Review Article

Color vision in civil aviation

Atul K Singh, Mansur A Khan, Anirudh Singh, Anjali Maheshwari

Color vision deficiency  (CVD) is a condition that results in individuals being unable to distinguish Access this article online
differences between certain colors. Occupational color vision standards were introduced in aviation in Website:
1919 by The Aeronautical Commission of the International Civil Air Navigation Authority. Concern has www.ijo.in
been expressed during the last few years that the current color vision standards in aviation may be too DOI:
stringent and, at the same time, also variable across the world. The tests employed do not always reflect 10.4103/ijo.IJO_2252_20
the tasks pilots encounter in today’s aviation environment. This ambiguity leads to the possible exclusion PMID:
*****
of deserving applicants for selection as aircrew. The compatibility of CVD with aircraft crew is assessed by
medical personnel using clinical diagnosis tests on the ground level. These clinical tests were developed Quick Response Code:
specifically to detect the presence, nature, and severity of CVD. No clinical tests yet provide a measure
of operational performance in operating an aircraft. Arbitrary pass marks have been assigned to clinical
tests such that a failing candidate will either be subject to operational restrictions or excluded completely.
The prescribed clinical tests and associated pass marks vary considerably between regulators. While an
individual may be subject to no restrictions in one jurisdiction, they may be excluded in another. This article
highlights newer diagnostic techniques adopted by different countries for assessing color vision to see for
the scope of evidence‑based guidelines for minimum color vision requirements for flight crew as well as
for civil aviation in India.

Key words: Anomaloscope, civil aviation, color vision, Ishihara chart, Martin Lantern test

Color in aviation is used for decoding signals, taking visual it has been seen that a normal trichromats applicant will commit
cues from runways, and from gathering information from some errors in the Ishihara color screening.[1]
the visual displays. Hence, it is the main thing in flight
Recent advancements in color vision[2] and the development
safety to set sufficient color vision standards to make sure
of newer instruments to measure precisely the loss of
that the in‑flight crew can discriminate and recognize
chromatic sensitivity[3] have prompted research into more
different colors, both on the flight deck as well as an external
accurate methods of measuring color vision sensitivity to
stimulus. In today’s era of civil aviation which has changed
establish minimum color vision requirements in aviation.
dramatically in terms of lights in visual displays inside the
Recent equipment has made a possibility of a new era to
aircraft, night flying concern has been raised all over the
define more accurately the population variability or range
world during the recent past that the current color vision
that exists within the normal color vision and to detect
standards are not adequate, since most of these tests can
with greater confidence the minute congenital color vision
screen only for normal red, green color blindness. The prompt
deficiencies that hitherto passed undetected in old color vision
and accurate perception of colors is necessary for aviation
tests equipment. These newer tests can quantify the color
safety. Although such a general statement is unlikely to
vision defects better as opposed to occupational tests. The
be vulnerable to serious disagreement, the issue of color
limitations of occupational color vision tests were brought out
vision deficiency (CVD) and aviation safety, especially the
by Squire et al. in their study comparing various occupational
medical assessment of aircrew, is prone to controversy. Many
tests in both normal trichromats and a large number of color
disagreements have been there against the application of CV
deficient observers. They have pointed out the need for tests
standards to pilots, and one of the more difficult tasks of the
that can reliably measure the range of chromatic sensitivity as
issue is that there is no universally agreed threshold between
well as variability expected to be present in the color normal
safe and unsafe degrees of CVD.
population.[4]
At present, color screening methods employed by most
In India, the Ishihara chart and Martin Lantern test is widely
authorities of civil aviation does not measure exactly the
used as a differentiation between trichromats and red‑green
severity of color vision deficiency, and this makes authorities deficiency. However, currently, in many of the western nations,
and examiner difficult to set cutoff values for the pass or fail
limits. Barring few exceptions as well as in day to day practice,
This is an open access journal, and articles are distributed under the terms of
the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License,
which allows others to remix, tweak, and build upon the work non‑commercially,
Department of Ophthalmology, Command Hospital, Air Force,
as long as appropriate credit is given and the new creations are licensed under
Bangalore, Karnataka, India the identical terms.
Correspondence to: Wg Cdr (Dr) Atul Kumar Singh, Associate Professor
(Ophthalmology), Command Hospital (Air Force), Bangalore ‑ 560 007, For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
Karnataka, India. E‑mail: draksingh78@gmail.com
Received: 09-Jul-2020 Revision: 08-Sep-2020 Cite this article as: Singh AK, Khan MA, Singh A, Maheshwari A. Color vision
in civil aviation. Indian J Ophthalmol 2021;69:1032-7.
Accepted: 06-Oct-2020 Published: 30-Apr-2021

© 2021 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow

May 2021 Singh, et al.: Color vision
in civil aviation 1033

the lantern tests have been replaced or augmented by newer yellow lower field. The test has two stages. First, the individual
methods which can to some extent quantify the deficiency. dominant eye is determined and the dominant eye (right,
left) is fully tested followed by others. This is to ensure the
An ideal color vision test must  (a) provides reliable
same deficiency. This also hints that color vision deficiency is
isolation of different color signals and gives the numerical
congenital or acquired only in one eye due to different retinal
value of the severity of color vision loss, (b) should be based
pathologies. The test is started after familiarization with the
on population‑based data of different races and countries
instrument and its controls, then the subject is asked to adjust
that have statistical limits of color discrimination in “normal”
both the control knobs (present at base) until the two halves of
trichromats, so that only those who are outside the range
the circle match completely in terms of color and brightness.
only are deemed anomalous (c) has sensitive enough to detect
Examiner has to “spoil” the match after each test. The interval
“minimal” deficiencies and to classify them exactly and (d) can
between each match is about ten seconds. The room is dimly
be monitor “significant changes” in color sensitivity with the
illuminated. In between each match, the subject looks away
aging process of humans.
from the instrument into the dimly lit room for a few seconds.
Apart from Pseudo‑isochromatic Plate Test  (for example, This exercise is done to minimize the effect of chromatic after
Ishihara plates, Dvorine plate test, AO Hardy‑Rand‑Rittler, images developed during the mixing of colors. The second stage
AO Hardy‑Rand‑Rittler, Tokyo Medical College Colour) and of the test begins to measure the limits of the matching range
lantern test  (examples are—Marin Lantern, Eldridge‑Green of colors. The earlier matches made by the subject taken as
Lantern, Holmes‑Wright Lantern, KBB—Martin Colour Vision reference points. This reference point set the red‑green mixture
Testing Lamp), others methods commonly used across the ratio near to the estimated limits of the range. After setting the
world are‑ reference point, the subject is asked to change the luminance
of the lower yellow half of the field for exact “match” in color
1) Farnsworth D-15 Test: The D‑15 test is a so‑called as well as in brightness in the upper half. This gives matching
arrangement test [Fig. 1]. The test objective is to set the colored range and limits of subject.
plates or discs to be arranged correctly. Individuals who are
color blind will find it confusing to arrange the given colors The Heidelberg Multicolour Anomaloscope  (HMC)
in a set pattern and make mistakes. Discs that are placed on is a new prototype of an anomaloscope that can also
the wrong side of the circle are considered a major error. Discs diagnose the blue‑green disorder. The instrument uses a
placed in a side to side position on the same side of the circle microprocessor‑controlled device for precision diagnosis of
indicate a minor error or normal confusion. If the individual color vision in the red, green area  (Rayleigh equation) and
makes two minor errors that can be taken as within normal the blue, green area  (Moreland equation) with integrated
limits and 2 or more major errors are considered outside the automatic neutral adaptation. Another added advantage over
normal range. Based on mistakes done by the subject and the other anomaloscopes is that it generates results automatically,
resultant confusion vector, the type of color blindness, and as thus eliminating the need for a skilled technician.
well its severity can be calculated.
4) Color Assessment and Diagnosis (CAD) Test‑The CAD
2) Aviation Light Test (ALT): The Aviation Lights Test is test has been recommended in an earlier CAA record of the
one step‑up version of Farnsworth Lantern Test[5] designed USA.[8] It has a calibrated visual monitor display. It projects
to meet the   FAA's (Federal aviation administration)   signal colored stimuli of precise chromaticity and saturation. This
color (USDOT‑FAA, 1988)[6] and International Civil Aviation colored stimulus presented moves along each of the diagonal
Organization (ICAO, 1988)[7] specifications for the red, green, directions of visual display  [Fig. 4]. The subject seats have
and white signal light colors on aircraft. The instrument has four buttons. The main objective of the subject is to report the
a total of nine vertically separated pairs of colored lights direction of motion of the color‑defined stimulus by pressing
presented to the candidate, who has seated 8 feet away from buttons at a measured distance. Randomly staircase procedures
the lantern [Fig.  2]. The vertical distance between the two are used to adjust the intensity of the color signals. The intensity
apertures is 1.3 cm or 18.3 min of arc. Three basic colors (red, of the color is automatically adjusted by computer‑controlled
green, and white) are projected from the aperture. A total of software according to the subject’s responses. This determines
27 presentations from the aperture. Before the test begins, thresholds for the color detection of red‑green and yellow‑blue
basic three test light colors are shown to candidates from the colors. The CAD test has several advantages over the
aperture for familiarization. The test requires a very dim room conventional test. This test can isolate the intensity of color
that simulates the approximate light level of the air traffic signals more accurately.
control (ATC) tower at night.
5) Precision Approach Path Indicator (PAPI) Simulator
3) Anomaloscope: The principal of anomaloscope is based Test: The PAPI is probably the most important and safety‑critical
on color matching and has turn out to be a standard test for task in aviation that relies mostly on color vision. The PAPI
identifying and diagnosing red, green color deficiency in system has four lights arranged horizontally and installed at
developed countries [Fig. 3]. The instrument produces a disc 90° to the runway. The nearest light some 15 m away from the
size stimulus that is divided into two halves of the same area edge. Each light is 30 cm in diameter with an inter‑ separation
and is viewed in an optical system. The upper half of the disc between light is 9 m. The unit is divided into two halves, red
is illuminated by a mixture of red and green lights, and the in the lower half and white in the upper half. The aircraft
lower half of the disc is illuminated by spectrally narrow yellow approach on the runway gives different elevation angles
light. In the base, two control knobs are placed, the upper with a combination of red and white lights. On a particular
knob is to change of the red‑green color mixture ratio of the slope, all lights visible as red if the aircraft is too low, and
top field, and the lower knob is to change the luminance of the all‑white if it is too high  [Fig.  5]. PAPI simulator test is a
1034 Indian Journal of Ophthalmology Volume 69 Issue 5

specific task test for the subject that is aimed to quantify the are presented randomly [Fig. 7]. When carrying out the PAPI
severity of a pilot's color vision deficiency which is still safe to simulator test, observers were required to report the number
fly. This simulator uses controlled laboratory environments.
A simplified laboratory setup was developed to reproduce the
actual environment of the PAPI tests [Fig. 6]. PAPI simulator
test simulates the photometric as well as the angular subtense of
the red and white lights under demanding viewing conditions.
A dark background is created for this purpose. The aim of this
simulator test to make a real‑time scenario and to identify the
type and severity of color blindness. Simulator test has four
horizontal lights that are presented for 3 s and the subject’s
job is to simply report the number of red lights in the display.
Figure 2: Aviation light test
There are five possible combinations of red and white lights that

Figure 1: Farnsworth D15 test

Figure 4: Color assessment and diagnostic test

Figure 3: Anomaloscope

Figure 5: The precision approach path indicator (PAPI) signal lights Figure 6: Schematic representation of PAPI simulator test designed
are used to inform pilots of the correct glide path for landing in the Lab
May 2021 Singh, et al.: Color vision
in civil aviation 1035

of red lights using the following names: one, two, three, four, 7) Operational Color Vision Analysis  (OCVA): This test
or zero (to avoid confusing “none” with “one”). Before the test, has two components: ground and flight assessment. Each
observers were dark‑adapted to the low mesopic surround assessment is carried out initially by day and maybe repeated
and then presented with a practice run before starting the test. at night for those subjects who wish to remove the limitation
of night flying. It is a two steps process: a) single light test—It
6) Rabin Cone Contrast Test (RCCT): The RCCT is a unique
is administered on the ground at an airport ATC tower. It’s a
test designed to diagnose rapidly as well as to see the severity of
live test where red, green, and white colors of 12 light signals
congenital CVD and is the only color vision test adopted by the
are projected from an air traffic tower (six from 1000 feet and
US Air Force.[9] The test is sensitive enough to detect the severity
six from 1500 feet). The signal would be shown for 5 s and after
of cone deficiency. RCCT uses a randomized red, green,
that candidates are allowed to answer in 5 s. b) Chart reading:
and blue color letters visible to a single cone type (long [L],
aeronautical charts are displayed in the table and candidates
medium [M], short [S]). Contrast is decreased in reducing steps
have to read and correctly interpret various sizes, terrain colors
to measure the final threshold for letter recognition. Hence, this
in a time‑bound manner.
is a very specific color vision test designed to diagnose rapidly
and easily to identify the type and severity of congenital CVD Discussion
too.[10] However, CCT scores in the elderly could be affected by
normal age‑related changes including senile miosis, ganglion The lack of uniformity in testing color vision across the world
cell loss, any slight misalignment of cones, and cognitive continues to be a cause for confusion and dispute. It is not
decline.[11] A score of 75 or greater was defined as normal in uncommon for a subject to fail the color vision assessment by
the RCCT. RCCT begins with one eye in a dark room with a one testing method in one country and to pass in another by
distance of 1 m with corrective glasses to be worn. After giving a different testing method. However, this is not completely
a demonstration of L, M, and S letter appearance on the central unexpected if we take intersubject variability, the different
location on the display to the subject, the test starts with a factors  (environment, lighting condition of the same test,
random series of 20 red letters (L), followed by green letters (M), contrast, and hue of testing instruments that can contribute
and then violet letters (S) progressing from most visible down to loss of chromatic sensitivity), and other characteristics of
to least visible  [Fig.  8]. The program randomly uses letters the various color vision tests. This also aids confusion among
from Bailey‑Lovie Early Treatment Diabetic Retinopathy applicants and allows them to attempt several tests to pass one
Study (ETDRS) visual acuity chart[12] (H, N, V, R, U, E, D, F, P, of the many color vision standards. Different countries have
Z) The font of the letter is Arial bold. On each trial, the program adopted peculiar methods for testing color vision.[13,14] In India,
presents a colored letter centered within a crosshair on a grey currently, pseudoisochromatic plates (Ishihara) and the Martin
background. The time interval between the appearance of the Lantern test (MLT) are the most common color vision testing
letter is 1.0 to 1.6 s (duration increases as contrast decreases), methods used by both military and civil aviation.[15] As pointed
followed by an equal duration of the grey field. During this out, these are not error‑free, even in the normal individuals
grey field duration, the subject is required to read the letter and going for color vision test by these methods.[1] In fact, the
then the program goes to the next stage. The technician records International Civil Aviation Organization  (ICAO) manual
the letters that have been read correctly and those missed. For clearly states that color plates can be too discriminating.[16]
each testing color, the number of errors done in projected 20 MLT is a very old device and commercially not available. The
letters is entered into the in‑built software which calculates and unique lantern design and form have not changed very much
gives a printout for the L, M, and S cone scores. Time taken to since their origin in the early 20th century.[17] To overcome this
complete this test is 3 min per eye. problem, computerized testing of color vision was innovated
and it was found that the computer made software able to
reproduce results comparable with the existing MLT.[18] As

Figure 7: The PAPI Simulator test presents five different conditions

(as shown) 12 times giving a total of 60 presentations Figure 8: Rabin cone contrast test
1036 Indian Journal of Ophthalmology Volume 69 Issue 5

far as newer equipment is concerned, the anomaloscope is were on the flight deck. One, the first officer, was color vison
considered as the gold standard for color vision testing in deficient though he had passed the necessary clinical lantern
clinical research.[19,20] The Nagel anomaloscope test is excellent test to be issued an unrestricted license. The remaining two
at distinguishing between red, green deficiencies, but fails to pilots had a normal color vision. The aircraft was on a visual
quantify reliably the amount of color vision loss, and does not approach at night and descended in a nonstabilized approach
test for yellow, blue deficiency.[21] In India, Khan et al. compared to descend shortly of the runway. The investigation by the
four different methods of color assessment on military as civil National Transportation Safety Board (NTSB) listed CVD as a
pilots aspirants. The author pointed out that the results of MLT contributory factor beyond crew fatigue. From 2004 to 2008 in
are questionable when testing is being done at 1.5 m compared the United States, there were only two occasions on which it
to other instruments. Authors have also suggested that MLT was reported that CVD pilots entered controlled or restricted
should not be used as the sole criterion for distinguishing air space without the necessary clearance.[33]
severe color deficiency. The results of MLT should be read very
carefully and should use other diagnostic tests for color vision The above incidents do not mean that every color vision
such as the anomaloscope before declaring MLT results.[22] deficient should be barred from flying but only emphasize
On the contrary, studies also have shown that different types the need to establish standards that can be considered safe to
of lanterns have many disparities and conflicting results.[23] fly. Multiple reviews by the Administrative Appeals Tribunal
Passing the Lantern test itself may not be a good idea for of Australia, and further supported by relevant research from
acceptance in civil aviation and night flying. In another the United Kingdom CAA and the United States FAA and
study conducted by Cole et al., more than 80% of errors were others, have consistently demonstrated that certain CVD
found in the PAPI signal test in deficient color vision (DCV) aircrew can perform operational tasks as competently as
who had passed the Farnsworth lantern test during initial those with normal color vision individuals. North Atlantic
entry[24] New Zealand aviation had adopted a new approach Treaty Organization  (NATO) recommends that CVD
to color vision. It has three stages: stage 1—color vision test by assessments should evaluate the capacity or competency of
Ishihara plates. If the subject clears the Ishihara chart, then no an individual to crew aircraft and not their ability to complete
restrictions on their medical certificate. Stage 2—If the subject clinical diagnostic tests.[34] In 2001, NATO has made special
is unsuccessful in stage1, he can opt for the Holmes‑Wright software (PROPOCAT), which assesses the candidate's color
lantern test, Farnsworth lantern and Anomaloscope, CAD test, vision based on a combination of colored puzzles, colored
or Farnsworth D15 tests. If he passes in any one opted vision mazes, and aeronautical images. The relevance of the colored
test, he will have no restrictions, if found unsuccessful they puzzles and mazes to aviation is however not clear and
will have restrictions on their certificate. Stage 3—this stage therefore this system does not appear to have been adopted
is for unsuccessful candidates in stage 2. The last option is by many nations.[35]
to take the operational color vision assessment (OCVA). The
OCVA allows subjects to be assessed in daytime or day and
Conclusion
night time both  (for night flying clearance) on the ground This review article aims to stimulate policymakers to adopt new
and in the air.[25] In the UK, those failing the Ishihara test will methods for accurate assessment of color vision in India at par
need to take the CAD test and to pass as “normal trichromats” with world standards and to see for a scope of evidence‑based
to gain a class 3 certificate. In other European countries, guidelines for minimum color vision requirements for flight
those that fail the Ishihara test can opt to be examined on crew in civil aviation. In the Indian context, MLT is sparingly
the anomaloscope (Nagel or equivalent). The UK CAA does available commercially and older models have not been under
not trust in lantern testing as evidence of being color‑safe.[26] service maintenance for years. This makes MLT even more
Whereas US FAA does not accept the D15 test for ATCs and questionable. Many countries have done away with MLT and
airmen but FAA seems to more liberal as it allows to get adopted other alternative lanterns or instruments. The present
a pass from any one of the 14 kinds of instruments from discrepancy in color vision testing methods and standards
different manufacturers and, as a result, more color deficient demonstrates the need of the hour to adopt more objective
applicants pass.[27] If we analyze large data, 84% of states use assessment techniques at par with developed countries and to
Ishihara plates as the first choice but the number of plates set minimum color vision requirements that are both safe and
required to be passed widely varies in the different regions.[28] fair to the civil aviation applicants. Therefore, in the Indian
In secondary methods, 47% uses different types of lanterns context, this requires evaluation of newer tests to augment
whereas 31% uses anomaloscopes.[28] In India, the DGCA occupational tests with quantitative tests as well as designing
manual uses Ishihara as a first screening method followed by algorithms for assessment on color‑coded tasks relevant to the
MLT as a second screening procedure as per Indian Air Force aviation environment.
guidelines.[15,29] This seems in line with the International Civil
Aviation Organization (ICAO) recommendations.[30] However, Financial support and sponsorship
MLT is only available in the armed forces clinics and very few Nil.
private hospitals. In scrutiny carried out at one of the aviation
Conflicts of interest
centers of Air Forces of India, of 69 flight crew for appeal
medical board at the highest echelon in India, three cases There are no conflicts of interest.
were found to be color defective.[31] There have been several
reports of color vision deficiency contributing to air incidents
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