Level of Visual Acuity Necessary to Avoid False-Positives on the HRR and Ishihara Color Vision Tests

Abstract

Purpose Minimizing false-positives (FPs) when evaluating color vision is important in eye care. Identification of plate 1 (demonstration plate) is often considered a way to avoid FPs. However, few studies have quantified the minimum level of visual acuity (VA) that would minimize FPs for the Ishihara and HRR color tests. Methods Threshold levels of optical defocus were obtained from 25 color normal subjects. Blur levels were obtained for Ishihara (38 plate) plates 1, 10, and 15 and 4th edition HRR plates 1, 7, 10, and 20 using the method of limits. Corresponding VAs were measured through these blur levels at 40 centimeters after adjusting for the dioptric distance difference. Analysis of variance testing was used to analyze the data. Results Mean optical defocus values in diopters (mean ± SD) for HRR plates 1, 7, 10, and 20 were 6.23 ± 1.61, 1.23 ± 1.16, 2.41 ± 1.31, and 7.96 ± 2.03, respectively, and for Ishihara plates 1, 10, and 15 were 5.70 ± 1.52, 3.68 ± 1.71, and 4.62 ± 1.56, respectively. There was a significant difference between the screening and demonstration plates for both tests (p<0.001). Conclusions Based on the plate in each test that was found to be the least tolerant to blur, the average minimum VAs needed to identify the screening plates were approximately 20/180 for the Ishihara test and 20/50 for the HRR test. Identifying the demonstration plate in the Ishihara and HRR tests does not ensure FPs will be avoided.