Naval Aerospace Medical Institute Terrace L. Waggoner, O.D. Ophthalmology Clinic Naval Aerospace Medical Institute 340 Hulse Road Pensacola, FL 32508 Phone: 850-452-2933 Mobile: 850-206-8225 Terrace.waggoner@med.navy.mil

Disclosure Information 84th Annual AsMA Scientific Meeting Terrace L Waggoner, O.D. I have the following financial relationships to disclose: Grant/Research support from: Naval Refractive Surgery Center San Diego, CA Consultant for: Department of the Navy Consultant/Contractual Agreement: Konan Medical usa Consultant for : Good-lite Company Consultant for : M & S Technology Consultant for: and anyone else that will pay me money for my advise. I will not discuss off-label use and/or investigational use in my presentation

The ColorDx Computerized Color Vision Test Windows Application (CCVT) was the primary color vision test used to detect and classify the different color vision deficiencies in the following cases. Consequently, I am including a brief overview of this particular computerized color vision test for those attendees not familiar with it.

The CCVT includes one demo & 25 pseudoisochromatic test plates in the General Section. The other three sections use desaturated test plates that progress from high visibility to low visibility as the hue becomes less saturated and contrast is decreased. Total 102

Example of an individual number using a protan confusion color.

It becomes less saturated, less visible.

Continues to be even less saturated/visible until it can no longer be seen by color deficient subjects.

It automatically scores itself and gives color normals a certificate

Color deficient subjects get a diagnosis plus a score of how they did on each section. The score can be printed or saved on your computer or network.

Characteristics of congenital versus acquired color vision deficiencies On set after birth color; vision previously normal Present at birth Type and severity remains the same Type and severity can change with time *Predominantly starts as a tritan Monocular differences in severity Frequently occur. Both eyes equally affected Reduces visual acuity and/or visual field defects Visual acuity and visual field normal Normally a Healthy individual Possible associated disease process

CASE #1 Right Eye

Left Eye

Additional Color Vision Test Results 1. Ishihara Rt Eye: Normal Color Vision Lt Eye: Abnormal Color Vision, 2/14 correct 2. Nagel Anomaloscope Rt Eye: Normal Color Vision +/- 6 from 46.5 Lt Eye: Abnormal Color Vision, Range 38-52.

OD FUNDUS PHOTO

OS Pallor of the Optic Nerve

Suspected Hemangioma of left optic nerve

VOTE Acquired Or Congenital Color Vision Deficiency?

Characteristics of congenital versus acquired color vision deficiencies On set after birth color; vision previously normal Present at birth Type and severity remains the same Type and severity can change with time Monocular differences in severity Frequently occur. Both eyes equally affected Visual acuity and visual field normal Reduces visual acuity and/or visual field defects Normally a Healthy individual Possible associated disease process

CASE #2 Color deficiency detected during a routine eye exam on a young healthy aviator.

Color Vision Deficiency? VOTE Acquired Or Congenital Color Vision Deficiency? Reference: A Family with Congenital Deutan and Tritan Defects by P.R. Kinnear

Characteristics of congenital versus acquired color vision deficiencies On set after birth color; vision previously normal Present at birth Type and severity remains the same Type and severity can change with time Both eyes equally affected Monocular differences in severity Frequently occur. Visual acuity and visual field normal Reduces visual acuity and/or visual field defects Normally a Healthy individual Possible associated disease process

CASE #3

VOTE Acquired Or Congenital Color Vision Deficiency?

Characteristics of congenital versus acquired color vision deficiencies On set after birth color; vision previously normal Present at birth Type and severity remains the same Type and severity can change with time Monocular differences in severity Frequently occur. Both eyes equally affected Visual acuity and visual field normal Reduces visual acuity and/or visual field defects Normally a Healthy individual Possible associated disease process

CASE # 4 Subject is a 33 aviator in good health. He just completed his annual flight physical.

Severe Tritan

Severe Tritan

Ishihara = Normal Nagel Anomaloscope 48 = normal D-15 = Normal Richmond HRR 4th Edition = Mild Tritan

VOTE Acquired Or Congenital Color Vision Deficiency?

Characteristics of congenital versus acquired color vision deficiencies On set after birth color; vision previously normal Present at birth Type and severity remains the same Type and severity can change with time Both eyes equally affected Monocular differences in severity Frequently occur. Visual acuity and visual field normal Reduces visual acuity and/or visual field defects Normally a Healthy individual Possible associated disease process

Case # 5 Should we be routinely testing color vision?

“We should all be routinely screening for color vision deficiencies.” Yes! “We should all be routinely screening for color vision deficiencies.” Detecting a color vision deficiency can raise a red flag and help diagnose a disease process.

I would like to thank my colleagues at the Naval Aerospace Medical Institute for their help preparing my presentation: Captain Mathew Rings Navy Aerospace Ophthalmologist Captain Edward Parks Navy Aerospace Neurologist