1. #415 Validation of a Tablet-based Waggoner Computerized Color Vision Test
CAPT Matt Rings, MC(FS), USN
Dr. Terrace Waggoner, OD
LCDR Kyle Dohm
Ophthalmology Dept
Naval Aerospace Medical Institute
Pensacola, FL
88th Annual Scientific Meeting
Aerospace Medical Association

2. Disclosure Information 88th Annual Scientific Meeting CAPT Matthew Rings, Medical Corps, US Navy
CAPT Rings has no financial relationships to disclose. Dr. Waggoner has a financial interest in the Waggoner Computerized Color Vision Test (“ColorDx”). Dr. Waggoner had no involvement in data analysis, conclusions, recommendations or AsMA presentation preparation. I will not discuss off-label use or investigational use in my presentation Disclaimer: The presentation are my opinions alone, and does not necessarily reflect the policies of the Department of Defense, or the Department of the Navy.

3. Learning Objectives
Learn the passing grade for computerized color vision testing for Naval aviation.
Be able to compare the tablet version of a computerized color vision test to the PC-based version.
Explain why the Farnsworth Lantern is a poor screening tool for detecting color vision deficiency.

4. Overview History of Computerized Color Testing USAF, USN standards
Tablet Advantages & Disadvantages
Tablet Types and Testing for Suitability
Surface Pro 3 Tablet and Waggoner CCVT
Methodology
Results
Conclusions

5. History of Color Vision Tests in Naval Aviation:
Pseudoisochromatic plates (Red/Green).
Primary R/G color test in Naval Aviation
Passing score 12 or better of 14 test plates
Failures use Farnsworth Lantern as backup.
Farnsworth Lantern (identify red, green or white lights) –
designed 1940’s to pass mild R/G color vision deficient sailors for duty, “Color Safe”
Occasionally passes more moderately severe CVD
Eliminated for new accessions JAN 2017

6. USN Allowed Computerized Tests:
Waggoner Computerized Color Vision Test (WCCVT)
Binocular testing
Calibration not critical / infrequent schedule
Laptop, desktop or tablet format (Surface Pro 3)
Rabin Cone Contrast Test (RCCT)
USN & USAF aviation accepted
Critical calibration required weekly
Netbook format and tablet format available (Surface Pro 3)
Colour Assessment & Diagnosis (CAD)
UK civil aviation standard
Expensive, large desktop format, research tool

7. Tablet Test Format Tablet Benefits: Single power plug
Battery powered (Portable)
Touch screen
Microsoft Windows tablets: USB calibration
Tablet Cons:
Impossible to calibrate Android and Apple tablets
Small  Easily stolen
Portable  fragile, dropping & breaking

8. Tablet Selection Process
Android Tablets (Lenovo, Asus, Samsung Pro S)
Wide range of saturation and color inaccuracies, many color “modes”
No calibration possible (no USB port for colorimeter)
Apple iPad Air 2
Accurate factory color
Wide color gamut, good gamma, good white-point
iTunes account required, Navy does not support Apple iOS
Windows Surface Pro 3  Chosen for research
Accurate factory color profile – wide color gamut, good gamma, good white point
USB ports for calibration, if desired / required
Windows software supported by Navy

9. Methodology
Purpose: Compare Uncalibrated Tablet vs. Calibrated PC version
IRB-approved: Naval Hospital Portsmouth
300 active duty aviation personnel: male, 33 female
Nagel Anomaloscope, Pseudoisochromatic plates, FALANT
Waggoner Computerized Color Vision Test (WCCVT, “ColorDx”)
PC: Spyder 4 Elite Calibrated LCD Monitor
Surface Pro 3: Windows sRGB color profile – no external calibration
Randomized ‘normal’ population selection (PIP passing score)
All CVD personnel offered to participate (PIP failures)
Randomized PC vice Tablet testing order

10. PC Monitor vs. Surface Pro 3 Tablet
PC laptop with Samsung IPS 19” TFT monitor
Spyder 4 Elite Colorimeter Calibration (94% sRGB)
85 cd/m2 (avg)
6698K white point (avg)
Gamma 2.2
DeltaE (50% grey) 1.40, avg all colors 1.80
Microsoft Surface Pro 3 Tablet – 12” IPS monitor
NO CALIBRATION
sRGB IEC Windows color profile (98% sRGB)
50% brightness setting, 83 cd/m2(avg)
6764K white point (avg), DeltaE white 2.13
DeltaE 50% grey: 1.60, avg all colors 1.79

11. Diagnosis of R/G CVD by Test

12. Computerized R/G CVD Grading Scores PC
R/G Normal
256
254 PC
MILD DEUTAN 21 17
TABLET
MILD RED GREEN 2
MOD DEUTAN 9 15
SEV DEUTAN 10 8
Total Deutan 40 42
MILD PROTAN 1
MOD PROTAN
SEV PROTAN
Total Protan 4
Total R/G CVD 44 46
Total
300
Two Tritan CVD scores not summed with R/G defects

13. Pass/Fail USN Aviation Standard

14. 21-25 Normal R/G
Abnormal R/G
Pearson Correlation = 0.964
Sig (1-tail) = .000

15. Significance (1-tail) p < .001 Constant error p < .395 32 32
Pearson Correlation = 0.861
Significance (1-tail) p < .001
Constant error p < .395
Pearson Correlation = 0.946
Significance (1-tail) p < .001
Constant Error p < .470 32
Mild Moderate Severe

16. Normal
Mild
Mod
Severe

17. Findings regarding WCCVT testing
Uncalibrated Surface Pro 3 Tablet and calibrated PC have similar high sensitivity (98%-100%) for detecting red/green CVD as compared to Nagel Anomaloscope
Uncalibrated Tablet screening scores correlate highly to calibrated PC screening scores (0.96, p<0.001)
Uncalibrated Tablet protan & deutan scores are highly correlated to PC protan & deutan scores (0.86 & 0.95, p<0.001)
Uncalibrated Tablet tended toward grading CVD more severely than calibrated PC version, with slightly higher screening failure rate using USN aviation standards, but trend not statistically significant.
Not enough Tritanomalous data to make statistically significant regression comparison for PC vs Tablet scores

18. Conclusions regarding WCCVT testing
Surface Pro 3 Tablet results sufficiently similar to the PC version to be used for screening aviation personnel for color vision defects
Tritan defects may be detected, but require further evaluation to determine cause and possibility of acquired CVD
Although calibration not required in a research setting, calibration may still be required for clinical use since tampering of video settings is possible by technicians (brightness, color profiles, display color sliders)
Navy Policy: requirement to perform testing and calibration as recommended by the manufacturer

20. Bibliography:
Assessment of Color Vision Screening Tests for U.S. Navy Special Duty Occupations Supplement 2, Reddix M, Gao H, Kirkendall C, 2014
CAA Paper 2009/04 Minimum Colour Vision Requirements for Professional Flight Crew
Assessing the Severity of Color Vision Loss with Implications for Aviation and Other Occupational Environments, Rodriguez-Carmon m. O’Neill-Bib M., Barbur JL, Aviation, Space and Environmental Medicine, Vol 83(1), 2012
Procedures for Testing Color Vision: Report of Working Group 41, Committee on Vision, National Research Council, 1981
Assessment of Color Vision Screening Tests for U.S. Navy Special Duty Occupations, Reddix M., Kirkendall C., Gao H., NAMRU-Dayton, AsmA 85th Annual Scientific Meeting, 2014
Variability in Normal and Defective Colour Vision: Consequences for Occupational Environments, Barbur JL, Rodriguez-Carmona M., City University London, 2012.
Rapid Quantification of Color Vision: The Cone Contrast Test, Rabin J, Gooch J, Ivan D, Investigative Ophthalmology and Visual Science, Vol 52(2), Feb 2011
The Cone Contrast Test: Normative Scores for Binocular Testing, Vu LK, USAF School of Aerospace Medicine, AsMA 84th Annual Scientific Meeting, 2013
Sloan, LL, Comparison of Tests for Red-Green Color Deficiency, Aviation Medicine, Dec 1948

21. Additional Bibliograpy and Resources:
1) Paulson, H. (1966). NSMC, Report 466 : The performance of the Farnsworth Lantern at the Naval Submarine
Research Laboratory and the Field from 1955 to U.S. Naval Submarine Medical Center, Groton, CT.
2) Rings, Picken, NAMI research; CCVT validation study vs. PIP vs. FALANT vs. Nagel. (2013).
3) DeHart, Fundamentals of Aerospace Medicine, 3rd Edition, p. 373.
4) NATO WG-24, Operational Colour Vision in the Modern Aviation Environment
5) Cole, B.L., & Maddocks, J.D. (2008). Color vision testing by Farnsworth lantern and ability to identify
approach-path signal colors. Aviation, Space, & Environmental Medicine, 79(6),
6) Zentner, A.B., (1987), A Proposal for a Diagnostic Colour Vision Standard for Civil Airmen
7) Cole, B.L., (1985), Do protanomals have difficulty seeing red lights? Proc. 20thSession CIE. 1, E Paris.
8) Dille, J.R., 1975 Accident Experience of Civilian Pilots with Static Physical Defects, FAA, AsMA, Feb, 1978
9) Dille, J.R., 1976 Accident Experience of Civilian Pilots with Static Physical Defects, FAA, AsMA, Feb, 1980
10) SUSNFS Newsletters, Oct 1984, Oct 1987, Jan 1986
11) Ivan, D.J., Yates, J.T., (1994) In Search of the Abominable Coneman, Clinical Sciences Division, Brooks AFB
12) Sloan, LL, Comparison of Tests for Red-Green Color Deficiency, Aviation Medicine, Dec 1948
13) US Navy Color Vision Standards Revisited
NSMRL Report 98-01
“Surface Pro 3 Technical Evaluation”