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FOR PSEUDOISOCHROMATIC TESTING OF RED/GREEN Plus BLUE/YELLOW

HRR Technical Information

HRR Technical Article (pdf)

The Basics:

The HRR Pseudoisochromatic Plates were originally printed in 1953 and 1955 by American Optical as the result of developments that began in 1943 by a committee of color experts. Richmond Products printed the book again in 1993. We are now announcing the printing of this Fourth Edition based on reengineering by Jay Neitz, Ph.D. and Maureen Neitz, Ph.D., both at the Medical College of Wisconsin, Milwaukee and James Bailey, O.D., Ph.D., Southern California College of Optometry, Fullerton.

Computer Controlled Heidelberg Press with natural daylight lighting and spectrometer quality control.

The original HRR color vision test was developed by LeGrand Hardy, M.D., Gertrude Rand, Ph.D. and M. Catherine Rittler, B.A. to serve a threefold purpose: (1) as a screening test to separate those with defective color vision from those with normal color vision, (2) as a qualitative diagnostic test to classify the type of color defect (whether protan or deutan, tritan or tetartan), and (3) as a quantitative test to indicate the extent of the color defect (whether mild, medium or strong). The screening goal of the test has consistently been achieved; however, weaknesses in the first two editions in diagnostic classification as to type and extent were discovered in subsequent critical evaluations.

The purpose of the reengineering effort to produce a fourth edition of the HRR color test has been to use the most current and accepted information about color vision, including genetics, as well as state-of-the-art printing methods to correct the imperfections of previous editions. Analysis of the earlier editions indicated that the chromaticities of colors in the test plates were not as close as desired to colors known to be confused by color defectives. These colors are located along the so-called dichromatic confusion lines of the CIE Color Diagram (see chart above). Work over the past 20 years has resulted in better definition of these confusion lines. Other variables known to significantly affect the accuracy of color printing were controlled in this edition of the test. The reference illuminant for this 4th Edition of the HRR is the Richmond Products Illuminator (P/N 1339), an illuminant that is a close approximation to CIE Standard Source 'C' that was recommended by Hardy, Rand, and Rittler in the original edition. In addition, data obtained from color deficient individuals was used to modify original HRR colors to improve the test's qualitative and quantitative diagnosis. The new HRR color vision test is administered and scored in the same manner as in previous editions.

The colors in each of the HRR 4th Edition test figures have been plotted to determine their alignment with the confusion lines. This HRR 4th Edition Final Chromaticities Plot shows how closely this recent printing matches the colors required as determined by the dichromate lines.

Growing Importance of Color Vision Testing: 

The advent of the information age brought with it an increasing importance of color. Color-coded computer information, color printers, color applications for safety, color comparison test mechanisms, and other needs are driving increasing changes in the occupational requirements for color vision. For example, blood banks are anticipating a new testing system that requires workers to judge color. Airport security systems are changing from black and white to pseudo-color images, and this requires verification of proper color perception.

Color Matching in a Dental Lab requires verified color vision

Other occupational examples include dental laboratory technicians who need to be tested for color vision to insure they can judge the proper color for fabrication of dental appliances. Safety systems are becoming increasingly complex, and are moving from a simple red/green display to a multi-color display to indicate additional information. These changes require that safety workers can properly recognize a broader range of colors. The latest developments in kits to test for hazardous waste spills use comparison color test mechanisms. Medical and nursing assistants routinely use similar comparison test strips that require proper color interpretation to monitor patients. Many states now require color testing for distinction of yellow versus orange as well as red versus green by commercial vehicle operators to insure public safety. The following listing shows 100 jobs where color is important and for which many employers now require that normal color vision has been tested and verified.

Causes of Color Vision Deficiency

There are two types of color vision deficiency: Congenital and Acquired. Congenital or Genetic defects occur in about 8% of males and about 0.5% of women in Western society. These defects are almost exclusively red/green defects and they are binocular.

Acquired defects occur later in life because of some environmental factor. Some recent studies have indicated that as much as 5% (see note 1.) of the population have acquired color vision defects. The defects are typically blue/yellow and they are monocular. If the causal factor is permitted to worsen, they can develop a deficiency that is red/green and binocular in some cases.

The major causes of acquired color vision loss are:

- Trauma

- Disease

- Optic Nerve Damage

- Occupational Exposure

- Toxicity to Medications

Lets look at each of these causes in more detail:

- Trauma - Eye or Head Injury

- Disease - Diabetes, Cataract, MD, Glaucoma,

- Optic Nerve Damage from retinopathy, optic neuritis, neuropathy, optic nerve lesions, ganglion cell, retinitis pigmentosa

- Occupational Exposure - Exposure to chemicals and lasers are the most frequently cited causes. Some hospitals have begun testing all employees assigned to laser based instruments in order to establish a baseline color capability. Monitoring is then conducted on a scheduled basis to determine any deterioration in color vision.

Chemicals such as solvents used in dry cleaning and in manufacturing processes from power boats to rayon can also damage color vision. Research in this area is on-going and some researchers have stated that acquired color deficiency testing in occupational situations is important because it is an early warning that toxins are building up in the body.

- Toxicity to Medications - These common mediations can cause various affects on vision, including loss of color capability. (see note 2)

Antibiotics: Cefaclor (Ceclor), Cefuroximne axetil (Ceftin), Ciprofloxacin (Cipro),

Minorcycline (Dynacin, Minocin), Rifampin (Rifadin and others)

Antidepressants: Aplrazolam(Xanax), Fluoxetine (Prozac), Imipramine (Trofranil),

Analgesics: Ibuprofen (Advil), Naproxen (Anaprox, Aleve), Pixroxicam (Feldene),

Asthma/Allergy: Corticosteroids, Anthistaminees

Cardiovascular: Amiodarone (Cardarone, Pacerone), Beta-blockers, Calcium Channel blockers, Captopril/Enalapril (Vaseretic), Digitalis glycosides, Diuretics (Thiazide- type), Flecainide (Tambocor) Wararin (Coumadin)

Hormones: Clomiphene (Clomid), Danazol (Danocrine), Estradiol, Leuprolide (Lupson), Oral Contraceptives, Tamoxifen (Nolvadex),

Specialty: Hydroxychloroquine (Plaquenil), Myambutol

1. Color Blindness - Causes and Effects by Donald McIntyre Dalton Publishing, and Fletcher, R. and Voke, J. Defective Colour Vision: fundamentals, diagnosis and management, Bristol:Adam Hilger, 1985, and Smith, D.P. Diagnostic criteria in dominantly inherited juvenile optic atrophy. American J Optometry 49:183-200, 1972.

2, 5th edition of Drug-Induced Ocular Side Effects by Fredrick T. Fraunfelder, MD, Fredrick W. Fraunfelder, MD, and Joan A. Randall. Also search for works by Fabriziomaria Gobba, the Reggio Emilia professor at University of Modena

Goals of All Color Tests

Given this growing importance of color vision testing what are the key objectives for testing of color vision? First, we need to reliably separate those with defective color vision from those with normal color vision. For example, in occupational situations, it is important to insure that normal color vision employees are assigned to jobs for which there is a substantial business risk that would be incurred if color misjudgment errors are made. Second, an ideal color vision test would provide a qualitative diagnostic test to classify the type of color defect (whether protan or deutan, tritan or tetartan). Finally, the ideal test would provide a quantitative test to indicate the extent of the color defect (whether mild, medium or strong).

It is important to be able to determine the type and the extent of any defect for several reasons. First, if the defect is Deutan or Protan, we are able to more closely predict the colors affected and we can then understand the impact of the defect on life style and job performance and the risk to the business. Second, if the defect is blue/yellow or Tritan, something is affecting the patient's vision and the cause needs to be investigated. If one of the other causes is suspected from a medical history, the employee needs to be referred to their personal medical eye physician.

HRR Test Administration

The HRR test supports very efficient color deficiency screening. The first four plates are used to show the patient how the test works. A camel's hair brush is provided for the patient to trace perceived patterns and avoid the deleterious affects of fingerprints. The fourth plate in this demonstration series has no pattern in order to detect for shirkers. The next six plates provide screening by presenting the most difficult yellow, blue, red, and green colors. Success with these plates defines the subject as having 'normal color vision' and completes the test for that person. Subsequent plates appear increasingly bold in color to test for a increasing color deficiency.

Proper administration of the color tests requires the use of an illumination of 10 to 60 foot-candles approximating C.I.E. Source C.

Scoring: For subjects with other than normal color vision, diagnosis of type and extent of defect plates 

11-24 are used. When the testing is completed, the pattern of checks in each column is examined. Using the test instructions, it is very straightforward to determine from this pattern of correct and incorrect responses whether the subject is Protan, Deutan or Tritan defective and the extent of the defect.

Diagnosis based on HRR Test Results:

This scoring is then converted to a Diagnosis based on the following table:

How do these HRR test results compare with Color Chip test results?

The most popular occupational color chip tests are the Farnsworth D15 and Lanthony desaturated tests. For some occupations requiring very exact color judgement, some firms use the 100 hue color chip test.

The Farnsworth D15 test separates subjects into two groups: 1.) those with normal or mild color defects and 2.) those with medium or strong color vision defects. The Lanthony desaturated color chip test is much more difficult and is used to separate those with 1.) normal color vision from those with 2.) mild (or greater) color defects. Administration of color chip tests takes substantially more time than conducting the HRR test.

Using the HRR diagnostic capability, the results of color chip testing correlate as follows:

Occupational Health Application:

From this diagnosis we can begin to determine what to do with each group in terms of accessing job performance and risk. Obviously, any Tritan defects should quickly be evaluated based on the factors discussed above. Again, if occupational chemical exposure is suspected, the source needs to be discovered. If one of the other causes is suspected form a brief medical history, the employee needs to be referred to their personal medical eye physician. A Correct Response to a plate includes the number, name and location of all colored symbols on the plate. An Error consists in failure to see all symbols, or an incorrect name of any symbols, or an incorrect location. The HRR test provides a conclusive test with minimal judgement requested of the administrator.

Next, we can eliminate any subjects with strong defects from occupations requiring good color vision.

Mild protans have some limitation in the long wavelengths or red pigment. They have some inability to see dark reds and the occupational affect is considered by many to be minimal. Individual firms need determine the risk factors for their situation.

Finally for those determined to be mild deutan or medium protan or deutan, an occupational color evaluation needs to be conducted to determine the business risk due to color misjudgments for these defects and the particular job assignment being considered. This evaluation needs to be conducted by a qualified professional. The key questions may be:

- What are the risks to the employee in performing this job assignment given they have imperfect color vision?

- What would the consequences be of the most serious color judgement error?

- What are the risks to the business if color judgement errors occur?

- What are the variations of colors which could be presented on the job?

- Can a 'work around' be developed to reduce these risks to acceptable levels?

- Will these color defects affect the overall efficiency of performance in a serious manner?

- Can the work be redesigned efficiently to eliminate color judgement requirements?

Color defects occur in specific places on the color wheel. The next illustration entitled 'Chart of Dichromatic Confusion Lines' shows the three 'color confusion lines' for the three types of color defect. For each type of defect, the colors on the lines will appear gray. During the evaluation of any job it is important to determine the potential variations of colors to be presented for discrimination by the employee.

It is important to note that the past success of employees with color vision defects on a particular job is not the primary factor to consider. The primary factors would seem to be assuring the safety of the employee and the reduction of consequences to the business (or customers) to an acceptable level. This is the reason that it is not advisable to 'take the employee out on the job and see if they can perform the required color tasks'. For example, in a color wiring assignment the issue is not 'can the employee accomplish the color selections on the specific job in front to them' but rather what is the potential that a future wiring assignment will involve a colored wire where the color is 'on the color confusion line' for that employee.

Occupations Requiring Normal Color Vision

Why No Computer Based HRR?

The Announcement Basics:

The HRR Pseudoisochromatic Plates were originally printed in 1953 and 1955 by American Optical as the result of post-war development by a committee American color experts. The book was printed again in 1993 by Richmond Products. We are now  announcing the printing of this Fourth Edition based on reengineering by Jay Neitz, Ph.D. M. Neitz , PhD ( Both at Medical College of Wisconsin) and  J.E. Bailey, OD, Ph.D. (Southern CA College of Optometry) and the printing of this Fourth Edition.

Complete Product

The HRR test from Richmond Products includes the four demonstration plates, the six screener plates and the 14 diagnostic series for a total of 24 plates. Each of these plates has its own tab for easy AND clean page selection. The test also includes a set of instructions in English and a laminated copy of the score sheet. The score sheet can then be copied directly onto the patient's record or copies can be made locally. A pad of score sheets is available separately.

4th Edition Packaging

n order to make the HRR 4th Edition easier to administer, several packaging changes have been made including tabs, a new binding technique, pages numbers and expansion of the types of editions available. A nuisance with the previous printings was the lack of tabs. The pages were very hard to turn one at a time without wetting the finger. Wetting the finger (and fingerprints in general) are the main contributors to the degradation of the paper and the images so carefully created in the manufacture of the test. This problem has been solved with the addition of tabs cut into each page. The camel's hair brush is also included with the HRR 4th Edition. The brush is used by the patient to trace the figures and helps avoid fingerprints on the plates.  The back of each tab is printed with the page number (in reverse) for easier scoring.

n the HRR instructions, repetition of the test with a 180° rotation is called for when re-testing is recommended. Rotation has been awkward with a full cover and book binding included with the previous versions. The new binding used on the 4th Edition permits easy 180° rotation, and, in order to promote focus on the target, the plates can be folded back on themselves completely without any damage to the binding. This permits easier presentation of the individual plates. In addition, the new coil binding does not permit removal of the plates. This helps keep the proper order of the plates intact. The new binding also includes the instructions and the laminated score sheet to insure they are never misplaced. The laminated score sheet makes it easy to copy the score sheet locally or directly onto the patient's examination record. The laminated score sheet is also a more environmentally sound solution than mailing pads of score sheets. For those who prefer, pads of score sheets  can be purchased separately.

Several new versions of the HRR 4th Edition have been developed including a combined HRR/Amsler Combined Test, various International Versions and a New Pediatric Version. 

The Pediatric version provides laminated examples of the HRR figures (X, O and D) along with a matching card and Pediatric instructions. The Spanish Version provides the instructions in both Spanish and English so that technicians can administer the test in regardless of which language is stronger for them. The test plates are unchanged for these versions.

Sample of the opening paragraphs of the Spanish Edition Instructions:

Mantenimiento:  Mantenga el libro de exámen cerrado cuando no esté en uso.  No toque los platos con los dedos.  Voltee la hoja por el borde.  Asegúrese que el paciente esté sentado con los ojos más o menos a treinta pulgadas de distancia del libro cuando el libro esté en el estante del caballete de lámpara.  Encienda la lámpara y excluya del cuarto cualquier luz superflúa que pudieracaer directamente a la prueba.

HRR Technical Article

HRR Illumination Specifications

Color Testing Diagnostic Codes

HRR 4th Edition Test - English Version

HRR 4th Edition Test - International Versions

Color Vision Test Index

 

All Products In Alphabetical Order

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