually do the tasks of identifying appropriately the wires. I mean, if you talk about a color deficient thing, a color deficient related accident that could go wrong, it would be somebody in avionics wiring the plane improperly and then the whole Boeing aircraft goes down sometime in the future, but those have not been really validated, so thus we're kind of to the point of coming up with better plate testing like the HR fourth edition and then the precision testing that is being the three tests, the Raven cone contrast, the CAD test from Europe, and there's one other one that are probably some of the best that are coming into play now. The second is just a very quick question about the FAA and the Farnsworth lantern, when they're moving out of? I don't know the date of that, but I just heard rumor that that is going to happen from a couple people at this meeting, so if anybody knows more about that from the FAA standpoint, please let us know. Thank you. Yes, sir. I was going to say, thank you for bringing up the part about the medical and the relevance for that for the field, because I remember we had this when the electrician came up, we started looking at how you validate for specific job tasks, and one of them we found was that they actually had a study on pathologists passing training, their ability to discriminate slides and what the correct diagnosis was, and when they retrospectively looked back at people's color deficiency, they had a higher rate of failures of people failing to complete training in pathology because they were color vision deficient and they didn't realize it beforehand. Same thing with the nurses on the bottle tops for medications, because they're color coded and the eye medications as well, so it was kind of useful now that you didn't think about just that question. But for the continuous color vision testing and the wagon seller color vision testing, for like Farnsworth, we know a specific percentage are going to be mildly anomalous and still pass, and we've been fine with that in aviation for a long time, but with the newer precision testing, when we find these subtle anomalies, how do we decide what degree of that should be acceptable, and do you have anything where people have tried to establish some cut points for what level of deficiency is acceptable? Well, that's a good question. There's always some subjectivity in making any standard, I mean, what's, you know, even visual acuity. Is there really that much difference between somebody with uncorrected 2125 or 2200 even than a 2100? There's some arbitrary point there. So no, that is a difficult one, and I think maybe that's why we'll give the FAA a break there, why it's taken 20 years to get to the point of looking at that and determining what is acceptable, particularly on the high stakes roles such as anyone involved with aviation. But I think that's, hopefully the precision testing will be even better for coming up with appropriate ones there. And that Tallahassee one was hard, too, because it wasn't so much color. Yes, he was deficient, but it was a zero-zero illumination night, and it was the runway was a narrow runway and it was long, and so your sight picture becomes different if you're not familiar with the approach, and so they don't think it was the color vision so much as the runway and configuration and optical illusion. Okay, yeah, you always read over those NTSB reports and wonder sometimes. But another thing that's kind of related to yours is thinking about mild deficiencies. We're all getting worse with our color perception every day as we get older. Our lenses become more sclerotic, except for those of us who had cataract surgery, so there is going to be those type of issues as well. Yes, sir? Dr. Weaver, thank you for a very clear presentation on a topic for which I have no mental Velcro, so I can only keep up with this by coming to these sessions every time they're offered. So thank you. My question relates to something that I can't do in my clinic generally, which is determine what degree of color vision is needed for the job, which is really the responsibility of the employer, and I'm just wondering if you think it would be possible to offer a session here on the topic of how to determine what is job necessary in terms of color vision discrimination, because I think that would be useful to a lot of us, particularly those of us who work in corporate. Yeah, I don't know we can do it in this type setting, but I mean, your point is well taken. So generally, as you all know, in setting any job standard, I mean, it has to be to essential job function. You can't over-regulate. You can't say, you know, every job out there, a person has to have 20-20 uncorrected visual acuity, normal color vision, 20 seconds of stereopsis, and a mom visual field. So where do you draw the line in its, I think it kind of goes back to safety. What is the consequences of an error, but even then, to the aviation, can you tolerate mild color deficiencies and still be safe for a high-risk role such as aviation? Probably, but coming up with a scientific evidence-based cut point or determination is a challenge, and I'll be happy to talk to you about it or talk to other experts in the room about it on how we might go about coming up with that specifically for color vision, but it's not an easy answer, I don't think. Yeah, I think if you ask most industrial hygienists, they look at you blankly and want you to leave the room. It's not easy for them either, but I can always give people an answer to a well-articulated question, but I can't determine if the question is the right one. I think it would be a great session. It would have to be multidisciplinary, but thank you so much. Absolutely. Yes, sir. Appreciate it. Thank you. Yes, ma'am. Are there any examples of accommodations employers could use for color deficiency? Accommodations for color deficiency, well, there's not a lot of good ones here other than, I mean, especially the roles there where color is important, I mean law enforcement, okay, if there's any type of role where you have to make a split-second decision on whether to shoot somebody, you can't be in that situation. I mean, there's no way to do that, so that would be the accommodation to give them a desk job, but if you're asking about accommodations such as, so I mentioned the Enchroma lenses, and there are some things out there that help individuals pass the color test, color plate test specifically, and you can do that. Even the old X-chrome contact lens in some cases would allow a person with a certain level of color deficiency to pass Ishihara plates, and the Enchromas probably do one of the better jobs of that, but that's not what we're here for. We're not here to try to get them through. We're trying to make sure they can safely and effectively do the job without causing harm to themselves or others, and so an accommodation for color deficiency other than kind of taking them out of those times where it's most critical, but probably those are their essential job functions, so you can't take a person out of their essential job functions. That's why we, you know, if they don't pass color standards, then they probably don't get that job. They get moved into a different role, so here's an example from Customs and Border Protection Agency, which I'm most familiar with. The two major jobs there are border patrol agent, who are basically the police force on the border. They're out chasing undocumented around the Rio Grande Valley, and there are Customs and Border Protection officers who are doing the inspection tasks of looking at trucks coming across, seeing if there's any hidden compartments in there, so the color requirement is greater for a Customs and Border Protection officer because they're doing the inspection versus the border patrol agent, so you might shift them from, okay, you can still be employed by our agency, but we're going to move you from this role to this role, so maybe that's the best accommodation answer I can give you. Thank you. Okay, sure. Hi. If you answered this question already, I apologize that I had to step out for a second. Sure. So you'd mentioned the lighting requirement for, I think it was the issue of hard plates of 5,000K. Yes. Everything. Everything. Really. So for the HRR, that was my question. The HRR fourth edition, is it the same? Yes, sir. Okay. You want to have, so the standard is northern daylight, so if you don't have good artificial lighting in the room, unless it's raining, take them outside, and you've got Saul up there that has appropriate lighting for your color test. It's not a real high-tech kind of situation. You can buy these bulbs, and the distance, you don't have to buy any special equipment for this. No. Well, I mean, just make sure. I mean, it can be done. They have fluorescents that'll do it, so if you have fluorescent lights above you, chances are they're not 5,000K, because those are, so just replace them and just tell whoever or do it yourself that we need, if we're going to do color vision testing in this room, we have to replace the bulbs up there. That's great help. Thank you. Hi. Very interesting talk. Thank you. Two questions. One, is there a reference that we can go to that we can have on the shelf and pull off, because like you said, the metal Velcro doesn't stick too well with this, so is there a reference that we can go to to refresh our memory? I'm just making this up. You're just making this up, all right. In terms of if there is, I will need to see what would be most appropriate for you. That's, I don't know if I've ever got asked that question before, but yeah, that's a good thing to send you to. There's some, there's things that are getting way, would get too technical in terms of wavelength of light, but send me, give me your email or something and I'll send you something. Okay. I'll send you an email. It would be a good review. Okay. Yeah, send me an email. The other question is, is there any difference between the fluorescent lights and if you've got LED lights in the room? Well, actually, the LED question came up here just before we started here, where's Dr. Bourgeois, that, and I don't know why I wasn't aware of this, the Titmus, one of the Titmus tests, because of the LED in there was not acceptable for doing the testing on it. It was invalidating the color test, but again, same thing. You just want to have the appropriate color rendering index and color temperature that are appropriate. But yeah, you need to watch your bulbs because that can be a big problem. I was talking to the stereo optical people there and they have a, their new computer based screener I think has made quite a good, really made some steps forward from their old standard one because they said, oh yeah, these things last forever. We've seen people that use it for 20 years. I said, I've seen these things 50 years old and the only problem with the old ones was the bulb would yellow. It was an incandescent bulb and you had to replace the bulb, otherwise it would invalidate color testing. But now with their internal, you know, the lighting that they have in there now, it's more appropriate and it's not going to change over time. But yeah, make sure, I can't believe Titmus made that error. They should know better than that because that's a crucial, that's a crucial point and so many people make that even from a clinical standpoint testing. My colleagues in optometry and ophthalmology back before we had the appropriate near point light it would just be that 40 watt bulb on our chair and stand that we use for near visual acuity and determining bifocal prescriptions using that for color vision and I don't know how many color tests we probably did wrong over the years. But thank you. If no one else, no one's jumping up to the mic there, thank you for coming and feel free to reach out to me. It's interesting.

color vision

occupations

color vision testing

coding

visual displays

color vision deficiency

males

Ishihara plates

aviation

safety