Medical Hypothesis, Discovery &Innovation

Ophthalmology Journal

Innovation

A Modified Pseudoisochromatic Ishihara Colour Vision Test

Based on Eastern Arabic Numerals

Fatemeh Heidary MD, FICO; Reza Gharebaghi MD

Shahid Beheshti University of Medical Sciences, Medical School, Tehran, Iran

ABSTRACT
Congenital colour vision defects affect about 8% and 0.5% of the male and female population, respectively.
Pseudoisochromatic Ishihara plates have shown to be successful in an early diagnosis of colour vision
defects. This commonly used colour vision test was initially intended to identify those who suffered from
red-green aspect of congenital colour blindness; however, it may be of use to reveal acquired colour vision
defects as well. Despite the Ishihara plates’ value, there are a number of shortcomings in their current
layout. We proposing a new colour plate modified from original Ishihara test. To best assist illiterates who
are not able to read English, standard Ishihara plates have been translated to Eastern Arabic numerals,
which are used in most parts of the Middle East, Central Asia and Africa populations. The purpose of the
present modification was to present the new plates to these regions, but more research and study is
required to work on the validity, reliability, and repeatability of these new plates.

KEY WORDS
Colour blindness; Pseudoisochromatic Ishihara plates; Eastern Arabic numerals
©2013, Medical Hypothesis, Discovery & Innovation Ophthalmology Journal (MEHDI Ophthalmol).
This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0
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Correspondence to:
Dr. Fatemeh Heidary, Shahid Beheshti University of Medical Sciences, Medical School, Tehran, Iran, Tel/Fax: +98 21 22554500, Email:
Heidary@sbmu.ac.ir

INTRODUCTION Congenital colour vision defects affect 8% and 0.5% of

Visual impairment and blindness has remained as one of males and females, respectively on a global basis. The
the most important health issues in the Eastern high prevalence of colour blindness necessitates early
Mediterranean countries [1], as there are 40.5 million diagnosis, since these individuals with this disorder
living with visual impairment and 5 million afflicted with cannot accurately make colour discrimination which will
blindness which in some cases could have been impact their performance both personally and
prevented with prophylactic and screening measures. professionally [3]. Therefore, colour vision assessment is
World Health Organization has estimated the prevalence essential in a complete visual examination. Many tests
and causes of visual impairment in the region [2]. have been developed and distributed worldwide to
diagnose colour vision defects. Colour defect tests are

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 A MODIFIED ISHIHARA COLOUR VISION TEST BASED ON EASTERN ARABIC NUMERALS 84

performed mostly for three goals, the first for screening to administer. Clinically, there has been a controversy
for the presence of congenital or acquired defects, the regarding the Ishihara test with English characters in the
second to diagnose the type and severity of the defects Middle East countries especially for those who are
and the third to assess the impact of the defect on a illiterate and/or children. To overcome this problem,
specific profession or employment [4]. Generally Arabic numerals optotype were substituted in the new
speaking, a precise, easy, and cost effective test is plates.
needed to diagnose visual colour defects accurately [5]. In other words, English format of pseudoisochromatic
Many tests are used clinically to diagnose visual colour Ishihara plates were translated, modified and newly
defects, these tests range from simple Ishihara plates to designed based on Eastern Arabic Numerals to assist
more complex grading tests including Farnsworth- illiterates and children who are not able to read English.
Munsell 100-Hue test (FM 100-Hue), the D-15 In Middle East, most children are able to read Arabic
Farnsworth-Munsell (D-15), and an anomaloscope for numerals prior to school age since they have been
more accurate and precise diagnosis [6-7]. educated either in kindergarten or by their families. In
Pseudoisochromic plates are the most popular tests and addition, illiterates are more able to recognize Arabic
are used widely for screening purposes [8]. However, the numerals rather than English characters in these regions.
goal of this paper is not to evaluate the advantages and
disadvantages of different diagnostic tests although each
test has its own limitations.
The commonly used Ishihara test was first designed to
evaluate and identify red-green colour vision defects. Of
course, this test is not comprehensive in scope and
sometimes some individuals with the colour vision
defects may be missed [7,9]. The Ishihara test includes
one demonstration plate and 14 screening plates, which
present three numeral designs of vanishing,
transformation and hidden digits. Transformation with
cards number of 2 to 7, vanishing design 8 to 13 and
hidden 14 and 15 compose the Ishihara test [10].
On the other hand, many Arabic scripts and words are
used in other languages in Islamic world, like Persian,
Turkish, Malay, Hausa, Somali, Urdu, Hindi, Bengali,
Pashto, Kazakh, and Bosnian. Mostly the Middle East,
Central Asia and some African people are able to read
easily Arabic numerals rather than English scripts and
words. In this manuscript we present a new colour vision
test based on standard pseudoisochromatic Ishihara
plates to be used in the aforementioned regions more
effectively.

Figure 1. Demonstration colour vision plate based on Eastern Arabic

HYPOTHESES/IDEA numerals showing number 12 in the upper plate and number 8 in lower
Optometrists and ophthalmologists use specific tests in plate on random pattern of differently sized dots.

many different clinical circumstances. Ease of use,

validity and reliability, and also speed are among the
most important factors affecting the choice of which test

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 A MODIFIED ISHIHARA COLOUR VISION TEST BASED ON EASTERN ARABIC NUMERALS 85

Historically, numbers in each plate were surrounded by a ACKNOWLEDGMENT

random pattern of differently sized dots. In the new test, This work has been registered as an innovation by
demonstration (figure 1), disappearing, alteration, and Department for Registration of Corporation and
hidden diagnostic plates were used accordingly. The Industrial Property, Iran, Patent No.: 64101, March 30,
author recommended a standard Ishihara grade of 2010.
illumination for measuring or screening purposes, and
numbers were constructed on a common square grid. All
Arabic numerals were evaluated to choose the best ones DISCLOSURE
as well as the common optotypes between several
Conflicts of Interest: None declared.
languages in the region to be used for designing the
colour vision plates. These designed plates are only used
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children as well. This test should be administered to
normal patients, as well as patients with colour vision
defects like anomalous trichromats to assess its broader
use in future studies.
Furthermore, the new test’s ability to classify visual
colour defects also needs to be assessed. The new test
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in the aforementioned geographical region.

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