Colour  vision  assessment  for  
maritime  navigational  lookout:    
 
review  for  UK  Maritime  and  
Coastguard  Agency  (MCA)  
 
 
 
 
 
Tim  Carter,  Norwegian  Centre  for  
Maritime  Medicine,  Bergen  
John  Barbur,  Applied  Vision  Research  
Centre,  City  University  London  
 
 
 
July  2015  
   

  1  
  

 
Executive  Summary  
 
Colour  vision  in  seafarers  has  to  be  tested  to  ensure  that  all  applicants  who  pass  
can  carry  out  visually  demanding,  colour-­‐related  lookout  duties  with  the  same  
accuracy  as  those  with  normal  trichromatic  vision,  while  at  the  same  time  there  
should  be  no  denial  of  career  opportunities  to  those  who  can  safely  carry  out  
such  duties.  The  current  test  protocol  used  by  MCA,  which  is  in  line  with  the  
requirements  in  international  conventions,  uses  the  Ishihara  test  as  initial  
screen,  with  access  to  confirmatory  testing  for  those  who  fail  the  initial  
screening.  
 
The  Holmes  Wright  B  lantern  (HW-­‐B),  used  for  confirmatory  testing  of  colour  
vision  in  UK  seafarers  with  navigational  lookout  duties,  is  no  longer  
manufactured  and  servicing  cannot  be  guaranteed.  This  report  was  
commissioned  to  evaluate  options  for  its  replacement  with  an  alternative  test.      
 
The  recommended  alternative  is  the  CAD  (Colour  Assessment  and  Diagnosis)  
test.  This  measures  the  severity  and  type  of  colour  vision  loss,  and  reliably  
detects  congenital  deficiency.    When  the  upper  pass  threshold  limit  is  set  at  2.35  
CAD  units,  the  test  can  provide  a  valid  alternative  to  the  current  lantern  test.  An  
additional  benefit  would  be  a  reduction  in  the  number  of  seafarers  with  
adequate  colour  vision  who  are  now  classified  incorrectly  as  unfit.  It  is  also  
practical  to  introduce  and  to  use  the  CAD  test,  as  it  is  currently  available  at  a  
number  of  centres  in  the  UK.    
 
Recent  evidence  about  the  characteristics  of  the  Ishihara  test,  used  as  the  initial  
screen  for  colour  vision  in  seafarers,  indicates  that  the  validity  of  the  current  
testing  protocol  could  be  improved  by  making  changes  either  to  the  criteria  used  
for  failure  on  this  test  or  by  using  the  CAD  test  more  widely  as  the  primary  
means  of  testing.    These  changes  have  the  potential  to  ensure  that  all  those  with  
colour  deficiencies  are  identified  correctly.  
 
All  current  approaches  are  limited  by  the  lack  of  up  to  date  information  on  the  
colour  vision  requirements  for  present  day  navigational  lookout  duties  and  the  
best  means  of  assessing  the  most  colour  critical  tasks.  This  means  that  the  
relative  risks  to  decision  taking  while  performing  such  duties  in  those  with  
normal  and  with  colour  vision  deficiencies  cannot  be  established    
 
   

  2  
  

Index  
 
Executive  summary                   2  
 
Authors:  conflicts  of  interest             4  
 
Background                     5  
 
History                   5  
 
Current  MCA  colour  vision  test  methods           7  
 
Relevant  Vision  Science               9  
Mechanisms  of  colour  perception           9  
Inheritance  of  colour  vision  deficiency         9  
Acquired  loss  of  chromatic  sensitivity         10  
Effects  of  normal  aging  on  red-­‐green    
and  yellow-­‐blue  colour  vision           12  
 
Characteristics  of  colour  vision  testing  methods         13  
  Ishihara  plates               13  
  Holmes  Wright  lanterns             16  
  Other  lanterns               18  
  Other  established  tests             18  
Screen-­‐based  tests               19    
CAD  (colour  assessment  and  diagnosis)  test       20  
  CCT  (Cambridge  colour  test)           22  
CCST  (cone  contrast  sensitivity  test)  and  Conan  DX     23  
 
Testing  protocols  and  use  of  sequential  tests         23  
               
Proposed  options  for  revisions  to  MCA  procedures       28  
 
Recommendations                 31  
 
Appendix  1:  MCA  colour  vision  testing  requirements       33  
 
Appendix  2:  the  Holmes  Wright  Lantern           35  
 
Appendix  3:  the  features  of  the  CAD  test           36  
 
Appendix  4:  CAD  testing  centres             38  
 
References                   39  
 
 
 
 
 

  3  
  

 
 
 
 
 
 
 
 
 
 
Authors:  conflicts  of  interest  
 
Prof.  Tim  Carter  was  formerly  Chief  Medical  Adviser  to  the  UK  Maritime  and  
Coastguard  Agency,  who  commissioned  this  review.  He  has  also  acted  as  adviser  
to  the  International  Maritime  Organization  on  colour  vision  testing  in  seafarers  
and  he  co-­‐organised  the  specialist  workshop  on  the  topic  held  in  Kobe,  Japan  in  
2014.  
 
Prof.  John  Barbur  developed  the  Colour  Assessment  and  Diagnosis  Test  (CAD).
The intellectual property rights for the CAD test are owned by City University
London and the Civil Aviation Authority. The test is manufactured and supplied by
City Occupational Ltd, a spin out company of City University. John Barbur is a
director of City Occupational Ltd. and benefits (together with two other inventors)
from the sale of the CAD test.  
 
 
   
 
 
   

  4  
  

Background  
 
1.  The  MCA  requested  this  review  because  the  current  test  protocol  for  colour  
vision,  based  on  initial  screening  with  Ishihara  plates  and  then  confirmatory  
testing  using  the  Holmes  Wright  B  (HW-­‐B)  lantern  is  becoming  unsustainable  as  
the  lanterns  are  no  longer  manufactured  and  quality  assured  servicing  
arrangements  can  no  longer  be  reliably  obtained.  The  review  aims  to  answer  
three  questions  posed  by  MCA:  
 
1. “How  efficient/appropriate  is  the  current  MCA  colour  assessment  
protocol?  
2. Do  CAD  or  other  computerised  colour  vision  tests  provide  a  simple,  more  
accurate  and  economical  alternative  to  the  lantern  test  currently  in  use  to  
establish  fitness  in  deck  department  personnel  who  fail  the  Ishihara  test  
for  colour  vision?  
3. If  so  what  cut  off  threshold  limits  for  the  CAD  or  other  tests  represent  
limits  that  are  ‘equivalent’  to  the  outcome  of  the  current  testing  protocol.”  
 
2.  At  the  same  time  it  has  become  apparent,  from  discussions  with  maritime  
authorities  and  with  those  who  carry  out  colour  vision  testing,  that  there  are  
considerable  inconsistencies  between  the  colour  vision  test  methods  and  
protocols  used  in  different  countries.  The  International  Maritime  Organisation  
wishes  to  see  this  addressed  but,  as  yet,  has  not  been  able  to  mobilise  the  
resources  needed  to  develop  a  valid  and  consistent  approach  that  can  be  adopted  
internationally.  Current  testing  methods  and  protocols  employed  in  various  
countries  produce  inconsistent  outcomes  that  in  some  cases  are  likely  to  result  
in  unjustified  discrimination  in  employment.  In  other  cases,  applicants  with  
congenital  colour  deficiency  may  be  passed  as  safe  without  guaranteeing  in  any  
way  that  they  are  able  to  carry  out  the  most  demanding  safety-­‐critical,  maritime  
colour-­‐related  tasks  as  well  as  those  with  normal  trichromatic  vision.      
 
History  
 
3.  The  need  for  colour  vision  testing  in  seafarers  with  navigational  duties  arose  
in  the  nineteenth  century,  not  from  the  recognition  of  safety  risks  in  the  natural  
maritime  environment  but  because  of  the  use  of  red  and  green  lights  to  indicate  
the  position  of  ships,  and  later  for  markers  in  seaways.  Red  and  green  were  the  
only  two  feasible  colours  at  a  time  when  oil  lamps  with  wicks,  burning  with  a  
yellow  flame,  were  used.  Co-­‐incidentally,  the  commonest  form  of  congenital  
colour  deficiency  involves  red/green  colour  discrimination.    Such  deficiencies  
vary  in  severity  from  almost  normal  colour  vision  to  a  total  absence  of  red-­‐green  
colour  discrimination  and  are  found  in  just  over  8  per  cent  of  males  and  some  0.4  
per  cent  of  females.1    
 
4.  Colour  vision  testing  was  introduced,  both  for  seafarers  and  in  the  rail  
industry,  in  the  1880s  after  a  number  of  serious  incidents  linked  to  the  inability  
to  recognise  coloured  signals  or  navigation  lights  correctly.  At  first  these  
procedures  were  based  on  colour  naming,  but  this  was  soon  replaced  by  colour  
matching  tests.  Many  anomalous  results  were  obtained,  often  to  the  detriment  of  

  5  
  

the  careers  of  navigating  officers.  This  led  to  public  concern  and,  in  the  UK,  to  a  
careful  study  of  the  validity  of  different  methods  of  colour  vision  testing  in  
1911.2    
 
5.  A  standard  colour-­‐testing  lantern  was  introduced  in  1914  that  was  designed  
specifically  to  simulate  ship  navigation  lights  at  a  distance.  Lantern  testing  
carried  out  at  Board  of  Trade  Marine  Offices  became  part  of  the  assessment  of  
officers  thereafter.  The  current  Holmes-­‐Wright  B  lantern  is  a  linear  descendent  
of  the  1914  version.  Later  developments  included  the  extension  of  colour  vision  
testing  from  navigating  officers  to  ratings  in  the  deck  department  and  the  use  of  
the  Ishihara  plates  (IH)  as  a  screening  test,  with  only  those  who  failed  them  
being  referred  for  lantern  testing.3  Both  the  screening  test  and  the  confirmatory  
tests  assess  colour  vision,  but  in  differing  ways.    
 
6.  The  outcomes  of  both  the  screening  test  and  the  confirmatory  tests  depend  on  
the  applicant’s  chromatic  sensitivity,  although  the  state  of  light  adaptation  and  
the  stimulus  conditions  differ  significantly.  As  a  result  even  those  with  normal  
trichromatic  vision  can  on  occasions  produce  inconsistent  results  on  the  
different  tests.4    This  is  largely  because  the  visual  tasks  required  of  those  tested  
differ  (from  identifying  large  characters  on  a  plate  when  adapted  to  daylight,  to  
naming  correctly  the  colours  of  pairs  of  small  signal  lights  when  seen  under  
unfavourable  conditions,  such  long  viewing  distances,  at  night).  It  is  well  
established  that  visual  parameters  such  as  the  dimensions  of  the  colour  stimulus  
and  the  state  of  light  adaptation  of  the  eye  affect  the  ability  to  see  colour  
differences.  This  approach  is  therefore  inherently  likely  to  lead  to  inconsistent  
findings  when  the  results  of  different  tests  are  compared.    
 
7.  Other  maritime  nations  introduced  their  own  procedures;  most  were  broadly  
comparable  to  those  in  the  UK.  However  the  plate  tests  and  protocols  used  for  
screening,  the  tests  used  on  those  who  had  failed  at  screening  and  the  extent  to  
which  there  was  discretion  based  on  expert,  ophthalmological,  opinion  varied  
greatly.      
 
8.  The  CIE  (Commission  Internationale  de  L’eclairage  /International  Commission  
on  Illumination)  is  the  main  international  organisation  that  sets  technical  
standards  for  illumination,  including  those  for  signal  lights.5  In  2001  CIE  
produced  a  technical  guide  to  colour  vision  testing  in  transport  (CIE  143:2001).6  
The  current  UK  test  procedures  were  and  are  in  line  with  these  
recommendations,  as  were  those  of  a  number  of  other  maritime  nations,  but  
there  were  also  many  national  criteria  that  were  at  variance  with  them.    
However  this  did  not  become  apparent  until  the  detailed  criteria  for  the  issue  of  
medical  certificates  to  seafarers  under  the  International  Maritime  Organisation  
(IMO)  Standards  for  Training  Certification  and  Watchkeeping  (STCW)  
Convention  became  mandatory  when  it  was  amended  in  2010.  This  convention  
indicated  that  colour  vision  testing  needed  to  accord  with  CIE  143:2001.7    
 
9.  Concerns  in  some  countries  about  their  lack  of  compliance  with  CIE  143:2001  
only  became  apparent  after  the  Convention  had  been  agreed  and  this  led  to  IMO  
agreeing  to  delay  introduction  of  the  mandatory  changes  to  colour  vision  testing.  

  6  
  

An  expert  workshop  was  held  in  early  2014  that  reviewed  current  practices  and  
the  scope  for  using  a  number  of  screen-­‐based  tests  to  replace  those  listed  in  CIE  
143:2001.8    
 
10.  The  report  from  the  workshop  also  identified  that,  as  these  newer  tests  could  
assess  the  class  of  colour  vision  and  also  measure  the  severity  of  colour  vision  
loss,  studies  were  needed  to  establish  appropriate  colour  thresholds  to  use  to  
ensure  that  safety  was  not  compromised  without  unjustifiably  discriminating  
against  those  seeking  to  work  at  sea.  While  no  recent  studies  have  been  done  on  
safety  critical  colour  vision  thresholds  in  the  maritime  sector,  there  are  no  
available  incident  reports  suggesting  that  colour  deficiency,  even  when  tested  by  
the  least  demanding  test  methods  currently  in  use  by  some  maritime  authorities,  
has  contributed  to  any  maritime  incidents  that  have  been  investigated.    
 
11.  However,  given  that  most  incidents  are  multi  factorial  it  is  not  always  easy  to  
assess  with  confidence  the  extent  to  which  lack  of  normal  trichromaticity  or  any  
other  aspect  of  vision  that  cannot  be  classed  as  completely  normal  may  have  
contributed  to  the  outcome.  Methods  for  establishing  upper  threshold  limits  of  
colour  vision  loss  that  can  be  classed  as  safe  within  specific  environments  have  
recently  been  developed.  There  is  good  evidence  from  other  transport  sectors,  
such  as  aviation  and  the  railways,  where  tests  that  can  measure  the  severity  and  
type  of  deficiency  are  already  in  use,  that  appropriate  threshold  limits  can  be  
derived  from  studies  of  safety-­‐critical  task  demands  and  that  such  limits  can  then  
form  the  basis  for  fair  and  valid  fitness  criteria.9    
 
 
Current  MCA  colour  vision  test  methods  
 
12.  The  procedures  used  by  MCA  have  evolved  over  the  years.  They  were  last  
revised  following  a  review  in  1997.10  Different  requirements  apply  to  those  in  
the  deck  department  who  may  carry  out  navigational  lookout  duties  (the  subject  
of  the  current  review),  those  in  the  engine  department  who  have  to  recognise  
colour  coded  safety  information  and  those  who  work  in  catering  or  other  
departments  of  a  ship.  For  crewmembers  with  navigational  lookout  duties,  initial  
testing  is  by  Ishihara  plates,  with  anyone  who  incorrectly  identifies  more  than  
two  plates  having  the  opportunity  to  then  have  their  colour  vision  assessed  using  
the  HW-­‐B  lantern.  
 
13.  Approved  Doctors  (AD)  performing  statutory  medicals  on  seafarers  on  behalf  
of  MCA  are  required  to  test  for  colour  vision  using  Ishihara  plates  at  each  
medical,  unless  they  performed  the  previous  one,  in  which  case  test  can  be  done  
every  four  years.  These  requirements  are  given  in  Merchant  Shipping  Notice  
(MSN)  1839.11  They  are  supported  by  guidance  given  in  Approved  Doctors’  
Guidance  (ADG)  14.12  The  relevant  sections  of  both  are  at  Appendix  1.  
Observation  indicates  that  tests  are  not  performed  in  exactly  the  same  way  by  all  
ADs.  
 
14.  HW-­‐B  tests  are  performed  at  three  of  the  MCA  Marine  Offices  (Southampton,  
Aberdeen,  Beverley).  Recently  City  University  London  has  also  been  designated  

  7  
  

as  a  centre  and  has  been  undertaking  comparisons  between  HW-­‐B,  HW-­‐A  and  
CAD  results.    All  testers  follow  a  specified  protocol.13  This  requires  a  blacked  out  
room,  which  is  generally  unsuitable  for  other  uses  and  is  only  used  for  testing  for  
a  few  hours  each  year.  A  period  of  dark  adaptation  is  required  prior  to  testing  
and  preparation  for  the  test  and  the  test  itself  may  take  around  30  minutes  of  a  
marine  surveyor’s  time.  
 
15.  The  statistics  available  from  MCA  show  that  in  2014  over  54,000  seafarer  
medicals  were  performed.  Of  these  24  seafarers  were  failed  either  temporarily  
or  permanently  and  626  were  restricted  because  of  colour  vision  deficiencies.    
However  these  crude  data  do  not  distinguish  between  medical  examinations  at  
the  start  of  career  and  those  later,  nor  do  they  separate  out  deck,  engineering  
and  other  crew  members:  each  has  different  colour  vision  requirements.    As  a  
result  they  do  not  enable  any  useful  conclusions  to  be  reached  on  the  importance  
of  the  problem,  the  consistency  of  test  results  or  their  implications  for  careers  at  
sea.    
 
16.  Information  has  also  been  collected  by  MCA  on  the  number  of  seafarers  who  
have  had  confirmatory  testing  using  the  HW-­‐B  lantern  because  they  have  failed  
to  meet  the  MCA  Ishihara  criteria.  Most  of  these  tests  will  be  at  the  start  of  career  
as  those  who  pass  the  HW-­‐B  are  given  a  certificate  that  means  repeat  testing  is  
not  needed  at  each  medical.  Not  all  those  tested  are  Merchant  Navy  seafarers  as  
some  other  groups  of  maritime  workers  are  also  assessed  and,  in  some  cases,  
less  demanding  criteria  for  passing  are  required.  The  pass  rates  vary  between  
the  four  testing  centres,  either  because  of  differences  in  the  application  of  the  
test  protocol  or  because  some  centres  see  a  higher  proportion  of  those  who  only  
need  to  meet  the  less  demanding  criteria.      
 
17.  An  average  of  98  tests  have  been  done  each  year  (2003-­‐2014)  with  an  
average  of  20  passes.  However  the  City  University  centre,  which  has  been  
following  the  testing  protocol  exactly  as  specified  for  HW-­‐B,  had  no  passes  in  the  
tests  done  since  2012,  suggesting  perhaps  that  variable  interpretations  about  the  
testing  procedures  have  enabled  some  candidates  to  pass.  Additional  tests  of  
colour  vision  were  also  performed  at  this  centre  (Table  1).  
 
Sample  statistics  -­‐  MCGA  applicants  that  took  HW-­‐A,  HW-­‐B  ,  lanterns  and  other  tests  at  City  University

%  pass  I H  (less   %  pass   %  pass   %  Nagel   %  pass  CAD  

Sample  size  (21)         N
than  3  errors)   HW-­‐A HW-­‐B (MR<9) (RG)
Normal  trichromats 2 100 100 100 100 100
Deutan 14 14 36 0 64 0
Protan 5 20 0 0 100 0
Acquired 0 NA NA NA NA 0  
 
Table  1.  Test  results  from  City  University  on  MCA  subjects  who  failed  initial  Ishihara  test.  (The  
terms  deutan  and  protan  are  explained  in  paragraph  19  and  Figure  1).  24%  of  those  who  failed  
the  first  Ishihara  test  (plates  1  to  25)  pass  on  retest.  36%  of  deutans  passed  on  the  HW-­‐A  lantern,  
but  none  on  the  HW-­‐B  lantern.  The  CAD  test  results  were  fully  consistent  with  the  HW-­‐B  findings.  
(CAD  and  Nagel  tests  are  described  in  paragraphs  38  and  42-­‐44).  
 

  8  
  

 
 
 
Relevant  Vision  Science  
 
18.  This  section  reviews  those  aspects  of  vision  science  that  are  relevant  to  the  
assessment  of  colour  vision  in  seafarers.  Colour  vision  deficiency  may  be  either  
inherited  or  acquired.  
 
Mechanisms  of  colour  perception  
 
19.  The  normal  retina  contains  three  classes  of  cone  photoreceptor  with  distinct  
spectral  responses:  short  wavelength  (S-­‐cones),  middle  wavelength  (M-­‐cones)  
and  the  long  wavelength  (L-­‐cones)  (Figure  1).  In  this  section  the  results  from  
several  hundred  subjects  tested  using  the  CAD  test  are  used  as  a  benchmark.  
This  test  is  described  later  in  this  section.  
 
 
Figure  1.  Spectral  sensitivities  of  L  (red),  M  (green)  
Red (L-cone)
and  S  (blue)  cones  in  a  normal  trichromat.    
Green (M-cone)  
Blue (S-cone) Red  /  green  dichromats  lack  either  the  L-­‐cones  
(protanopes,  protans)  or  the  M-­‐cones  (deuteranopes,  
deutans).    
 
Deuteranomalous  subjects  rely  on  a  variant  L-­‐cone  
pigment  that  differs  in  the  wavelength  of  peak  spectral  
responsivity  from  the  normal  L-­‐cone  pigment  by  as  
much  as  12nm.  14  
 
350 450 550 650 750 Protanomalous  subjects  rely  on  a  variant-­‐cone  M  
Wavelength (nm) pigment   with  a  maximum  peak  separation  of  ~  7nm  
from  the  normal  M-­‐cone  pigment.      
 
Subjects  with  absent  or  non-­‐functioning  S-­‐cones  are  very  rare  (~  one  in  15  to  20  thousand).1    
 
Subjects  with  acquired  loss  of  colour  vision  (that  can  affect  both  the  RG  and  YB  colour  vision)  are  
more  common  above  55  years  of  age  and  increase  rapidly  above  65  years  of  age  (often  exceeding  
the  percentage  of  those  with  congenital  deficiencies).  15  
 
 
Inheritance  of  colour  vision  deficiency  
 
20.  Normal  colour  vision  depends  on  the  presence  of  each  of  the  three  colour  
sensitive  pigments  in  a  form  that  has  the  optimum  spectral  response.  An  
understanding  of  the  pattern  of  inheritance  for  colour  vision  and  its  expression  
in  terms  of  limitations  to  colour  discrimination  is  needed  in  order  to  understand  
the  rationale  for  colour  vision  testing  and  to  evaluate  its  ability  to  assess  the  
nature,  severity  and  significance  of  any  deficiencies  identified.  
 
21.  The  genes  responsible  for  the  red  /  green  colour  sensitive  pigments  form  a  
sequential  array  and  are  localised  to  the  X-­‐chromosome.  A  person  may  inherit  a  
variant  gene  in  the  array  that  determines  the  spectral  tuning  (wavelength  of  

  9  
  

maximum  sensitivity)  of  red  or  green  cone  pigments.  This  will  result  in  
anomalous  colour  vision.  There  are  several  cone  pigment  genes  in  the  array  (e.g.,  
L,  M,  M,  L  or    L,  L,  M).  Although  the  first  two  genes  are  most  likely  to  be  expressed  
sometimes  even  the  third  one  can  be  expressed)  When  the  first  two  cone  
pigment  genes  in  the  array  are  of  the  same  kind,  it  is  highly  likely  that  these  are  
expressed  resulting  in  the  same  pigment  class  which  results  in  dichromacy  (i.e.,  
the  absence  of  red-­‐green  colour  discrimination).      
 
22.  The  proximity  of  red  and  green  cone  genes  in  the  array  facilitates  genetic  
mutations  and  hence  the  production  of  variant  pigments.  The  small  wavelength  
separation  in  peak  spectral  responsivity  of  red  (L)  and  green  (M)  cones  (28-­‐30  
nm)  means  that  even  moderate  shifts  in  peak  wavelength  sensitivity  may  cause  
significant  changes  in  red-­‐green  colour  vision.    
 
23.  The  red  and  green  cone  pigment  genes  are  carried  on  the  X  chromosome  
hence  their  expression  can  be  expected  to  differ  in  males  and  females.  In  females  
there  are  two  of  these  chromosomes  and,  provided  one  is  fully  functional,  red  
and  green  pigments  will  be  produced.  If  the  cone  pigment  genes  on  the  first  
chromosome  produce  only  red  cone  pigment  and  the  second  chromosome  only  
green  pigment,  functionally  normal  colour  vision  will  result  although  the  relative  
numbers  of  red  and  green  cones  may  differ  significantly  from  the  2:1  ratio  
observed  in  those  with  normal  trichromatic  vision.    
 
24.  Males  only  have  one  X  chromosome  and  so  if  both  cone  pigment  genes  in  the  
array  specify  the  same  pigment  type  there  will  be  complete  loss  of  red-­‐green  
colour  vision.  If  one  of  the  first  two  cone  pigment  genes  specifies  a  variant  
pigment  of  the  same  class,  the  subject  will  have  reduced  (anomalous)  chromatic  
sensitivity.  It  is  for  this  reason  that  deficiencies  are  much  more  frequent  in  
males.      
 
25.  The  separation  between  the  spectral  sensitivity  peak  of  blue  (S)  cones  and  
green  (M)  and  red  (L)  cones  is  large  (up  to  130nm)  and  so  anomalous  variants  of  
blue  pigments  are  unimportant.  Deficiency  of  this  pigment  is  very  rare.  The  
majority  of  deficiencies  in  blue  perception  are  therefore  linked  to  acquired  
colour  deficiency  (i.e.  a  loss  of  chromatic  sensitivity  caused  by  age-­‐related  eye  
disease).      
 
Acquired  loss  of  chromatic  sensitivity  
 
26.  The  ability  to  discriminate  or  see  small  colour  differences  can  be  affected  
severely  by  diseases  of  the  retina  and  the  visual  pathways.    Eye  disease  is  
associated  with  loss  of  both  yellow/blue  and  red/green  discrimination  and  in  
older  people  this  can  be  an  even  more  important  contributor  to  colour  vision  
deficiency  than  congenital  deficits.  Figure  2  shows  the  contribution  of  various  
conditions  to  the  increased  colour  thresholds.  The  subjects  were  all  refracted  
appropriately.  Small  amounts  of  refractive  error  do  not  affect  the  CAD  test  
results.  Traditional  yellow/blue  colour  vision  has  been  considered  less  relevant  
in  safety  critical  jobs.    The  relatively  recent  introduction  of  blue  LED-­‐based  signal  
lights  and  the  extensive  use  of  yellow  and  blue  colours  on  modern  visual  displays  

  10  
  

means  that  yellow/blue  colour  vision  loss,  usually  from  acquired  deficiency,  has  
now  become  an  important  part  of  colour  vision  assessment  for  some  safety  
critical  tasks.    
 
 

40
RG thresholds

30

20

10

0
0 10 20 30 40 50 60 70 80 90

8
RG thresholds

6
4
2
0
0 10 20 30 40 50 60 70 80 90
Age (yrs)

Figure 2. The upper graph shows CAD thresholds measured in 393 subjects who attended an
optometric clinic for routine refraction and eye checks (See paragraph 42 for explanation of CAD
thresholds and units). Acquired red/green deficiency is important and not uncommon in older
subjects. The lower graph shows the remaining ‘normal’ eyes after excluding the following
conditions:
• Subjects with congenital colour deficiency (i.e. elevated RG thresholds and ‘normal’ YB)
• Subjects with medical conditions such as diabetes, hypertension and ocular abnormalities
• Subjects with abnormal fundus appearance or drusen
• Subjects with statistically significant differences (in either RG or YB or both) between the two
eyes.16
 
 

  11  
  

 
 
Effects  of  normal  aging  on  red-­‐green  and  yellow-­‐blue  colour  vision  
 
27.  Colour  perception  sensitivity  declines  with  age  (Figure  3).  This  occurs  even  
in  the  absence  of  other  eye  disease.15  The  effects  of  normal  aging  on  RG  and  YB  
colour  sensitivities  are  relevant  to  the  frequency  of  testing  and  to  which  forms  of  
test  are  most  effective  at  identifying  those  with  safety  critical  deficiencies,  
especially  later  in  their  careers  when  eye  disease  is  likely  to  be  more  frequent.  
 

 
 
 

 
 
Figure  3:  RG  (A)  and  YB  (B)  binocular  thresholds  as  a  function  of  age  for  the  normal  trichromats  
examined  in  the  study  and  deemed  to  reflect    the  effects  of  normal  aging  on  colour  vision  (See
paragraph 42 for explanation of CAD thresholds and units)  The  filtered  results  show  significant,  but  
relatively  uniform  variability  and  only  a  gradual  increase  in  colour  thresholds  as  a  function  of  
age.    black  dashed  lines  in  sections  A  and  B  describe  how  normal  aging  affects  colour  vision  and  
the  corresponding  dotted  lines  above  and  below  the  mean  represent  the  ±2.5σ  limits.  15    
[Koenker’s  test  for  heteroscedasticity  carried  out  for  data  points  within  age  range  35  to  75  years  
confirmed  this  observation  (Ho-­‐true,  p=0.224,  n=270).17    
The  mean  binocular  thresholds  as  a  function  of  age  are  given  by:    
RGbin  =  0.698  +  0.0121*age  +3.373*exp  (-­‐0.19*age)  and  YBbin  =    0.24  +  0.0218*age  +2.99*exp  (-­‐
0.1136*age).  ]    

  12  
  

 
 
 
 
 
Characteristics  of  colour  vision  test  methods  
 
28.  Most  currently  used  colour  vision  tests  aim  to  detect  red/green  deficiencies  
because  of  their  high  frequency  and  functional  importance.  Some  tests  produce  a  
measure  of  the  severity  of  colour  vision  loss  but  the  majority  use  arbitrary  cut  off  
points  as  the  basis  for  determining  the  presence  or  absence  of  colour  vision  
deficiency.    
 
Ishihara  plates  
 
29.  The  most  widely  used  test  is  the  Ishihara  book  of  plates  (IH).  The  plates  
improve  the  identification  of  colour  vision  deficiencies  by  using  several  different  
approaches  such  as  confusion  between  and  disappearance  of  digits  as  well  as  
digit  recognition  and  trail  following.  The  number  of  plates  the  subject  fails  to  
read  correctly  does  not,  however,  provide  a  reliable  indication  of  the  severity  of  
red/green  colour  vision  loss.18  When  applied  correctly  some  19%  of  normal  
trichromats  and  almost  all  colour  deficient  observers  (98%  of  deutan  (green  
deficient)  and  99%  of  protan  (red  deficient)  subjects)  fail  one  or  more  plates  on  
the  Ishihara  test  (Figure  4).19    These  findings  are  confirmed  from  a  number  of  
studies  on  occupational  populations  (Table  2).  
 
 
  1
Probability of making k or less errors

  Color Vision Class

  0.8 normal (n=236)
  deutan (n=340)
protan (n=166)
 
  0.6
 
  0.4
 
 
  0.2
 
  0
  0 6 12 18 24
 
k, number of errors on the Ishihara test
Figure  4.  The  probability  of  
making  (k)  or  less  errors  when  reading  the  numerals  on  the  Ishihara  test  plates  plotted  for  a  
group  of  normal  trichromats  and  for  subjects  with  congenital,  deutan  and  protan  colour  
deficiency.  The  order  of  presentation  was  random  for  the  remaining  24  plates  of  the  Ishihara  38-­‐
plate  test.  16    
 

  13  
  

 
Table  2.  Data  showing  the  percentage  of  subjects  within  each  colour  vision  class  that  pass  the  
Ishihara  test  for  the  different,  currently  accepted  testing  protocols  within  the  listed  professional  
environments.  The  subject  groups  represent  random  samples  that  reflect  normal  (N),  deutan  (D)  
and  protan  (P)  colour  vision  classes.  The  samples  do  not  represent  the  distribution  of  colour  
deficiency  within  any  occupational  population.      
Before  the  introduction  of  the  CAD  test  the  CAA  (UK  Civil  Aviation  Authority)  used  both  the  38  
and  the  24  plate  editions  to  screen  for  pilots  and  air  traffic  controllers.    JAR  guidelines  (for  
European  commercial  pilots)  allow  for  the  use  of  the  first  24  plates  of  the  38  plate  edition.    The  
USA  Federal  Aviation  Administration  (FAA)  also  use  the  38  plate  edition,  but  only  use  21  plates.  
In  addition,  the  FAA  also  allow  a  number  of  other  different  tests.  Currently,  TfL  (Transport  for  
London)  use  only  the  CAD  test.  Fire  service  applicants  are  tested  at  City  University  using  the  CAD  
test.  20  
 
 
24
 
 
 
No. of errors / subject

18
 
 
 
12  
 
Colour Vision Class  
6 normal
deutan
 
protan  
 
0  
0 5 10 15 20 25
RG sensitivity (CAD units)

 
Figure  5.  The  number  of  errors  made  by  each  subject  on  the  Ishihara  test  plotted  against  the  
subject’s  RG  threshold  (measured  in  Standard  Normal  (SN)  CAD  units.  Data  are  shown  for  normal  
trichromats  (grey  diamonds),  deutan  (green  discs)  and  protan  (red  squares)  subjects.  19  
 
30.  The  frequency  of  errors  on  Ishihara  plates  can  be  compared  with  the  grading  
of  severity  of  colour  vision  loss  using  more  accurate  tests  for  colour  thresholds  
(such  as  the  CAD  test,  paragraphs  42-­‐44).  This  shows  only    a  weak  correlation  

  14  
  

between  the  number  of  plate  errors  made  and  the  severity  of  the  deficiency  
(Figure  5).  
 
It  can  be  seen  that  if  no  errors  on  the  Ishihara  test  are  allowed  almost  all  those  
with  congenital  colour  deficiency  fail,  but  19%  of  normal  trichromats  also  fail.  By  
contrast  if  2  or  less  errors  are  accepted  more  normal  trichromats  pass  although  
in  order  to  pass  all  normals  one  needs  to  allow  4  or  less  errors.  This  error  score    
also  passes  10%  of  deutan  subjects  and  1%  of  protans.  
 
 
   Classification  of  class  of  colour  vision  using  Ishihara   Table  3.  Ishihara  test  (1  to  25  
Normals   Deutans                 Protans           Tritans   plates),  all  plates  read  correctly,  in  
  (n=340) (n  =  343) (n=169) (n=3) 855  subjects  (Normals  (340),  
%  classified  as   Deutans  (343),  Protans  (169  and  
81 1 0 100
normal Tritans  (3).  Note  that  this  plate  test  
%  classified  
19 99 100 0
does  not  test  for  yellow-­‐blue  loss,  
with  CCD hence  the  tritan  subjects  are  
%  classified  as   unclassified.      
0 62 6 0
deutan The  results  show  that  the  test  yields  
%  classified  as   poor  classification  with  only  62%  and  
0 0 48 0
protan 48%  classified  correctly  as  deutan  
%  classified  as  
19 38 46 0 and  protan,  respectively.  
indeterminate
Interestingly,  19%  of  normals  are  
%  classified  as  
0 0 0 0 classed  as  defective  and  unclassified  
tritan
whilst  6%  of  protans  are  classified  as  
deutan.  (CCD  –  congenital  colour  deficienciy)  
 
 
31.  The  Ishihara  isochromatic  plate  test,  when  used  as  a  screening  test,  has  the  
advantage  of  ease  of  use  and  low  cost,  but  the  test  lacks  specificity  if  sensitivity  is  
to  remain  high  and  also  fails  to  diagnose  accurately  the  class  of  deficiency  
involved.  Table  3  shows  the  classification  for  normal,  deutan,  protan  and  tritan  
subjects  based  on  the  Ishihara  test.  Use  of  this  test  as  the  sole  criterion  for  
suitability  for  navigational  lookout  duties,  if  no  incorrect  readings  are  accepted,  
means  that  a  number  of  those  with  normal  colour  vision  are  denied  employment,  
whereas  if  some  errors  are  accepted,  as  seen  in  Figure  5,  not  all  those  with  
colour  vision  loss  will  be  correctly  identified.  
 
32.  Because  of  these  characteristics  neither  Ishihara  nor  other  pseudo-­‐
isochromatic  plate  based  tests  can  be  optimised  for  use  as  a  single  definitive  test  
for  fitness  to  undertake  navigational  lookout  duties,  which  will  ensure  suitability  
without  denying  some  of  those  tested  employment.  It  is  for  this  reason  that  a  
second  ‘confirmatory’  test  is  needed  for  those  who  do  not  achieve  the  criterion  
set  for  the  Ishihara.  The  criterion  currently  set  for  the  Ishihara  by  MCA  will  
reliably  let  almost  all  of  those  with  normal  colour  vision  pass,  but  will  fail  to  
detect  some  of  those  with  deficiencies  in  red/green  colour  vision  (Figure  5  
shows  the  frequency  and  severity  of  reductions  in  colour  threshold  that  will  
arise  from  acceptance  of  different  numbers  of  Ishihara  plate  errors).  This  latter  
group  will  avoid  further  scrutiny,  but  like  others  at  the  borderline  of  normal  
vision  they  are  more  likely  to  make  errors  when  repeat  Ishihara  tests  are  done  as  
part  of  their  statutory  two  yearly  medicals.    The  significance  of  such  deficiencies  
as  predictors  of  errors  during  lookout  duties  is  not  established.  The  inability  of  

  15  
  

the  Ishihara  test  to  be  used  to  determine  the  severity  or  nature  of  deficiencies  
has  only  become  apparent  as  a  result  of  recent  studies  undertaken  since  the  
current  MCA  test  protocols  were  reviewed  in  1998.  
 
8  
 
 
 
 
 
Figure  6.  Photograph  showing  vertical  section  through  Ishihara  test  plate  2  
(which  displays  number  8).  Learning  experiments  carried  out  with  black  and  
white  photocopies  of  the  IH  test  plates  show  that  within  two  hours  a  subject  can  
learn  to  make  use  of  the  spatial  distribution  and  size  of  dots  along  either  the  
vertical  or  horizontal  sections  of  the  circumference  to  pass  with  less  than  two  
errors.      
 
 
 
 
 
 
 
 
 
 
33.  The  Ishihara  and  other  plate  tests  require  appropriate  illumination  and  
correct  presentation  and  recording  of  results  plate  by  plate,  as  well  as  a  method  
of  use  that  avoids  conscious  or  unconscious  prompting.  As  the  pattern  of  dots  at  
the  margin  on  some  plates  can  provide  candidates  with  non-­‐colour  related  clues  
that  can  be  learnt,  examiners  need  to  closely  observe  the  behaviour  of  those  
tested  (Figure  6).  It  is  possible  that  testing  in  poorly  standardised  clinical  
settings  may  not  give  the  same  level  of  reliability  as  that  obtained  during  
carefully  controlled  research  studies.    
 
The  Holmes-­‐Wright  Lanterns  (see  Appendix  2)  
 
34.  The  current  confirmatory  test,  the  HW-­‐B  lantern,  is  used  only  on  a  group  of  
people  pre-­‐selected  because  they  have  not  met  the  criteria  set  for  the  Ishihara  
test.  The  HW-­‐B  lantern  design  was  based  on  assumptions  about  the  luminous  
intensity  of  ship  navigation  lights  at  a  distance  of  two  miles,  thus  it  is  to  an  extent  
a  ‘trade  test’  rather  than  one  that  is  derived  from  studies  of  visual  performance.  
It  is,  however,  a  demanding  test  that,  when  used  according  to  the  current  MCA  
protocol,  fails  over  10%  of  normal  trichromats  and  all  subjects  with  congenital  
colour  deficiency.  This  is  discussed  in  paragraph  47  where  the  relevance  of  this  
to  multi  stage  test  protocols  is  reviewed.  It  follows  that  an  applicant  with  mild  
congenital  loss  of  colour  vision  or  a  subject  with  normal  trichromatic  vision  but  
with  poorer  RG  colour  sensitivity  is  more  likely  to  pass  the  Ishihara  test  plates  
than  the  HW-­‐B  confirmatory  test.    The  variability  in  repeat  HW-­‐B  tests  is  also  
high.  The  more  widely  used  Holmes-­‐Wright  A  lantern  (HW-­‐A)  has  a  larger  

  16  
  

aperture  than  the  HW-­‐B  but  similar  colour  characteristics:  all  normal  
trichromats  pass,  1%  of  protans  and  22%  of  deutans  also  pass  (see  Figure  7).  
 

Figure  7.  Ranked  RG  thresholds  (CAD  units)  for  226  deutan  subjects  investigated.  Each  subject  
was  also  tested  on  the  HW-­‐A  lantern  using  the  CAA  protocol.      
   
 
35.  Both  HW  lanterns,  at  a  viewing  distance  of  6m  with  aperture  diameters  of  
0.87’(type  A)  and  0.3’  (type  B),  tend  to  produce  close  to  ‘diffraction  limited’  
images.  The  total  light  flux  captured  by  the  eye  and  hence  the  perceived  
brightness  of  a  diffraction-­‐limited  image  is  proportional  to  the  reciprocal  of  the  
square  of  the  distance  between  the  signal  lights  and  the  eye.    The  larger  size  
aperture  in  type  A  causes  an  almost  10-­‐fold  increase  in  light  intensity  and  as  a  
result  the  applicant  finds  it  easier  to  name  the  correct  colours.  This  is  the  
equivalent  of  a  reduction  in  the  distance  at  which  the  same  intensity  signal  light  
would  be  seen  from  2  to    0.63  miles.  The  correlation  between  the  HW-­‐A  and  HW-­‐
B  lanterns  is  discussed  at  paragraph  50  where  this  is  discussed  in  relation  to  
sequential  test  protocols.    
 
36.  The  HW-­‐A  lantern  is  used  in  other  modes  of  transport  such  as  aviation  there  
is  much  more  detailed  information  on  its  performance  than  on  that  of  HW-­‐B.  
This  is  because  users  in  the  aviation  and  rail  industries  have  funded  extensive  

  17  
  

investigations  of  its  performance,  but  similar  studies  have  not  been  done  for  the  
HW-­‐B,  which  is  used  only  in  the  maritime  sector.    
 
Other  lanterns  
 
37.  A  number  of  other  lanterns  are  or  have  been  in  use  such  as  the  Farnsworth  
lantern  (Fallant),  the  Fletcher  CAM,  the  ALT  (FAA  Aviation  Lights  Test:  Figure  8)  
and  the  Beyne.  The  ALT  lantern  is  a  modified  version  of  the  Farnsworth  lantern  
using  filters  that  bring  it  more  in  line  with  the  HW-­‐A  lantern.  The  pass  /  fail  rates  
on  the  ALT  lantern  are  also  very  similar  to  the  HW-­‐A  lantern.  The  Fletcher  CAM  
is  designed  to  mimic  the  HW-­‐A  and  –B  lanterns,  but  has  proved  not  to  be  
satisfactory  in  use.  Lanterns  can  differ  in  terms  of  their  intensity,  aperture  size  
and  whether  their  filters  provide  the  same  spectral  output,  as  opposed  to  similar  
chromaticities.    For  instance,  the  Falant  lantern  employs  a  2.54mm  aperture  
viewed  from  8  feet  (~  2.44m).  The  angle  subtended  by  image~  3.58’;  this  means  
that  the  aperture  is  resolved  by  the  great  majority  of  subjects  and  images  are  not  
diffraction  limited  but  are  seen  to  have  a  finite  size.  These  parameters  and  the  
protocol  employed  significantly  affect  the  outcome  in  terms  of  passes  /  failures.  
A  systematic  review  of  the  published  data  on  the  performance  of  lanterns  has  
recently  been  completed.21  Several  lanterns  are  currently  are  out  of  regular  
production  and  have  problems  with  quality  assured  servicing.  Therefore  further  
comparisons  are  not  needed.    
 
   
Figure  8.  Photograph  
showing  the  ALT  
lantern  with  vertical  
pairs  of  colours  very  
similar  to  those  
produced  by  the  HW-­‐
Aviation Lights Test (ALT) A  lantern.    
 
lantern  
 
 
 
Other  established  test  methods  
 
38.  Some  countries  use  other  test  methods  as  confirmatory  tests  such  as  the  
Nagel  anomaloscope  test  (Figure  9).    This  instrument  can  provide  valid  data  on  
the  relative  sensitivity  of  the  eyes  to  red  and  green  light,  but  neither  the  match  
midpoint  nor  the  size  of  the  red/green  matching  range  (MR)  provide  reliable  
information  on  the  severity  of  colour  vision  loss.22  This  test  is  an  accepted  
alternative  to  the  HW-­‐B  lantern  in  CIE  143:2001.    The  anomaloscope  is  however  
a  costly  optical  instrument  and  requires  maintenance  and  a  skilled  operator  in  
order  to  obtain  reliable  and  reproducible  results.    
 
 
 
 

  18  
  

 
Yellow (589nm) field  
 
 
 
R (671 nm) & G (546 nm)  
 
 
 Figure  9.  The  Nagel  anomaloscope  presents  a  split  field  stimulus  (usually  2  degrees  in  
diameter).  This  shows  a  monochromatic  yellow  light  and  a  red  /  green  mixture  field.  The  
subject’s  task  is  to  adjust  the  red/green  mixture  to  match  the  monochromatic  yellow  field.  A  
normal  trichromat  accepts  only  a  small  range  of  red  /  green  mixtures  as  matches  to  the  yellow.  In  
those  with  colour  deficiencies  the  match  points  differ  and  the  matching  range  may  be  wider.  
However  some  of  those  with  unusual  genetic  mutations  can  produce  matching  ranges  and  match  
midpoints  that  fall  within  the  normal  range.23  In  addition  differences  in  the  optical  density  (i.e.,  
the  amount  of  visual  pigment)  between  L  and  M  cones  can  also  produce  significant  shifts  in  
match  midpoint,  even  when  the  subjects  have  excellent  red  /  green  chromatic  sensitivity,  but  
may  not  be  able  to  make  completely  normal  matches  
 
 
39.  CIE  143:2001  makes  provision  for  the  use  of  a  second  plate  test  as  an  
alternative  confirmatory  test  when  IH  is  failed.  Most  other  plate  tests  are  not  as  
well  validated  as  the  IH,  although  some  such  as  the  Hardy,  Rand  and  Rittler  
(HRR),  which  overall  has  a  lower  sensitivity  than  IH,  do  have  advantages  such  as  
a  format  that  makes  memorisation  of  the  plates  more  difficult  and  an  ability  to  
identify  yellow/blue  as  well  as  red/green  deficiencies.  
 
40.  The  Farnsworth  D  15  test  is  commonly  used  for  those  with  less  demanding  
colour  vision  tasks  than  navigational  lookout,  but  some  countries  use  it  for  
selection  for  these  duties.  It  is  less  sensitive  and  will  pass  a  proportion  of  those  
with  a  significant  loss  of  colour  discrimination  (Table  4)  
 
  D15  analysis
  %  of  subjects  
  P F that  pass
  N(81) 81 0 100%
  D(232) 136 96 59%
    P(93) 48 45 52%
 
Table  4:  Pass  and  failure  rates  on  Farnsworth  D  15  test  for  those  with  normal  colour  vision  (N),  
deutans  (D)  and  protans  (P),  showing  its  low  sensitivity  for  detection  of  colour  vision  deficiency.  
 
 
 
 
 
Screen  based  tests  
 
41.  Several  screen-­‐based  tests  have  been  developed  and  marketed  for  
occupational  colour  vision  assessment  in  recent  years.    
 
 

  19  
  

 
The  CAD  Test  
 
42.  The  best-­‐validated  and  most  widely  available  screen-­‐based  test  in  the  UK  is  
the  Colour  Assessment  and  Diagnosis  (CAD)  test.24  The  test  is  based  on  findings  
from  camouflage  studies  and  makes  use  of  dynamic  luminance  contrast  noise  to  
isolate  fully  the  use  of  RG  and  YB  colour  signals  (Figure  10).  The  CAD  test  has  
been  shown  to  provide  identifiable  thresholds  that  closely  correspond  to  those  
in  current  use  for  HW-­‐A  lanterns  in  aviation  (Figure  7).25    The  CAD  test  has  the  
ability  to  diagnose  accurately  the  subject’s  class  of  colour  deficiency  and  to  
quantify  the  severity  of  colour  vision  loss.    It  also  separates  those  with  normal  
trichromatic  vision  from  those  with  any  form  of  deficiency  (Figure  11).  
 
 
 
Figure  10:  The  CAD  test  screen.  A  flickering  image  
is  presented,  through  which  move  blocks  of  varying  
colours.  The  person  being  tested  has  to  identify  the  
direction  of  travel  of  the  coloured  blocks.  The  
colour  intensities  are  then  adjusted  depending  on  
the  subject’s  response  accuracy  and  this  allows  the  
thresholds  for  detection  of  each  colour  to  be  
determined.  
 
 
 
 
 
 
 
 
  2
6
 
normal
1 deutan  
YB (CAD units)

4 protan  
0  
0 1 2 3  
2  
 
  0
  0 6 12 18 24
    RG (CAD units)
 
Figure  11.  CAD  red  /  green  and  yellow  /  blue  thresholds  for  normal  trichromats  (black  symbols),  
deutan  (green  symbols)  and  protan  (red  symbols).  The  inset  shows  a  magnified  region  of  the  full  
graph  to  show  the  clear  separation  between  normal  trichromats  and  subjects  with  acquired  
colour  deficiency.  
 
43.  Performance  is  measured  in  CAD  Units  (Figure  12).  These  units  are  derived  
from  population  studies  and  one  unit  represents  the  average  signal  level  needed  
for  colour  perception  in  a  young  observer  (15-­‐35)  as  their  colour  discrimination  
is  tested  in  both  red/green  and  yellow/blue  axes.    This  approach  makes  it  easy  to  

  20  
  

quantify  and  understand  the  severity  of  colour  vision  loss.    The  CAD  test  uses  
commercial  software  and  should  be  used  with  a  high  quality  monitor  with  full  
spectral  and  luminance  calibration.    The  output  display  provides  a  clear  
summary  of  the  results  and  their  implications  for  the  task  being  tested  for  
(Figure  13).  
 
 
Normal trichromat Figure  12.  Example  of  CAD  test  results  for  a  young,  
RG=0.73, YB=1.24 normal  trichromat.  The  results  are  expressed  in  
0.35
CAD  units  and  are  plotted  on  the  standard  CIE  
Chromaticity  chart.  One  CAD  unit  describes  the  
0.34 colour  signal  strength  at  threshold  for  young  
normal  trichromats  obtained  by  averaging  the  
0.33 thresholds  measured  in  333  subjects.    The  data  
obtained  in  this  way  also  provide  statistical  limits  
y that  define  variability  within  normal  trichromatic  
0.32 vision.  These  limits  are  indicated  by  the  grey  
shaded  area  bounded  by  the  ellipses.  The  centre,  
0.31 black-­‐dotted  ellipse  shown  the  median  threshold  
which  define  the  RG  and  YB  CAD  limits.  A  subject  
with  a  threshold  of  3  CAD  units  requires  a  three  
0.3 times  larger  colour  signal  strength  when  compared  
0.28 0.29 0.3 0.31 0.32 0.33
to  the  median,  normal  young  observer.  Data  
x
Standard Normal Observer
showing  the  effect  of  normal  aging  on  RG  and  YB  
thresholds  (as  measured  with  the  CAD  test)  are  
RG=1.0, YB=1.0
shown  in  Fig.  3    
 
 
 
Figure  13.  CAD  output  
window  showing  the  
applicant’s  RG  and  YB  
threshold.  (C.  Jordan  is  a  
pseudonym)The  
horizontal,  grey  bars  on  
the  left  (under  
Certification)  show  the  
limits  of  the  normal  range  
for  the  applicant’s  age,  
together  with  the  
measured  thresholds.    The  
centre  dots  show  the  
actual  thresholds  
measured  along  the  RG  
and  YB  colour  directions.  
The  graph  provides  a  full  
summary  of  the  results  of  
the  CAD  test.  Instructions  
on  testing  procedures  are  
included  with  the  majority  
of  Menu  functions.  .Pass  /  fail  outcome  based  on  task  specific  criteria  are  also  provided  for  some  
working  environments.        
 
 
 

  21  
  

44.  The  calibration  of  the  display  needs  periodic  checking,  usually  every  six  
months,  and  the  photometer  then  recalibrates  the  display  automatically.    The  
test  does  not  require  dark  adaptation.  The  test  starts  with  a  learning  period,  
usually  taking  less  than  one  minute.  For  occupational  use  this  is  followed  with  
the  Rapid  Screening  option  which  tests  for  both  RG  and  YB  colour  vision  in  just  
over  one  minute.  When  the  age-­‐corrected  version  of  the  CAD  test  is  used  ~  95%  
of  normal  trichromats  pass  and  all  congenital  colour  deficient  fail  (~  8%).    Hence  
~  12.6  %  of  applicants  will  require  the  full  RG  CAD  test,  taking  around  ten  
minutes,  when  first  investigated.  The  YB  test  takes  around  3  minutes  to  
complete.  The  results  of  the  full  CAD  test  (RG  and  YB)  define  the  applicant’s  class  
of  colour  vision  (i.e.,  normal  trichromacy,  deutan-­‐,  protan-­‐  or  tritan-­‐like  
deficiency  of  congenital  origin).  In  addition  the  test  also  identifies  acquired  loss  
of  colour  vision  and  quantifies  the  severity  of  colour  vision  loss.      
 
The  Cambridge  Colour  Test  (CCT)    
 
45.  The  CCT  employs  static  noise  to  isolate  the  use  of  colour  signals  and  in  this  
respect  is  similar  to  the  Ishihara  and  /  or  the  American  Optical  HRR  test,  except  
for  the  use  of  a  black  and  not  a  white  background  (Figure  14).    The  test  measures  
unidirectional  colour  thresholds  along  the  three  colour  confusion  axes  or  
chromatic  detection  ellipses  (Figure  15).    This  test  has  mainly  been  used  in  
research  studies  and  has  not  been  validated  in  large  scale  studies  for  
occupational  fitness  assessment.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure  14:  Examples  of  CCT  test  images  displaying  a  Landolt  ring  made  up  of  coloured  discs  of  
varying  luminance.  The  subject’s  task  is  to  indicate  the  orientation  of  the  gap.  26  
 
 

  22  
  

Figure  15:    Unidirectional  thresholds  measured  using  the  Cambridge  Colour  Test  along  colour  
directions  that  correspond  to  the  colour  confusion  axes  of  deutan,  protan  and  tritan  observers.  
The  thresholds  were  measured  in  subjects  with  normal  trichromatic  vision  and  are  plotted  as  a  
function  of  age.  The  threshold  is  measured  as  a  displacement  away  from  background  
chromaticity  in  the  CIE  –  (u’  v’)  chromaticity  chart.    
 
 
Cone  Contrast  Sensitivity  Test  and  Conan  DX  
 
46.  Two  other  tests,  the  Cone  Contrast  Sensitivity  Test  (CCST)  and  the  Conan  DX  
have  been  assessed  in  smaller  groups  of  USA  military  flight  crew  but  not  more  
widely.27  28  The  cone  contrast  test  aims  to  isolate  and  assess  L,  M  and  S  cones  
separately,  however  as  discussed  in  paragraphs  20-­‐25  this  is  a  complex  task  in  
subjects  with  congenital  colour  deficiency.  The  Conan  DX  test  is  similar  to  the  
CCT  and  Ishihara  in  that  coloured  numbers  are  produced  as  dots  that  vary  
randomly  in  luminance  so  as  to  minimise  the  use  of  luminance  contrast  in  
reading  the  numbers,  particularly  when  colour  deficient  subjects  are  involved.    
Both  tests  have  the  advantage  of  lower  initial  purchase  cost  compared  with  the  
CAD  and  CCT  tests,  but  the  limited  validation  data  on  the  performance  of  these  
two  tests  as  well  as  the  CCT  makes  them  unsuitable  for  adoption  at  present.  A  
programme  involving  a  large  amount  of  assessment  in  a  wider  range  of  
populations  as  well  as  comparisons  with  other  test  methods  is  needed  before  
they  can  be  considered.  This  would  take  some  years  and  considerable  resources.      
 
 
Testing  protocols  and  use  of  sequential  tests  
 
47.  Test  protocols  should  be  based  on  information  about  the  characteristics  of  
the  available  test  methods.  Each  test  can  be  reviewed  on  its  own  (Table  5),  but  a  
more  useful  analysis  for  the  purposes  of  this  review  is  to  compare  the  
performance  of  those  who  pass  and  those  who  fail  the  MCA  Ishihara  testing  
protocol  on  other  tests  (Figures  16-­‐18,  paragraphs  49,  50).  
 

  23  
  

Sample  statistics  -­‐  subjects  that  took  HW-­‐A  and  HW-­‐B  lanterns  and  other  tests  
Sample  size  (116)      
%  pass  I H   %  pass   %  pass   %  Nagel   %  pass  CAD  
Males  (104)         N
Females  (12) (<3  errors) HW-­‐A HW-­‐B (MR<9) (RG)
Normal  trichromats 38 100 100 87 100 100
Deutan 49 6 33 0 55 0
Protan 26 0 4 0 12 0
Acquired 3 100 100 67 100 0  
 
Table  5.    Comparison  of  outcome  using  Ishihara,  HW-­‐A,  HW-­‐B,  Nagel  and  CAD  tests.    116  subjects  
were  investigated  using  the  Ishihara  tests  (using  plates  1  to  25).    
 
48.  However,  no  test  will  be  a  fully  reproducible  substitute  for  any  other  test  as  it  
will  be  performed  in  different  conditions  of  lighting  and  will  also  frequently  
assess  different  uses  of  colour  signals.  For  instance  a  screen-­‐based  test,  such  as  
the  CAD,  will  be  free  from  confounding  factors  such  as  test  stimulus  reflectance,  
changes  in  the  spectral  power  distribution  of  the  illuminants,  aperture  size,  
acuity  limits,  state  of  dark  adaptation  or  ability  to  name  colours.  In  spite  of  these  
advantages,  screen-­‐based  tests  will  not,  however,  reproduce  some  of  the  
subsidiary  features  of  a  ‘trade  test’  such  as  HW-­‐B.  These  differences  in  outcome  
will  also  apply  to  related  test  methods.  As  
a  result,  even  lantern  tests  that  have  been  
designed  to  mimic  the  properties  of  the  
HW  lanterns  (e.g.,  ALT  and  CAM  lanterns)  
do  not  give  identical  results.  
 
Figure  16:    Percentage  Ishihara  test  error  scores  
(using  plates  1  to  25)  plotted  against  the  subject’s  
RG    CAD    117  subjects  were  investigated  (Normal  
=  45;  Deutan  =  46  ;  Protan  =  26).  The  green  
symbols  show  subjects  with  less  than  3  errors.    
Subjects  with  3  or  more  errors  are  shown  in  
black.  72  subjects  failed  with  3  or  more  errors      
Subsequent  figures  use  this  population  to  explore  
the  comparability  of  different  confirmatory  tests.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

  24  
  

Figure  17:  Performance  of  those  who  passed  (green  circles)  and  those  who  failed  MCA  Ishihara  
protocol  on  HW-­‐A  and  HW-­‐B  lanterns,  with  reference  to  CAD  thresholds.  It  can  be  seen  that,  
while  HW-­‐A  errors  are  rare  in  those  who  pass  the  Ishihara  there  is  a  significant  failure  rate  on  
HW-­‐B  for  those  who  pass  Ishihara  and  have  minimal  loss  of  CAD  threshold.  
 
 
Figure  18:  Comparison  of  HW-­‐A  and  HW-­‐B  
results  in  those  who  passed  and  those  who  
failed  MCA  Ishihara  protocol.  This  indicates  
that,  while  the  error  rate  on  HW-­‐A  is  
compatible  with  that  from  Ishihara,  the  HW-­‐B  is  
a  considerably  more  demanding  test  and  has  a  
higher  rate  of  misclassification.    If  the  
misclassification  of  those  who  have  normal  
colour  vision  and  the  mild  deutans  who  pass  
the  MCA  Ishihara  protocol  by  the  HW-­‐B  is  
discarded  then  the  results  of  the  two  tests  are  
comparable.  
 
 
 
 
 
49.  The  implications  of  sequential  testing  and  its  results  using  different  
confirmatory  tests  are  shown  in  Figures  16-­‐17.  The  CAD  RG  threshold  is  used  for  
reference  in  Figures  15  and  16.  Figure  18  shows  the  correlation  between  HW-­‐A  
and  HW-­‐B  lanterns.  The  results  are  of  interest  since  they  also  show  that  normal  
and  mild  deutan  subjects  that  pass  HW-­‐A  can  end  up  with  HW-­‐B  error  scores  in  
the  range  0  to  30%.      
 
50.  The  correlation  between  the  HW-­‐A  and  HW-­‐B  error  scores  is  consistent  for  
applicants  who  pass  using  the  MCA  Ishihara  protocol  (HW-­‐B  results  can  be  
predicted  well  from  subject’s  HW-­‐A  results:  HW-­‐B  (%  error  score)  =  27.502778  
+  0.6491888*HW-­‐A    (r2  =  0.72).  The  intercept  shows  that  on  average  the  subject  
makes  27%  more  errors  on  the  HW-­‐B  lantern.  The  latter  is  a  demanding  test  
which  according  to  the  current  MCA  protocol  fails  just  over  ~  10  %  of  normal  
trichromats  and  all  subjects  with  congenital  colour  deficiency.    It  follows  that  an  
applicant  with  mild  congenital  loss  of  colour  vision  or  a  subject  with  normal  
trichromatic  vision  but  with  poorer  red/green  colour  sensitivity  is  more  likely  to  
pass  the  IH  test  plates  than  the  HW-­‐B  confirmatory  test.    The  variability  in  repeat  
lantern  tests  is  also  high.  The  consistency  of  the  gradient  between  HW-­‐A  and  
HW-­‐B  results,  once  the  intercept  caused  by  the  over-­‐sensitivity  and  
misclassification  when  using  HW-­‐B  is  discarded,  means  that  correlation  data  
from  the  extensive  cross-­‐validation  studies  between  HW-­‐A  and  CAD  can  be  used  
to  provide  valid  indicators  of  the  degree  of  comparability  between  HW-­‐B  and  
CAD  results.  
 
51.  Any  two  stage  process  will  only  be  effective  at  correctly  identifying  those  
with  colour  vision  deficiencies  if  the  threshold  for  the  initial  screening  test  is  set  
at  such  a  level  that  all  such  deficiencies  are  identified.  For  Ishihara  this  means  
using  zero  plates  incorrectly  read.  However  a  consequence  of  this,  as  distinct  
from  the  current  MCA  practice  of  accepting  a  small  number  of  incorrect  readings,  

  25  
  

will  be  that  a  larger  number  of  those  with  normal  colour  vision  are  referred  for  
confirmatory  testing.  The  present  protocol  does  result  in  some  of  those  with  
colour  deficiencies,  although  in  the  main  those  with  relatively  minor  levels  of  
impairment,  being  accepted  and  there  is  at  present  no  means  of  establishing  
whether  their  deficiency  is  of  sufficient  severity  to  be  safety  critical.    
 
52.  The  HW-­‐A  lantern,  using  low  intensity  settings,  could  form  a  valid  
replacement  for  the  HW-­‐B  and  would  be  more  compatible  with  the  MCA  Ishihara  
test  protocol.  However,  as  the  same  problems  of  supply  and  maintenance  apply  
to  both  models,  this  is  not  a  rational  approach,  except  insofar  as  it  enables  the  
better  validation  data  for  the  HW-­‐A,  given  the  consistency  of  rankings  found  
between  HW-­‐A  and  HW-­‐B  lanterns  (see  paragraph  50),  mean  that  HW-­‐A  data  can  
validly  be  used  to  help  determine  the  best  option  to  adopt.  The  other  available  
lanterns  all  have  similar  supply  and  maintenance  problems  and  are  less  well  
validated  that  the  HW-­‐A  or  B,  therefore  they  should  not  be  adopted.  The  other  
established  tests  (paragraphs  30-­‐40)  that  do  not  use  coloured  light  lanterns  are  
not  recommended  as  they  would  give  results  that  would  differ  widely  from  those  
using  the  current  procedures.  Of  the  three  screen-­‐based  tests  only  the  CAD  is  
sufficiently  well  validated  to  be  considered  for  use  (paragraphs  41-­‐46).  
 
53.  There  are  two  benchmarks  that  could  be  used  to  determine  a  valid  CAD  
threshold  functionally  equivalent  to  that  in  current  use  by  MCA;  i.e.  that  should  
ensure  safety  critical  colour  vision  performance  requirements  are  met  and  that  
unjustifiable  discrimination  by  failing  applicants  capable  of  performing  colour  
related  safety-­‐critical  tasks  is  minimised:  
 
• Age  related  equivalence:    
As  seafarers  with  normal  colour  vision  continue  to  perform  lookout  
duties  into  their  sixties,  without  apparent  excess  risk  to  maritime  safety  
from  colour  perception,  it  is  proposed  that  the  threshold  when  CAD  is  
used  as  a  confirmatory  test  is  set  at  the  upper  limit  that  defines  normal  
red/green  colour  vision  in  those  aged  65.  Such  information  is  available  
already  for  CAD:  the  upper,  65  years  old  limit  of  normal  red/green  colour  
vision  (for  binocular  viewing)  is  2.25  CAD  units  and  that  for  yellow/blue  
colour  vision  is  2.44  CAD  units.    
 
• Holmes  Wright  A  equivalence:  
The  available  data  on  CAD/HW-­‐A  equivalence  forms  the  basis  for  this  
approach.  As  noted  in  paragraph  50,  there  is  a  constant  relationship  
between  the  results  of  testing  with  HW-­‐A  and  HW-­‐B  lanterns  and  so  
information  from  the  more  fully  investigated  HW-­‐A  lantern  can  be  
extrapolated  to  determine  equivalent  thresholds  for  the  HW-­‐B.  This  
approach  would  have  a  number  of  benefits  and  would  be  consistent  with  
approaches  that  are  likely  to  be  adopted  in  other  transport  sectors.  A  
maximum  CAD  threshold  limit  of  2.35  would  be  roughly  equivalent  in  
outcome  to  the  current  MCA  protocol  for  navigational  lookouts  (Appendix  
1).  All  those  with  at  binocular  red/green  CAD  threshold  of  <2.35  CAD  
units  pass  the  HW-­‐A  lantern  (Figure  7).  This  threshold  could  also  be  
regarded  for  all  practical  purposes  as  reflecting  ‘normal  colour  vision’.  All  

  26  
  

normal  trichromats  pass  with  a  threshold  less  than  2.35  units,  while  only  
~  4  to  5%  of  the  mildest  deutans  also  pass.    
 
6 Figure  19.  Enlargement  from  Figure  
HW-type A lantern 7  with  proposed  ‘normal  colour  
All deutans vision’  (horizontal  line  of  green  dots)  
Deutans that pass separating  all  those  applicants  that  
5 Pass/Fail limit pass  the  HW-­‐A  protocol.  The  red  
Subject ID
dotted  line  defines  the  upper  limit  
that  is  equivalent  to  the  CAA  HW-­‐A  
protocol.    The  latter  passes  all  normal  
RG CAD thresholds

4 trichromats  and  ~  22%  of  deutan  

subjects  and  less  than  1%  of  protans.  
The  number  of  subjects  that  fail  HW-­‐
A  with  a  threshold  less  than  4  units  
3
equals  those  that  pass  with  a  
threshold  ≥  4  units.      
 
 
2
54.  Although  beyond  the  remit  
of  this  analysis,  a  similar  
approach  could  be  applied  to  
1 other  groups  of  seafarers,  such  
0 10 20 30 40 50 60 70 80 as  engineers  with  visual  tasks  
Rank
that  are  not  at  the  limits  of  
colour  perception.  An  equivalent  that  passes  as  safe  all  those  with  thresholds  <  4  
(i.e.,  ~  22%  of  deutans  and  significantly  less  than  1  %  of  protans)(Figure  4).    This  
could  be  considered  as  a  functionally  adequate  level  of  colour  vision  for  less  
demanding  tasks.  All  applicants  with  thresholds  <  2.35  pass  the  HW-­‐type  A.  The  
adoption  of  a  functionally  adequate  category  based  on  a  CAD  threshold  of  <  4  
units  is  statistically  equivalent  to  limits  widely  used  in  other  transport  sectors  
based  on  initial  Ishihara  screening  with  zero  errors  and  a  pass  on  HW-­‐A  lantern.  
 
55.  Given  the  identification  of  the  same  CAD  threshold  both  from  considerations  
of  age  related  decline  and  from  HW-­‐A  equivalence,  2.35  CAD  units  is  an  
appropriate  and  justifiable  threshold  to  adopt.  For  the  HW-­‐A  equivalence  
approach  CAD  test  thresholds  are  directly  proportional  to  the  cone  
photoreceptor  signals  generated  and  the  upper-­‐threshold,  age-­‐corrected  limits  
for  normal  vision  have  been  incorporated  in  the  test.    However  it  should  be  
noted  that  any  approach  that  simply  substitutes  one  test  for  another  or  varies  
thresholds  without  a  clear  rationale  is  going  to  be  less  reliable  than  one  that  is  
based  on  a  detailed  visual  task  analysis  for  the  duties  being  undertaken.  
 
56.  As  the  majority  of  colour  deficiencies  are  congenital  and  relate  to  red/green  
discrimination  it  would  be  rational  to  put  most  effort  into  ensuring  that  a  
person’s  colour  vision  capability  is  carefully  evaluated  when  they  first  start  to  
work  at  sea.  Periodic  testing  for  congenital  red/green  defects  in  younger  
seafarers,  the  only  sort  identified  by  Ishihara  plates,  is  unnecessary,  and  not  
entirely  logical,  despite  it  being  required  every  six  years  in  the  STCW  
Convention.    Acquired  yellow  /blue  and  red/green  deficiency  are  commonly  

  27  
  

secondary  to  other  eye  disease  and  so  are  rarely  present  early  in  life  but  are  
more  frequent  later  in  life.  Yellow/blue  testing  has  been  seen  as  less  directly  
safety  critical,  although  this  may  no  longer  be  valid  if  visual  displays  using  a  full  
range  of  colours  are  used  for  navigation,  for  instance  to  display  charts.    Any  
underlying  disease  can,  however,  also  interfere  with  other  aspects  of  vision  that  
can  be  safety  critical.  The  benefits  of  testing  for  acquired  defects  routinely  has  
not  been  assessed  here,  but  the  general  use  of  a  test  method  such  as  CAD  that  
could  identify  early  stage  retinal  or  systemic  diseases  that  affect  vision  might  be  
desirable.      

 57.  This  review  is  solely  concerned  with  colour  vision.  In  reality  all  aspects  of  
visual  function  interact  with  each  other  to  affect  overall  visual  performance.    For  
instance:  dark  adaptation,  acuity  under  variable  lighting  conditions,  glare  and  
visual  field  integrity.  A  holistic  view  on  the  required  visual  performance  
‘envelope’  is  needed  and,  as  for  colour  vision,  this  needs  to  be  based  on  an  
analysis  of  visual  task  requirements  coupled  with  information  on  the  limits  of  
visual  performance  in  those  without  any  impairment.  
 
Proposed  options  for  revisions  to  MCA  procedures    
 
58.  The  previous  section  identified    CAD  as  the  preferred  test  to  substitute  for  
the  HW-­‐B  as  a  confirmatory  test  and  identified  an  appropriate  threshold  to  use.  
Any  substitution  needs  to  be  of  a  single  new  test  for  the  one  it  replaces.  
Acceptance  of  more  than  one  confirmatory  test  will  lead  to  lack  of  clarity  in  
decision  taking  and  to  those  wanting  employment  at  sea  seeking  to  perform  
multiple  tests  until  they  manage  to  pass  one.  The  ease  with  which  pass/fail  CAD  
threshold  limits  can  be  revised  in  the  light  of  new  knowledge  about  safe  levels  of  
colour  deficiency  and  the  ability  to  go  back  over  past  records  to  identify  anyone  
affected  by  a  change  to  the  threshold,  the  potential  to  detect  yellow/blue  defects  
associated  with  other  eye  pathology  and  the  ability  to  use  the  same  testing  
hardware  to  assess  other  facets  of  visual  function  would  be  additional  
advantages  from  adopting  this  test    
 
59.  As  noted,  the  differences  between  HW-­‐B  and  CAD  mean  that  the  CAD,  or  
indeed  any  other  test,  cannot  be  direct  like  for  like  substitute.  Because  CAD  has  
the  advantage  of  determining  the  severity  of  colour  deficiencies  in  both  
red/green  and  yellow/blue  axes  a  quantitative  threshold  has  to  be  established  as  
the  basis  for  taking  pass/fail  decisions.  Based  on  the  analysis  of  results  and  
comparison  with  other  tests  and  with  previous  practices,  a  threshold  of  2.35  CAD  
units  is  recommended  and  can  be  justified.  
 
60.  Given  that  some  of  those  assessed  as  fit  will  be  close  to  the  pass/fail  criterion  
it  may  be  appropriate  to  repeat  CAD  testing  periodically,  and  give  the  person  
advance  notice  that  their  continued  employment  for  lookout  duties  may  be  
endangered  if  they  fall  below  the  threshold.  Retesting  would  also  provide  an  
opportunity  to  assess  whether  any  loss  of  yellow/blue  sensitivity  is  also  
accompanied  by  yellow/blue  loss,  indicating  the  presence  of  early  stage  eye  
disease  in  those  having  repeat  CAD  tests.  However  this  would  only  be  applicable  

  28  
  

to  those  who  had  the  CAD  as  a  confirmatory  test  because  they  had  failed  at  the  
Ishihara.  
 
61.  Four  options  are  proposed  and  it  is  for  MCA  to  decide  on  the  preferred  one:  
 
Option  1:  continue  with  existing  Ishihara  protocol  (>2  failed  on  24  plate  or  >3  
failed  on  38  is  unacceptable)  and  then  use  the  CAD  test  with  a  threshold  of  2.35  
CAD  units  in  a  similar  way  to  the  current  testing  with  HW-­‐B  lanterns.    
 
This  option  would:    
 
• Retain  some  of  the  limitations  of  the  current  MCA  testing  protocol.    
If  ~  two  or  less  IH  errors  are  allowed  on  the  first  25  plates  of  the  
38  plate  edition  ~  98%  of  normals  pass,  4%  of  deutans  pass  and  
less  than  1%  of  protans  pass.  The  number  of  plates  failed  on  the  
Ishihara  test  is  not  a  good  indicator  of  severity  of  colour  vision  loss  
(see  Figure  5).  Hence  some  of  those  with  an  unquantified  level  of  
colour  vision  deficiency  are  considered  fit.      
 
• Reduce  the  misclassification  that  currently  arises  from  the  use  of  
the  HW-­‐B  lantern  where,  when  used  strictly  according  to  the  MCA  
protocol,    virtually  everyone  fails.  Use  of  a  CAD  thresholds  <  2.35  
CAD  units  would  ensure  that  all  normals  pass  as  well  as  5%  of  the  
least  affected  deutans  pass.    
 
• Be  expected  to  result  in  the  number  of  requests  for  CAD  tests  being  
broadly  similar  to  those  for  HW-­‐B  tests  at  present.    
 
 
Option  2:  revise  Ishihara  test  protocol  to  minimise  numbers  of  those  with  colour  
deficiencies  being  excluded  from  more  detailed  testing.  Use  zero  errors  on  
Ishihara  as  the  criterion  for  confirmatory  testing.  Then  test  with  CAD  using  
threshold  of  <2.35  CAD  units.    
This  option  would:  
• ensure  that  all  those  with  colour  vision  deficiencies  that  are  above  the  
threshold  of  2.35  CAD  units  would  be  correctly  identified.    It  would  
also  mean  that  some  of  those  who  do  not  reach  this  threshold  can  be  
advised  that  they  may  be  suitable  for  other  less  colour  vision  
demanding  types  of  work  at  sea,  as  proposed  in  paragraph  51.  
• result  in  increased  demand  for  CAD  tests,  compared  to  option  1,  but  it  
would  reduce  the  frequency  of  misclassification  of  those  who  are  
normal  as  colour  vision  deficient,  as  happens  using  HW-­‐B.  It  would  
also  further  reduce  the  number  of  those  incorrectly  identified  as  
normal  because  of  the  acceptance  of  up  to  two  errors  on  IH.  This  
option  would  also  give  more  accurate  results  with  potentially  fairer  
and  more  widely  applicable  outcomes.  It  would  be  at  variance  with  the  
first  stage  of  the  currently  suspended  IMO  requirements  for  testing  
based  on  CIE  143:2001.  

  29  
  

 
Option  3.  One  off  use  of  CAD  at  start  of  career  for  all  those  with  navigational  
lookout  duties.  A  life-­‐long  certificate  that  indicates  absence  of  congenital  colour  
deficiencies  is  justified.    At  above  40  years  of  age  periodic  assessments  could  be  
justified  to  test  for  acquired  deficiencies.  Red/Green  could  be  tested  with  
Ishihara  plates  as  is  now  done.  Yellow/Blue  would  either  require  use  of  the  CAD  
test  or  one  of  the  other  tests  such  as  HRR  that  also  assess  this.    
This  option  would:  
Align  maritime  practice  with  that  in  other  sectors  of  transport  where  
•
there  are  colour  critical  tasks.  
• Mean  that  ADs  had  to  test  far  fewer  seafarers  for  colour  vision  using  
Ishihara.    
• Create  the  need  for  CAD  test  facilities  would  need  to  be  available  to  test  c  
500  officer  cadets  and  a  smaller  but  unquantifiable  number  of  trainee  
deck  ratings  each  year.  For  cadets  this  could  be  practically  organised  in  
the  vicinity  of  training  colleges,  especially  as  a  small  number  of  ADs  see  
the  majority  of  cadet  applicants.    Tests  for  ratings  could  not  be  
geographically  localised  so  easily.  
• Improve  the  reliability  of  the  initial  test,  which  determines  career  choice,  
by  making  it  less  dependent  on  ADs’  adherence  to  Ishihara  test  
requirement  and  greatly  reducing  the  opportunities  for  cheating  (see  
paragraph  33  and  Figure  6).    
• Pose  practical  problems  about  the  need  for  six  yearly  testing  to  comply  
with  international  Convention  requirements  and  raise  complex  issues  
about  timing  for  repeat  tests  to  detect  significant  deterioration  from  
disease  or  aging.  
 
Options  1-­‐3  are  suitable  for  meeting  MCA’s  current  needs.  They  vary  in  their  
implications  for  the  Agency,  for  seafarers  and  for  Approved  Doctors.    
 
Option  4:  perform  visual  task  analysis  for  present  day  navigational  lookout  
duties  and  use  the  results  to  identify  the  most  colour  critical  tasks.  The  pass/fail  
CAD  threshold  could  then  be  based  on  the  level  of  colour  deficiency  that  is  
compatible  with  safe  performance  of  these  tasks.  The  analysis  would  identify  the  
threshold  at  which  performance  of  colour-­‐critical  tasks  was  the  same  as  in  those  
with  normal  trichromatic  vision.  The  overall  approach  to  testing  could  then  be  
optimised  using  a  mix  of  test  methods,  but  with  a  better-­‐validated  threshold  for  
unsafe  levels.  
 
This  option  would:  
• Improve  the  validity  of  the  colour  vision  testing  process  by  providing  an  
up  to  date  evidence  base  for  it.  It  may  well  enable  more  applicants  with  
congenital  colour  vision  deficiency  to  have  maritime  careers  and  would  
lead  to  validated  pass/fail  thresholds  for  deutan  and  protan  like  
deficiency.    
 
• Make  existing  procedures  more  secure  by  determining  red/green  and  
yellow/blue  thresholds  and  the  various  categories  of  results  that  are  

  30  
  

appropriate  for  safe  performance  of  navigational  lookout  duties.  This  

information  could  form  the  basis  for  sound  standard  setting  and  
determination  of  the  optimal  test  protocols.    
 
• Form  a  valid  basis  for  achieving  an  international  consensus  on  the  colour  
vision  test  protocol  to  be  adopted  by  IMO.  
 
63.  All  options  would  mean  that  the  three  rooms  in  MCA  Marine  Offices  
dedicated  to  HW-­‐B  testing  could  be  released  and  that  staff  time  would  not  need  
to  be  spent  on  testing  unless  CAD  was  made  available  at  MCA  centres.    There  are  
already  a  number  of  locations  where  CAD  tests  are  available  in  UK,  some  of  these  
would  be  willing  to  perform  the  assessments  required  by  MCA,  usually  on  an  
item  of  service  basis  (Appendix  4).  MCA  would  need  to  decide  which  of  these  
centres  to  work  with  and  agree  terms.  MCA  will  also  need  to  take  a  view  on  
whether  any  additional  centres  are  required  and,  if  so,  how  these  should  be  
funded.    
 
64.  The  lantern  tests  are  a  long  established  part  of  the  maritime  world.    
Seafarers,  employers  and  regulators  will  all  need  to  be  made  aware  of  and  
understand  that  a  test  that  is  less  directly  related  to  the  critical  visual  tasks  of  
navigational  lookout  is  capable  of  providing  a  fairer  and  more  valid  assessment  
of  colour  vision  that  existing  protocols.  
 
Recommendations  
 
67.  The  following  are  our  recommendations,  for  consideration  by  MCA:    
 
1. MCA  should  move  from  the  use  of  the  HW-­‐B  lantern  to  the  CAD  test  for  
confirmatory  testing  of  colour  vision  in  those  with  navigational  lookout  
duties.  Testing  could  either  be  arranged  on  an  item  of  service  basis  from  
those  who  already  have  the  test  or  by  creation  of  dedicated  MCA  facilities.  
A  programme  of  information  and  consultation  on  the  proposed  changes  
will  need  to  be  mounted.  
 
2. Based  on  the  available  evidence,  the  preferred  option  at  this  stage  is  2  
(see  paragraph  61).  This  would  improve  the  ability  of  the  two-­‐stage  
process  to  reach  valid  decisions,  with  potential  benefits  for  maritime  
safety.  Compared  to  use  of  HW-­‐B,  it  would  reduce  the  numbers  rejected  
from  service  who  have  normal  colour  vision.  An  additional  advantage  
would  be  comparability  with  procedures  in  commercial  aviation  where  
there  is  already  practical  experience  of  the  use  of  a  similar  protocol  and  
where,  in  future,  both  maritime  and  aviation  sectors  could  benefit  by  
sharing  developments  in  knowledge.  
 
3. If  option  1  was  to  be  adopted  there  should  be  no  reduction  in  the  current  
standards  of  maritime  safety  as  compared  to  the  present  position,  and  it  
would  reduce  unjustifiable  discrimination.    The  costs  of  purchase  of  CAD  
tests  could  be  offset  against  the  savings  in  time  and  accommodation  

  31  
  

needed  to  perform  HW-­‐B  tests  in  MCA  Marine  Offices.  

 
4. An  intermediate  approach  between  options  1  and  2  would  be  to  require  
CAD  testing  on  all  those  who  made  any  errors  on  Ishihara  testing  at  the  
start  of  their  careers,  thus  increasing  the  validity  of  the  test  protocol  at  
the  time  when  this  was  critical  to  a  person’s  career  choices.  The  current  
Ishihara  pass  criterion  could  be  used  for  subsequent  tests.      
 
5. Options  3  and  4  are  rational  approaches,  but  3  would  make  MCA  practice  
out  of  line  with  the  currently  suspended  IMO  Convention  requirements  
and  a  lead  to  a  considerable  increase  in  CAD  tests.  This  would  be  offset  by    
a  reduction  in  the  requirements  for  ADs  to  routinely  perform  Ishihara  
tests.  Option  4  would  need  a  programme  of  research  to  determine  visual  
task  requirements.  Because  of  their  implications  both  of  these  options  
would  need  to  be  discussed  internationally  and  in  the  case  of  option  4  
would  require  agreement  on  support  for  the  required  investigations.    
 
6. Ishihara  testing  is  performed  in  a  not  entirely  consistent  way  by  MCA  
Approved  Doctors  (Paragraph  13),  especially  regarding  the  lighting  used  
and  the  order  and  mode  of  display  of  plates:  precision  could  be  improved  
by  specifying  the  testing  protocol  in  more  detail  and  taking  steps  to  
ensure  that  it  is  being  followed.  
 
7. The  feasibility  of  developing  a  simplified  low  cost  version  of  the  CAD  test  
suitable  for  standard  IT  equipment  and  used  by  ADs  in  the  quick  
screening  mode  could  also  be  explored.  
 
 

  32  
  

Appendix  1  
 
MCA  colour  vision  testing  requirements  (extract  of  MSN  1839)  
 
Deck  officers  and  ratings  -­‐  Colour  vision  should  be  tested  by  the  Approved  
Doctor  with  Ishihara  plates,  using  the  introductory  plate,  and  all  the  
transformation  and  vanishing  plates.  Those  used  should  be  recorded  on  the  
medical  report  form  (ENG  2).  Candidates  who  fail  the  Ishihara  colour  plate  test  
may  apply  to  one  of  the  MCA’s  nominated  Marine  Offices  listed  at  Annex  C  to  this  
MSN,  for  their  colour  vision  to  be  re-­‐tested  using  a  Holmes  Wright  B  lantern.  
(MSN  1839)  
 
Supplementary  guidance  on  colour  vision  testing  (extract  of  ADG  14  2010  
manual)  
 
Colour  vision  
 
Initial  testing  
The  AD  must  ensure  that  the  seafarer  meets  the  colour  vision  standards.  To  
comply  with  international  guidelines,  testing  for  all  seafarers  should  be  done  
with  the  standard  Ishihara  plates.  Some  screen-­‐based  tests  for  colour  vision  are  
now  available,  however  to  ensure  consistency,  ADs  should  continue  to  use  the  
book  of  Ishihara  plates.  Testing  should  be  carried  out  at  every  medical  
examination  unless  the  AD  has  their  own  record  of  a  previous  medical  where  
the  test  has  been  passed  within  the  previous  four  years.  Illumination  should  be  
good  north  facing  daylight  or  with  daylight  fluorescent  lighting.  Incandescent  
lighting  is  unsuitable  because  of  its  colour  balance.  The  criteria  for  a  pass  are  two  
or  less  misreadings  on  the  24  plate  test,  or  three  or  less  misreadings  on  the  38  
plate  test.  It  is  essential  that  seafarers  applying  for  certificates  of  competency  as  
deck  or  dual  career  (merchant/fishing)  officers  have  full  colour  vision.  
Search   Print  this  section  
When  testing  a  seafarer  for  the  first  time,  special  care  must  be  exercised  to  
ensure  that  the  test  is  properly  conducted.  Such  testing  should  not  be  delegated,  
and  the  AD  should  be  aware  that  those  with  problems  have  been  known,  on  
occasions,  to  memorise  the  sequence  of  Ishihara  plates.  An  inappropriate  pass  
causes  major  problems  for  the  seafarer  and  their  employer  if  detected  at  a  
subsequent  medical.  
 
The  Ishihara  test  is  an  effective  screening  test  but  where  supplementary  testing,  
see  below,  is  performed  the  results  of  the  supplementary  test  will  determine  any  
restrictions  to  be  placed  on  the  seafarer.  
 
Supplementary  testing  –  Deck  
A  deck  applicant  who  fails  the  Ishihara  test  may  arrange  for  their  colour  vision  to  
be  re-­‐tested  free  of  charge,  using  the  Holmes  Wright  B  Lantern,  at  one  of  the  3  
MCA  Marine  Offices  (see  annex  B  of  MSN  1839)  that  offer  lantern  tests.  The  AD  
should  withhold  the  issue  of  an  ENG  1  until  the  test  has  been  carried  out.  Failure  
in  this  test  will  mean  that  a  medical  certificate  may  only  be  issued  with  the  
restriction  “not  fit  for  lookout  duties”  (and/or  solo  navigational  watch).  Although  

  33  
  

there  is  a  tick  box  on  the  ENG  1  form  relating  to  fitness  for  lookout  duties,  non-­‐
fitness  must  also  be  written  as  a  restriction  on  duties.  
 
A  seafarer  who  is  referred  for  a  lantern  test  should  not  be  issued  with  an  ENG  1  
until  the  results  of  the  lantern  test  have  been  returned  to  the  AD.  Alternatively,  
the  AD  can  offer  to  issue  the  seafarer  with  an  ENG  1  suitably  restricted  to  ‘no  
look  out  duties’,  ‘daylight  duties  only’  or  ‘no  work  with  coloured  cables’  from  the  
outset.  
ADG  14  
In  cases  where  a  seafarer  being  examined  by  a  non-­‐UK  based  AD  fails  Ishihara,  
the  AD  should  advise  the  seafarer  of  their  right  to  attend  for  a  lantern  test  in  the  
UK  if  they  choose  to  although  it  should  be  pointed  out  that  the  likelihood  of  
passing  a  lantern  test  is  small.  It  may  aid  their  decision  on  whether  to  travel  for  a  
lantern  test  if  they  have  additional  investigation  by  an  optometrist  or  
ophthalmologist  locally  to  determine  the  severity  of  their  colour  impairment  as  it  
is  very  unlikely  that  anyone  who  has  more  than  a  minor  degree  of  impairment  
will  pass  a  lantern  test.  Unfortunately  there  are  no  acceptable  equivalent  lantern  
tests  outside  the  UK.    
 
 
Follow  up  
Where  a  seafarer  has  failed  the  Ishihara  test  but  has  subsequently  passed  a  
lantern,  City  University  or  Farnsworth  D15  test,  they  should  be  issued  with  a  
note  by  the  tester,  on  letter-­‐headed  paper,  giving  details,  including  the  date  and  
location  of  the  test  and  the  name  of  the  tester.  Presentation  of  this  letter  at  
subsequent  medicals  should  generally  obviate  the  need  for  repeat  tests.  Clear  
pass  results  should  normally  be  considered  valid  for  the  duration  of  the  
seafarer’s  career.  
 
Most  colour  vision  defects  will  be  found  in  new  seafarers  and  appropriate  
vocational  advice  should  be  given.  Cases  do  occur  where  defects  are  detected  in  
seafarers  who  previously  apparently  met  the  standards.  The  AD  should  normally  
try  to  obtain  details  of  past  test  results  and  contact  the  AD  concerned.  It  may  be  
appropriate  to  recommend  that  the  seafarer  seeks  an  ophthalmological  opinion  
in  case  of  any  undetected  eye  disease.  
 
A  seafarer  with  colour  vision  defects  working  or  potentially  working  in  both  
deck  and  engine  departments  should  be  tested  and  restricted,  if  necessary,  in  
relation  to  both.  For  new  entrants  to  officer  cadetships  where  restricted  duties  
are  impractical  because  the  full  range  of  training  cannot  be  carried  out,  those  
with  defects  should  be  made  permanently  unfit  but,  where  appropriate,  advised  
of  the  duties  for  which  they  could  be  suitable  if  they  chose  to  apply  for  a  different  
cadetship.  
   

  34  
  

Appendix  2  
 
The  Holmes  Wright  Lantern  
 
Pairs  of  coloured  lights  are  displayed  and  the  candidate  has  to  identify  them  
correctly.  The  lantern  can  be  operated  in  two  modes.  In  A  mode  the  dimension  of  
the  aperture  are  wider  and  two  levels  of  lighting  can  be  used.  The  B  mode  has  a  
smaller  aperture  and  a  single  lighting  level,  which  aims  to  mimic  ship  navigation  
lights  at  2  nautical  miles.    
 
Stimulus  dimensions  employed  in  HW  types  A  and  B  lanterns.  The  dimensions  
given  are  based  on  measurements  carried  out  on  available  lanterns  using  a  
travelling  microscope  with  a  resolution  of  0.01mm.  
 
0.5 mm
 
Traditional  geometry  for  
25.4 mm 6m marine  lantern  tests  (HW  type  
B)  
 
Demonstration  colour  uses  5.08  mm  aperture  size  at  6m  (~  3  min  arc).  
Simulation  of  marine  red  /  green  lights  is  achieved  with  two  apertures  (0.5  mm  
each  ~  0.3’)  separated  by  ~  25.4  mm,  giving  a  simulated  angular  separation  of  ~  
15  min  arc.  This  is  assumed  to  simulate  the  angular  subtense  of  real  signal  lights  
at  2  miles  (1  mile  =  1.609  km).    The  real  lights  on  the  boat  will  be  separated  by  ~  
13.6m.  Also  the  diameter  of  each  light  will  be  26.8  cm?.  The  average  light  
intensity  of  the  signal  lights  is  ~  12.7  ±  0.9  mcd  (mean  ±  standard  deviation).  
 
00 W W HW  lantern  colour  pairs    (D  =  5.08  mm;  d  =  0.5  mm)  
15 R G Demonstration  mode:    uses  9  filter  wheel  positions      
50 W R  
17 R G  
11 G G  
53 G R  
55 R R  
01 G W  
33 G G  
 
 
 
Comparison  with  HW  type  A  lantern  
This  lantern  employs  three  different  intensity  settings:  Demo,  High  and  Low.  The  
HW  type  B  lantern  employs  a  single  intensity  setting.  Demonstration  aperture  
diameter  =  5  mm,  Test  aperture  diameter  is  1.52  mm  (subtending  an  angle  of  ~  
0.87’).  The  two  lights  are  separated  by  ~  25.5mm  giving  an  angular  separation  of  
~  15’  at  a  viewing  distance  of  6m.  Type  A  with  the  low  intensity  setting  turns  out  
to  be  almost  equivalent  to  type  B  (but  type  A  is  almost  always  used  with  the  high  
intensity  setting).  The  vertical  or  horizontal  orientation  of  the  two  signal  lights  is  
not  likely  to  cause  any  significant  difference  in  performance.        
   

  35  
  

Appendix  3.  
 
The  features  of  the  CAD  test  
 
 
The  Colour  Assessment  and  Diagnosis  (CAD)  test  was  developed  at  City  
University  London  (Barbur  et  al.,  199429;  Rodriguez-­‐Carmona  et  al.,  200530)  and  
has  been  adapted  for  use  in  aviation  with  support  from  the  Civil  Aviation  
Authority  (CAA,  UK),  and  the  Federal  Aviation  Administration  (FAA,  USA).    
The  CAD  test  has  a  number  of  advantages  which  make  it  ideal  for  setting  up  
standard  protocols  that  are  safe  and  reliable  and  can  be  can  be  implemented.    
 
Key  features  
• Complete  isolation  of  colour  signals  (i.e.,  in  the  absence  of  colour  signals  the  
applicant  cannot  do  the  test)  
• The  test  uses  an  internationally  recognized  and  reproducible  system  of  
colour  representation  (i.e.,  the  CIE  –  (x,y)  chromaticity  chart)  
• The  test  can  be  used  to  assess  both  the  RG  and  the  YB  chromatic  mechanisms  
• The  measured  thresholds  are  directly  proportional  to  the  signals  generated  
by  the  coloured  stimulus  in  cone  photoreceptors  
• The  test  cannot  be  learned  and  the  applicant  cannot  make  use  of  other  cues  
• The  equipment  supplied  for  the  test  includes  a  30  bit,  stable  visual  display  
system  and  an  accurate  photometer  that  can  be  used  periodically  (e.g.  six  
monthly)  to  check  the  calibration  of  the  display  and  to  recalibrate  
automatically,  if  necessary.    
• The  test  relies  on  extensive  studies  designed  to  assess  accurately  the  
variability  in  RG  and  YB  chromatic  sensitivity  in  young,  normal  trichromats.  
The  CAD  unit  for  RG  and  YB  colour  vision  is  based  on  the  median  thresholds  
estimated  in  333  young,  normal  trichromats.  All  thresholds  are  expressed  in  
standard  normal  CAD  units  for  ease  of  use  and  understanding.    The  test  
accurately  classifies  the  applicants  class  or  colour  vision  as  normal  
trichromacy,  congenital  deficiency  (i.e.  deutan-­‐,  protan-­‐,  or  tritan-­‐defect)  or  
acquired  deficiency  
• The  test  results  are  not  affected  significantly  by  pupil  size,  higher  order  
ocular  aberrations,  small  refractive  errors,  moderate  levels  of  absorption  of  
short  –wavelength  light  by  the  lens  and  small  variations  in  viewing  distance.          
• The  test  employs  normal,  upper-­‐threshold  age  limits  derived  from  extensive  
studies  carried  out  in  393  subjects  with  normal  colour  vision  (Barbur  and  
Rodriguez-­‐Carmona,  2015).  Upper-­‐thresholds  limits  for  normal  colour  vision  
that  describe  monocular  viewing  are  also  provided.  
• The  CAD  test  provides  ‘Fast  screening’  option  which  uses  the  upper-­‐
threshold,  normal  age  limits  to  screen  for  both  RG  and  YB  colour  vision  in  
less  than  one  two  minutes.  Approximately  95%  of  applicants  with  normal  
colour  vision  pass.  ~  5%  of  normal  trichromats  and  all  subjects  with  
congenital  and  acquired  deficiency  fail.  Those  that  fail  have  the  option  to  

  36  
  

carry  out  a  Full  CAD  test  which  determines  the  applicant’s  class  of  colour  
vision  (i.e.,  normal,  deutan,  protan  or  acquired)  and  the  severity  of  RG  and  YB  
loss.    
• Pass  /  Fail  limits  of  colour  vision  loss  that  are  considered  safe  within  visually  
demanding  working  environments  have  been  obtained  for  commercial  pilots  
and  TfL  train  drivers  and  the  test  is  also  being  used  with  normal  age-­‐
corrected,  upper  threshold  limits  to  select  normal  trichromats  within  the  fire  
service  and  for  air  traffic  control.    
• In  addition  to  colour  vision  assessment,  the  Advanced  Vision  and  Optometric  
Tests  (AVOT)  system  (implemented  on  the  same  equipment  that  runs  CAD)  
also  offers  tests  to  assess  photopic  and  mesopic  spatial  vision,  scattered  light  
and  rapid  flicker  and  motion  sensitivity.  
There  are  over  120  systems  available  worldwide,  some  with  several  units  at  the  
same  centre,  and  the  number  of  users  is  increasing  every  year.  
 
 
   

  37  
  

Appendix  4  
 
Principle  CAD  users  
 
 
Airlines    /  Aviation  Authorities  /  Research  Labs Medical  practitioners  /  Hospitals  /  Universities
Aeglia  Medical  Center,  Netherlands Anglia  Ruskin  University  ( UK)
Aeromedical  Research  Labs  ( USA) Antwerp  University  Hospital  ( Belgium)
Bangkok  Aviation  Institute Aston  University,  Optometry  &  V isual  Science
Belgian  Army Belfast  City  Hospital,  Northern  Ireland
Cathay  Pacific Birmingham  Eye  Hospital  ( UK)
Civil  Aviation  Authority  ( UK) Brookdale  Medical  Centre  ( UK)
Defence R&D Canada Buskerud  and  V estfold  University,  Kongsberg,  No
Emirates  Airlines Calhoun  V ision  Inc
Etihad  Airlines Cardif  University,  Optometry  &  V isual  Science
Federal  Aviation  Administration  ( USA) Dublin  Institute  of  Technology
Home  Office  ( UK) FJ  Parkes  Clinics,  Dods  St.  Brunswick,Australia
Italian  Air  Force KUPA  Medical  Center  ( Lagos,  Nigeria)
Lufthansa Liverpool  Hope  University  ( UK)
Maina  Group,  Mumbai Mastricht  University  Hospital  ( Netherlands)
National  Air  Traffic  Control  Centre  ( UK) Mends  Specialist  Hospital  ( Nigeria)
National  Defence,  Toronto,  Canada Ophthalmology  Dept,  University  of  Toronto
Naval  Medical  Research  Unit  ( Dayton,  USA) Papworth  Hospital,  Cambridge
Norwegian  Aviation  Authority Raffles  Medical  Group,  Singapore
Royal  Air  Force,  Henlow  ( UK) Rohan  Medical  Centre,  Mumbai
South  African  Civil  Aviation  Authority Stansted  Aviation  Medical
Spanish  Airforce,  Madrid The  Livingstone  Clinic,  Sydney,  Australia
Swedish  Air  Force Universidad  Federal  do  Pará,  Brazil
Swiss  Institute  of  Aviation University  of  Auckland  ( NZ)
Thailand  Aviation  Authority  ( Bangkok) University  of  Braga,  Portugal
Transport  Canada University  of  Leipzig,  Germany
Transport  f or  London   University  of  New  South  Wales,  Australia
William  J.  Hughes  Technical  Center  ( USA) University  of  Pretoria  ( Ophthalmology)
Wright-­‐Patterson  AFB  ( USA) Vision  Test  Australia  Pty
VU  Medical  Centre,    Amsterdam  ( Netherlands)
Wisconsin  University  ( Ophthalmology)  
   
 
 
 
 
 
 
   

  38  
  

 
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9  Minimum  Colour  Vision  Requirements  for  Professional  Flight  Crew.  

Recommendations  for  new  colour  vision  standards.  

http://www.caa.co.uk/application.aspx?catid=33&pagetype=65&appid=11&mo
de=detail&id=3560    
 
10  Birch  J.  Assessment  of  Colour  Visions  Requirements  for  Seafarers  and  Testing  

Procedures.  City  University,  London.  Marine  Safety  Agency  Project  414  8/1997.  
 
11  Seafarer  Medical  Examination  System  and  Medical  and  Eyesight  Standards:  

Application  of  the  Merchant  Shipping  (Maritime  Labour  Convention)  (Medical  

Certification)  Regulations  2010.  MSN  1839.  Maritime  and  Coastguard  Agency,  
2009.    pp35-­‐37.  
https://www.gov.uk/government/uploads/system/uploads/attachment_data/fi
le/281947/msn1839.pdf  
 
12  Approved  Doctor’s  Manual:  Seafarer  Medical  Examinations,  Maritime  and            

  39  
  

                                                                                                                                                                                                                                                                                                                           
Coastguard  Agency,  2010.    ADG  14:  Vision,  pp  234-­‐236.  
https://www.gov.uk/government/uploads/system/uploads/attachment_data/fi
le/285747/mca_doctors_manual__links_.pdf  
 
13  Work  instruction  seafarers  colour  vision  test  by  examiners  conducting  lantern  

tests.  Quality  management  system  documentation.  Document  number  MCA  

710/001.  Revision:  02  Date:  29.07.04.  This  has  been  supplemented  by  the  
additional  instruction  that  if  there  were  only  two  errors  on  the  fifth  random  run  
the  combinations  failed  could  be  re-­‐tested.  
14  J.  Neitz  and  M.  Neitz.  The  genetics  of  normal  and  defective  color  vision.  Vision  

Res  51  (7):633-­‐651,  2011.  

 
15  Barbur  J  L,  Rodriguez-­‐Carmona  M  (2015).  ‘Colour  Vision  Changes  in  Normal  

Aging’  in:  Handbook  of  color  psychology,  Andrew  J.  Elliot  and  Mark  D.  Fairchild,  
Editors.  Cambridge  University  Press,  2015.  
 
16  Barbur  JL,    Rodriguez-­‐Carmona  ML    in:  Handbook  of  color  psychology,  Andrew  

J.  Elliot  and  Mark  D.  Fairchild,  Editors  Cambridge  University  Press,  2015  (in  
press).  
 
17  Koenker  R.  A  Note  on  Studentizing  a  Test  for  Heteroscedasticity.  Journal  of  

Econometrics,  1981;17:  107-­‐12.  

18  Rodriguez-­‐Carmona  M,  O'Neill-­‐Biba  M,  Barbur  JL.  Assessing
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environments.  Aviat  Space  Environ  Med  2012;  83:  19-­‐29.  
19  Squire  TJ,  Rodriguez-­‐Carmona  M,  Evans  ADB,  Barbur  JL  (2005)  Color  vision  

tests  for  aviation:  comparison  of  the  anomaloscope  and  three  lantern  types.  Aviat  
Space  Environ  Med;  76:422-­‐429.  
20  J.  L.  Barbur  and  M.  Rodriguez-­‐Carmona.  Variability  in  normal  and  defective  

colour  vision:  consequences  for  occupational  environments.  In:  Colour  design,  

edited  by  J.  Best,  Cambridge:  Woodhead  Publishing  Limited,  2012,  p.  24-­‐82.
 
21  Bailey  KGH.  How  consistent  are  the  results  of  Occupational  colour  vision  tests?  

Dissertation,  University  of  Birmingham,  UK,  2013.  

 
22  Wright  WD.  Researches  on  normal  and  defective  colour  vision,  London:  Henry  

Kimpton,  1946.  
 
23  Barbur  JL,  Rodriguez-­‐Carmona  M,  Harlow  JA,  Mancuso  K,  Neitz  J,  Neitz  M  

(2008)  A  study  of  unusual  Rayleigh  matches  in  deutan  deficiency.  Vis  Neurosci  
25:507-­‐516.    
 
24  CAD  Test,  City  University  London.  www.city-­‐occupational.co.uk      

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25  Minimum  Colour  Vision  Requirements  for  Professional  Flight  Crew.  

Recommendations  for  new  colour  vision  standards.  

http://www.caa.co.uk/application.aspx?catid=33&pagetype=65&appid=11&mo
de=detail&id=3560    
 
26  Paramei  GV,  Oakley  B.  Variation  of  color  discrimination  across  the  life  span.  

J.Opt.Soc.Am.A  Opt.Image  Sci.Vis.  31  (4):  A375-­‐A384,  2014.

 
27  Cone  Contrast  Sensitivity  Test,  www.innovasysi.com      

 
28  Color  DX  Test,  Konan,  USA.    http://colordx.com        

 
29  Barbur  JL,  Harlow  AJ,  Plant  GT  (1994)  Insights  into  the  different  exploits  of  

colour  in  the  visual  cortex.  Proc  R  Soc  Lond  B  258:327-­‐334.  

30  Rodriguez-­‐Carmona  ML,  Harlow  JA,  Walker  G,  Barbur  JL  (2005)  The  variability  

of  normal  trichromatic  vision  and  the  establishment  of  the  "normal"  range.  pp  
979-­‐982.  Granada.  

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