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Colour vision deficiency part 3

occupational standards
44

Jennifer Birch

31/01/14 CET

In this final part in the series on colour vision, occupational requirements are discussed along with the various
methods of assessment and an overview of recent developments.

Course code: C-34766 | Deadline: February 28, 2014

Learning objectives
To be able to explain the occupational implications of colour vision defects to
patients (Group 1.2.4)
Be able to identify the tests suitable for occupational colour vision screening
and interpret the results (Group 3.1.4)

Learning objectives
To be able to identify the occupational implications of colour vision defects
to patients (Group 1.2.4)

About the author

Jennifer Birch was formerly a senior lecturer in Clinical Optometry at City University London, and is now a senior research fellow in the Henry
Wellcome Research Laboratory in the Department of Optometry. She was a founder member of the International Research Group on Colour Vision
Deficiencies and has written extensively on clinical aspects of colour deficiency and on occupational colour vision requirements. She was appointed
to an Honorary Life Fellowship of the College of Optometrists in 2012.

Introduction

Colour vision lanterns

Tests that examined general colour-naming

Standard

45

Figure 1 The Holmes-Wright lantern Type A (left) and the Farnsworth lantern (FALANT) (right)
ability were thought to be more appropriate
for transport workers and several colour vision
lanterns were produced before 1895.2 For
example, the Edridge-Green Lantern, devised in
1891, included blue and purple as test colours
although these are not used for transport
signalling. The Board of Trade (BOT) approved
a dedicated occupational lantern in 1913 for
use in the merchant marine service. This lantern
displayed nine pairs of red, white and green
signal colours separated horizontally.3 The
angular subtends and separation of the lights is
equivalent to ship navigation lights viewed at
a distance of 2,000 yards (two nautical miles) in
scotopic viewing. The BOT lantern was replaced
by the Martin lantern in 1939 and subsequently

Test results

by the Holmes-Wright (H-W) lantern Type B

in 1974.4,5 The new lanterns reproduced the
original design but had improved mechanical
construction and modern light sources. A
second version of the Martin lantern was made
for rail transport and included yellow/amber as
a test colour.6 A colour vision requirement for
aircraft pilots was proposed in 1919 but correct
naming of red and green flags or flares, which
indicated permission to land, was probably all
that was required prior to 1945.2 The Martin
lantern was subsequently adopted by the Civil
Aviation Authority (CAA) and by the Ministry
of Defence (MoD) until the H-W lantern Type A
came into service.5 The examination procedures
for the H-W lanterns are clearly documented to

Application

Standard 1
Normal Colour Vision

Pass the Ishihara test

(or pass The H-W lantern Type B)

High risk activities when correct recognition of colour signals or other codes is safety
critical

Standard 2
Defective Colour Vision A

Fail the Ishihara test and pass an

approved lantern test (the Nagel
anomaloscope to identify protans
if needed)

Low risk activities needing the ability to recognise signal lights at a moderate
distance

Fail the Ishihara test and

pass the Farnsworth D15 test

Low risk activities needing the correct recognition of pigment colours or large signal
lights at short distances in photopic viewing

Slight deutan deficiency

Protans are excluded

Standard 3
Defective Colour Vision B
Slight/moderate red-green
deficiency

Table 1 CIE Colour vision standards for transport

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31/01/14 CET

Colour vision standards for marine watchkeepers and train drivers were introduced
following two fatal accidents in the nineteenth
century. Ten people were killed in July 1875
when a tug collided with a steam ship off the
coast of Virginia in the US. The tug failed to
give-way and the captain was later found to
confuse port and starboard navigation lights.
In November of the same year, two passenger
trains collided head-on near the town of
Lagerlunda in Sweden; both drivers and seven
passengers were killed.1 Colour deficiency
was assumed to be the cause but there was
no evidence of this. However, following these
incidents, the Holmgren Wool Test was adopted
to examine railway personnel and recruits for
the armed services. The examination procedure
was similar to that used to select colour
matchers in the textile industry and involved
matching shades of wool. Pigment tests based
on camouflage patterns composed of confusion
colours were developed in Germany in 1876,
with the Ishihara pseudoisochromatic test
introduced in 1917. Other pseudoisochromatic
screening tests and occupational lanterns
were produced in different countries, and it
became routine to use a pseudoisochromatic
test to identify colour deficiency followed
by a secondary occupational lantern test to
determine colour-naming ability.

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ensure that consistency is maintained. These
lanterns are no longer manufactured but
are robust and can continue in service if the
calibrated light source is replaced after 1,000
hours of operation. Replacements for the H-W
lantern have been produced but have not
been validated.

31/01/14 CET

46

Recommended colour vision

requirements for transport
A review, which aimed to harmonise colour
vision standards in international maritime,
air and road transport, was made by the
Commission Internationale dEclairage (CIE)
in 2001.7 Three new standards were proposed
with the Ishihara test, the Farnsworth D15
(D15) test and an approved lantern test
recommended for implementation (see
Table 1). The Ishihara test was recommended
for screening with three errors as the
fail criterion.8 More than two diametric
crossings on the D15 results diagram was the
recommended fail criterion.7 This criterion
fails about 40% of colour deficient people but
favours protans because perceived luminance
contrast can be used to obtain a good result.

Standard

About 60% of colour deficient people fail if

a circular results diagram with no diametric
crossings is needed to pass.9 Only the Beyne
Lantern (France), the Farnsworth Lantern
(FALANT) (USA) and the H-W lanterns, Type
A and B (UK) were approved. The TriTest 13
and the Optec 900 are recent replacements
for the Beyne lantern and the FALANT
respectively. The Nagel anomaloscope was
recommended to confirm the identification of
protan deficiency if required. The Spectrolux
lantern (Switzerland) is not listed in the CIE
report although the Joint Aviation Authorities
(JAA) approves it as a secondary test for Joint
Aviation Requirements (JAR). In the test,12
pairs of specified red, green and white signal
lights are displayed.
The aim of the CIE to harmonise
international standards cannot be achieved,
primarily because the approved lanterns
are differently designed and examination
procedures vary.10 For example, the Beyne
lantern shows five single colours, including
yellow and blue, derived from narrow
wavelength bands. The H-W and the FALANT
both display nine pairs of red, green and

Test specification

CP 1: Superior colour
discrimination

No errors on a Holmes-Wright lantern at low brightness in

scotopic viewing

CP 2: Normal colour vision

No errors on the first 17 plates of the Ishihara test 38 plate

edition

CP 3: Slight red-green
deficiency

No errors on the H-W Lantern Type A at high brightness in

scotopic viewing

CP 4: Adequate colour
discrimination

Correct recognition of coloured wires, resistors or stationery

tabs used in different trades

CP 5: Severe colour deficiency

(Royal Navy only)

Unable to obtain any of the above CP classifications

Table 2 Colour Perception (CP) standards that may be applied in the Armed Forces

white lights separated vertically (see Figure

1). This configuration is not used in transport
systems and neither lantern is dedicated to
the needs of a particular occupational task.
The H-W Type A displays specified signal
colours, approved by the CIE, but the FALANT
displays red, yellow-green and yellowish-white
lights that have x, y chromaticity co-ordinates
within a common protan/deutan isochromatic
zone.3 The FALANT is, therefore, a grading test
intended to identify significant isochromatic
colour confusions. The D15 test has a similar
aim but a pass on the D15 does not predict
whether a person will be successful on the
FALANT.11 The recommended fail criterion
for a lantern test is two errors on two runs
(sequences) of nine colour pairs in photopic
viewing but this can only be applied to the
H-W lanterns and the FALANT. Between 25%
and 30% of colour deficient people are likely to
pass using this criterion but some individuals
may have severe deficiency.12-14 Neither the
number of errors nor the number of qualitative
error categories are a reliable guide to the
severity of deficiency.14,15 Sensitivity of the
H-W Type A at high brightness in photopic
viewing is 97% if three runs are completed and
a single error is a fail.14 Results obtained from
125 colour deficient men who completed three
runs at high brightness in photopic viewing
showed that green/white errors (green called
white or white calledgreen) were the most
common 70% of subjects made red/white
errors and 43% made red/green errors.15
Green/white discrimination is needed by
marine watch keepers and correct red/white
discrimination is critical for safety in aviation.

New developments
The UK Disability Discrimination Act
(1995) (DDA), extended by the Disability
Discrimination Order (2006) (DDO), aimed to
limit discrimination against disadvantaged
groups in the work place with similar laws
passed in other developed countries.

1 Knowledge of the needs of the occupation

and work environment with awareness of the
consequences of error or slow working
2 Identification of the most difficult safety
critical task that must be performed in the
unfavourable viewing conditions
3 Knowledge of the characteristics of
different types of inherited red-green colour
deficiency
4 Assessment of the ability of a colour deficient
person to complete the most safety critical
task with the same accuracy as a normal
trichromat
5 Selection of an appropriate validated test
or examination procedure that ensures that

47

a new standard is implemented fairly and

consistently

A review of colour vision

requirements in aviation
and rail transport
The need for a radical review of colour vision
standards for employees in aviation and rail
transport was emphasised by major accidents
in 1996, and 2002. In 1996 two passenger
trains collided head-on near Secaucus, New
Jersey. Three people were killed, including one
of the drivers, and 69 people were injured.
The cost of the damage was estimated at
more than $3.3m. The cause of the accident
was attributed to the known acquired colour
deficiency of the deceased driver.18 In 2002,
a FedEx Boeing 737 landed in trees short
of the runway at Tallahasse Airport, Florida
and was destroyed by fire with all three crew
members seriously injured.19 The pilot had
severe congenital red-green deficiency but

had passed an examination with the FALANT.

The official accident report ordered a review
of colour vision examination procedures
and recommended that the FALANT be
discontinued. Poor interpretation of the
Precision Approach Path Indicator (PAPI) code
was identified as the primary cause of the
accident. A subsequent study found that 10
of 52 colour deficient subjects that passed the
FALANT were unable to perform a simulated
PAPI task as normal.20
PAPI consists of four lights in a horizontal
line at the side of the runway (see Figure 2). The
correct approach path is shown by two white
and two red lights and must be maintained
until the aircraft has landed. Commercial airline
pilots must identify these lights at a distance
of four miles (5.5 km) and adjust altitude to
achieve the correct angle of approach.
This discrimination task was replicated in
a laboratory investigation at City University
London. Results for 60 random presentations

Type of colour vision:

Normals
Deutans
Protans

RG threshold units
Figure 3 Red/Green discrimination thresholds obtained on the Colour Discrimination and
Diagnosis (CAD) test by 64 normal trichromats, 40 protans and 61 deutans. Normal trichromats
are clearly distinguished from deutans with minimal/slight deficiency (insert)

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31/01/14 CET

Figure 2 The Precision Approach Pilot Indicator (PAPI) lights

YB threshold units

Restrictive colour vision standards were

particularly targeted for review. The
background necessary for setting a new
occupational colour vision standard is outlined
in Table 2. The DDA required employers to
modify colour codes and important tasks to
enable colour deficient people to work as
normal. Exclusion from employment remained
lawful if this could not be done.
Colour codes have different functions
connotative codes provide information by
colour recognition alone and are used in
electrical work as well as transport systems
whereas denotative codes segregate items
of information and are widely used in
business and industry. Text, number or shape
differences are usually available in denotative
codes and the use of colour is said to be
redundant because information can be
obtained in another way. However, colour
recognition helps to retrieve information
quickly and a delayed reaction might
compromise safety or efficiency. Guidelines
issued by the Health and Safety Executive
(HSE) provide good advice to employers on
how to identify important tasks and consider
whether redundant features can be added
that would enable colour deficient people
to work as normal.16 As a result, considerable
improvements have been made to colour
codes on stands and taxiways at airports and
some equipment used by fire fighters has
been withdrawn. Breathalysers used by police
constables now display digital information and
traffic wardens take photographs rather than
write down the vehicle colour. Guidelines on
colour vision examination produced by the
HSE are less helpful:17

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31/01/14 CET

48

of red and white light combinations were

obtained for a representative group of
111 colour deficient men (40 protans and
71 deutans) and 64 normal trichromats.21
The results were then compared with
RG thresholds measured with the Colour
Discrimination and Diagnosis (CAD) test; this
test is performed on a colour calibrated visual
display unit and presents stimuli of precise
chromaticity and saturation as moving targets
within a dynamic background of neutral
grey dots that mask luminance contrast. The
target moves along one of four diagonal
directions and the subject presses a button
to indicate the direction of motion. Protans
who obtained R/G CAD thresholds less than 12
SN (standard normal) units and deutans that
obtained thresholds less than 6 SN units were
able to perform the PAPI test as normal and
could safely begin pilot training (see Figure
3). Acceptance of these criteria particularly
favours minimal/slight deuteranomalous
trichromats that would have failed the lantern
test and been rejected. Use of the CAD test was
accepted by the CAA as a replacement for the
H-W Type A in 2009.22 There are considerable
advantages in setting an evidence-based
occupational standard derived from results
obtained with a single objective test that has
a validated pass criterion linked to satisfactory
completion of the most safety critical task. A
computerised assessment procedure removes
examiner variance and ensures that the same
pass/fail decisions are always made. The CAD

test has also been accepted by more that 50

National Airline companies that use the CAA
pilot licensing facilities and by the National
Air Traffic Society (NATS) as a screening test
for air traffic controllers.23

New lanterns
Equal opportunity laws in Australia and
Canada require colour vision standards to be
implemented with a dedicated occupational
test that replicates the most safety critical
task. As a result, two new dedicated lanterns
have been developed for rail transport that
display the chromaticities and configuration
of trackside signals in these countries.24,25
Both lanterns display red, yellow/amber and
green lights. Only the inability to see a red
light at all or naming a red light incorrectly
results in failure of the Australian RailCorp
(LED) lantern. This criterion passes a higher
percentage of colour deficient people than
the FALANT and about 50% of those that pass
the D15. The CNLAN displays 22 triplicates
of red, yellow and green lights. This is a
difficult test for normal trichromats and up
to five errors must be allowed as a pass. Only
deutans with minimal/slight deficiency are
likely to be successful.

The Ministry of Defence

The colour perception (CP) standards in the
Armed Forces are under review but continue
to be implemented with the Ishihara test
and the H-W Type A (see Table 2). Different

CP classifications are required which are

dependent upon the role.

Colour vision standards in the

fire service and the police force
A new standard was introduced for firefighters
in 1996 after a review of important tasks.26
Applicants that fail the Ishihara plates and
deutans that pass the Farnsworth D15 test
without error were accepted. More recent
online information prepared for fire service
and police recruits are ambiguous and show
poor background knowledge. The advice
offered is based on the assumption that
clinical tests are able to distinguish anomalous
trichromats and dichromats when this is not
the case. It is also suggested that anomalous
trichromats can be relied upon to develop
individual coping strategies. Some colour
deficient people may be employed as police
officers on this basis but may be unaware
that normal colour vision may be needed for
special police roles, such as pursuit driving and
armed surveillance, which require additional
training.27

The Merchant Marine Service

The Marine Coastguard and Safety Agency
(successors to the BOT) aims to implement
the colour vision standards recommended
by the CIE.7 Watch keepers must pass the
Ishihara test. An examination with the
H-W Type B is given to rejected applicants
on appeal.

MORE INFORMATION
References Visit www.optometry.co.uk/clinical, click on the article title and then on references to download.
Exam questions Under the new enhanced CET rules of the GOC, MCQs for this exam appear online at www.optometry.co.uk/cet/exams.
Please complete online by midnight on February 28, 2014. You will be unable to submit exams after this date. Answers will be published on
www.optometry.co.uk/cet/exam-archive and CET points will be uploaded to the GOC every two weeks. You will then need to log into your CET
portfolio by clicking on MyGOC on the GOC website (www.optical.org) to confirm your points.
Reflective learning Having completed this CET exam, consider whether you feel more confident in your clinical skills how will you change the way you
practice? How will you use this information to improve your work for patient benefit?