Cone contrast test-HD: sensitivity and specificity in red&#x2013;green dichromacy and the impact of age

Tatsuya Iizuka; Takushi Kawamorita; Takushi Kawamorita; Tomoya Handa; Tomoya Handa; Hitoshi Ishikawa; Hitoshi Ishikawa; Hitoshi Ishikawa

doi:10.1364/JOSAA.480467

Journal of the Optical Society of America A
Vol. 40,
Issue 5,
pp. 849-858
(2023)
•https://doi.org/10.1364/JOSAA.480467

Cone contrast test-HD: sensitivity and specificity in red–green dichromacy and the impact of age

Tatsuya Iizuka, Takushi Kawamorita, Tomoya Handa, and Hitoshi Ishikawa

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Tatsuya Iizuka, Takushi Kawamorita, Tomoya Handa, and Hitoshi Ishikawa, "Cone contrast test-HD: sensitivity and specificity in red–green dichromacy and the impact of age," J. Opt. Soc. Am. A 40, 849-858 (2023)

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Table of Contents Category
- Vision, Color Vision, and Psychophysics
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About this Article
History
- Original Manuscript: November 14, 2022
- Revised Manuscript: February 22, 2023
- Manuscript Accepted: February 28, 2023
- Published: April 11, 2023

Abstract

We report normative cone contrast sensitivity values, right–left eye agreement, and sensitivity and specificity values for the cone contrast test-HD (CCT-HD). We included 100 phakic eyes with color vision normal (CVN) and 20 dichromatic eyes (10 with protanopia and 10 with deuteranopia). The CCT-HD was used to measure L, M, and S-CCT-HD scores, and the right and left eyes were evaluated for agreement using Lin’s concordance correlation coefficient (CCC) and Bland–Altman analysis to investigate the sensitivity and specificity of the CCT-HD based on diagnosis with an anomaloscope device. All cone types were in moderate agreement with the CCC (L-cone: 0.92, 95% CI, 0.86–0.95; M-cone: 0.91, 95% CI, 0.84–0.94; S-cone: 0.93, 95% CI, 0.88–0.96), whereas the Bland–Altman plots showed that the majority of cases (L-cone: 94%; M-cone: 92%; S-cone: 92%) fell within the 95% limits of agreement and showed good agreement. The ${\rm mean}\;{\pm}\;{\rm standard}$ error L, M, and S-CCT-HD scores for protanopia were ${0.6}\;{\pm}\;{1.4}$, ${74.7}\;{\pm}\;{2.7}$, and ${94.6}\;{\pm}\;{2.4}$, respectively; for deuteranopia, these were ${84.0}\;{\pm}\;{3.4}$, ${40.8}\;{\pm}\;{3.3}$, and ${93.0}\;{\pm}\;{5.8}$, respectively; and for age-matched CVN eyes (${\rm mean}\;{\pm}\;{\rm standard}$ deviation age, ${53.1}\;{\pm}\;{5.8}$ years; age range, 45–64 years), these were ${98.5}\;{\pm}\;{3.4}$, ${94.8}\;{\pm}\;{3.8}$, and ${92.3}\;{\pm}\;{3.4}$, respectively, with significant differences between the groups except for S-CCT-HD score (Bonferroni corrected $\alpha = {0.0167}$, $p \lt {0.0167}$). The sensitivity and specificity of the CCT-HD were 100% for protan and deutan in diagnosing abnormal types in those aged 20 to 64 years; however, the specificity decreased to 65% for protan and 55% for deutan in those aged ${\gt} {65}$ years. The CCT-HD is comparable to the diagnostic performance of the anomaloscope in the 20–64-year-old age group. However, the results should be interpreted cautiously in those ${\ge} {65}$ years, as these patients are more susceptible to acquired color vision deficiencies due to yellowing of the crystalline lens and other factors.

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Supplementary Material (1)

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Supplement 1	Supplemental document.

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Parameter	Young	Middle-aged	Elderly	Protanope	Deuteranope
	CVN			CCVD
Participants (eyes)	20 (40)	10 (20)	20 (40)	10 (10)	10 (10)
Age (y, $m e a n \pm S D$ , range)	$23.2 \pm 2.7$ (20–29)	$53.1 \pm 5.8$ (45–64)	$69.3 \pm 5.9$ (65–78)	$54.2 \pm 4.6$ (46–59)	$54.6 \pm 4.4$ (48–64)
Sex (% male)	50	60	50	100	90
AQ	$0.97 \pm 0.05$	$1.08 \pm 0.05$	$1.24 \pm 0.06$	–	–
CVN, color vision normal; CCVD, congenital color vision deficiency; SD, standard deviation;
AQ, anomalous quotient.

	SPP-1				F-D15
	Number of	Classification:	Classification:	Correct			Correct
	Correctly Read	Protan	Deutan	Classification (%)	Angle	C-index	Classification (%)
CVN $n = 100$	$9.8 \pm 0.04$		$M e a n \pm S E$	97	–	$1.2 \pm 0.1$	90
Protanope $n = 10$	$0.8 \pm 0.3$	$4.2 \pm 0.5$	$0.6 \pm 0.3$	90	$1.0 \pm 1.1$	$4.3 \pm 0.1$	50
Deuteranope $n = 10$	$1.9 \pm 0.4$	$0.2 \pm 0.13$	$4.5 \pm 0.2$	100	$- 13.7 \pm 1.1$	$3.9 \pm 0.1$	1.00
CVN, color vision normal; SE, standard error; C-index, Confusion index.

	Young $n = 40$ (l, m, s)	Middle-aged $n = 20$ (l, m, s)	Elderly $n = 40$ (l, m, s)	Protanope $n = 10$ (l, m, s)	Deuteranope $n = 10$ (l, m, s)
Mean	(114.1, 111.2, 115.4)	(100.0, 94.6, 91.7)	(81.3, 77.0, 70.3)	(0.6, 74.7, 94.6)	(84.0, 40.8, 93.0)
SE	(1.9, 1.9, 2.6)	(2.2, 2.4, 2.4)	(2.2, 1.9, 2.2)	(1.4, 2.7, 2.4)	(3.4, 3.3, 5.8)
SD	(12.3, 12.2, 16.6)	(10.0, 10.9, 10.9)	(13.9, 11.9, 13.8)	(4.3, 8.6, 7.7)	(10.9, 10.5, 18.3)
Min	(88, 92, 77)	(83, 79, 65)	(59, 56, 34)	(-5, 63, 84)	(70, 28, 66)
Max	(148, 142, 146)	(117, 116, 108)	(121, 109, 95)	(6, 91, 111)	(111, 56, 116)
Med	(111, 112, 116)	(99, 96, 91)	(79, 76, 70)	(1, 75, 94)	(83, 37, 92)
QD	(8.6, 9.0, 9.0)	(8.4, 7.3, 5.6)	(9.6, 6.4, 7.9)	(3.8, 5.5, 4.0)	(2.8, 7.4, 14.3)
95%CI lower	(107.6, 107.4, 110.2)	(95.7, 89.8, 86.9)	(77.0, 73.3, 66.0)	(-2.0, 69.4, 89.8)	(77.3, 34.3, 81.7)
95%CI upper	(115.2, 115.0, 120.5)	(104.4, 99.4, 96.5)	(86.6, 80.7, 74.6)	(3.2, 80.0, 99.4)	(90.7, 47.3, 104.3)
L, L-CCT-HD score; M, M-CCT-HD score; S, S-CCT-HD score;SE, standard error; SD, standard deviation; Min, minimum; Max, maximum; Med, median; QD, quartile deviation;

Parameter	Young	Middle-aged	Elderly	Protanope	Deuteranope
	CVN			CCVD
Participants (eyes)	20 (40)	10 (20)	20 (40)	10 (10)	10 (10)
Age (y, $m e a n \pm S D$ , range)	$23.2 \pm 2.7$ (20–29)	$53.1 \pm 5.8$ (45–64)	$69.3 \pm 5.9$ (65–78)	$54.2 \pm 4.6$ (46–59)	$54.6 \pm 4.4$ (48–64)
Sex (% male)	50	60	50	100	90
AQ	$0.97 \pm 0.05$	$1.08 \pm 0.05$	$1.24 \pm 0.06$	–	–
CVN, color vision normal; CCVD, congenital color vision deficiency; SD, standard deviation;
AQ, anomalous quotient.

	SPP-1				F-D15
	Number of	Classification:	Classification:	Correct			Correct
	Correctly Read	Protan	Deutan	Classification (%)	Angle	C-index	Classification (%)
CVN $n = 100$	$9.8 \pm 0.04$		$M e a n \pm S E$	97	–	$1.2 \pm 0.1$	90
Protanope $n = 10$	$0.8 \pm 0.3$	$4.2 \pm 0.5$	$0.6 \pm 0.3$	90	$1.0 \pm 1.1$	$4.3 \pm 0.1$	50
Deuteranope $n = 10$	$1.9 \pm 0.4$	$0.2 \pm 0.13$	$4.5 \pm 0.2$	100	$- 13.7 \pm 1.1$	$3.9 \pm 0.1$	1.00
CVN, color vision normal; SE, standard error; C-index, Confusion index.

Abstract

Supplementary Material (1)

Data availability

Cited By

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Tables (3)

Journal of the Optical Society of America A