Innovative Color Vision Testing (simultaneous congenital & acquired) Stuart P Richer, OD, PhD, FAAO Director, Ocular Preventive Medicine James A Lovell.

Innovative Color Vision Testing(simultaneous congenital & acquired)

Stuart P Richer, OD, PhD, FAAO

Director, Ocular Preventive Medicine

James A Lovell Federal Health Care Facility

Associate Professor, Family and Preventive Medicine, Rosalind Franklin University of Medicine & Science /

Chicago Medical School

North Chicago, Illinois 60064, USA

Assistant Clinical Professor, UIC Dept of Ophthalmology and Visual Science - Chicago 

[email protected]

AAO 11 Nov 2014AFOS

Rabin Cone Contrast Testby Innova Systems

• 15 Years of US Air Force research

• Published, Peer Reviewed

• Validated against Anomaloscope

• Innova Approved as Sole Color Vision Test for US Air Force

• Over 400 in Use Worldwide

• Colored letters stimulate single cone type / pathway

• Decreasing contrast steps detects cone function threshold

• Numeric scores provide Hereditary vs. Acquired discrimination

• Change over time metric

1 V Z N F U

2 F V N H P

3 R P F D U

4 Z E D H P

5 H R P E D

6 D R E Z U

7 N Z V E H

8 U V R N F

9 E R P D N

10 D V H F E

1 H V R N F

2 D R E Z U

3 N Z V E P

4 Z E D N F

5 H R P E D

6 F V N H P

7 R P F D U

8 V Z N F H

9 H P F D N

10 V H U R E

1 D R E Z U

2 F V N H P

3 R P F D U

4 N Z V E H

5 H R P E D

6 V Z N F U

7 Z E D H P

8 U V R N F

9 H P F D N

10 V N P U D

Red Cone Green Cone Blue Cone

Cone Contrast Sensitivity

Rabin Cone Contrast Test by Innova Systems

• A Color Vision Test Sensitive Enough to Detect Severity of Cone Deficiency

• Used to Detect and Monitor Acquired Color Deficiency– AMD– Glaucoma– Diabetic Retinopathy– MS– Parkinson’s Disease– TBI– Retinal Toxicity due to High

Risks meds such as Plaquenil

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80 90 100

CCT Score (right Eye)

CCT Score (left Eye)

> 2SD

Normal upper right quadrant

75

75

Green deficiency (n=183)

Red deficiency (n=43)

Normals (n=92)

Upper 5% color

deficients

> 5SD

60

60

> 5SD

In color deficiency and in normals

Color Normalvs.

Deficient

a

BLUE CONE LOSS1. Acquired blue cone loss occurs early in

eye disease, sometimes before visual field defect(s)

2. Very few blue cones: small amount of damage has large effect

3. Secondary to disease, trauma or toxicity

4. Often asymmetric

Rabin Cone Contrast in Eye DiseaseAcquired Color Deficiency

0

25

50

75

100

RedScore

GreenScore

BlueScore

0 0.5 1 1.5 2 2.5

Central Serous

Normal Eye

Rabin Log Score

Acquired Color Deficiency in Central Serous Retinopathy

normal range

Red cone

Green cone

Blue

Red cone

Green cone

Blue (Tritan)

Blue

RE & LE 20/20

Acquired Color Deficiency in Optic Neuritis

(Blue – Tritan)

0 20 40 60 80 100

Blue Cone Rabin Score

RE(20/15

VA)

LE(20/15

VA)

2 SDs

5 line decrease

Normal mean

Resolved Optic Neuritis

Right Eye•Tritan Defect•MRI & CSF—•Probable MS

170 ms

LE

RE

109 ms

170 ms

LE

RE

109 ms VEP

170 ms

LE

RE

109 ms

170 ms

LE

RE

109 ms VEP

Current Research• Military - Cases of Optic Neuropathy

– Identified with RCCT that was missed by all other equipment. – Cone recovery shown with RCCT.

• Military – Central Serous Retinopathy• Military – Traumatic Brain Injury

– Identified with RCCT

• Duke University – Dry AMD– Clinical Trial results: the AREDS 3 intermediate AMD group exhibited visual

dysfunction on the Rabin Cone Contrast Test, in the presence of normal visual acuity

– New clinical trial begins fall 2014

• Other: Diabetes , MS, Plaquenil, Alzheimers, Glaucoma, Macular Pigment Density Loss

Patient BenefitSimultaneous Hereditary + Acquired Color Vision Evaluation

1. Identification of patients at-risk for developing disease.

2. Earlier recognition and intervention of disease.

3. Rapid detection of disease progression.

4. Evaluation of treatment efficacy.

Improved Quality of

Care

Macular Health Center

• VEP………………………………….………….…$156.77• ERG……………………………………………….$184.67• Macular Pigment ……………………………$25.00

• OCT ………………………………………………..$50.73• Multi-Spectral Imaging…………………...$91.41• Rabin cone contrast sensitivity………..$67.28• Gene Testing – Macula Risk,99213…. $81.30

• Total per Patient…………..………………...$657.16• x 50 patients/year……………..……....$32,858.00

Rabin Cone Contrast TestEye Disease Detection and Monitoring

byInnova Systems

AFOS Room FAAO Booth #314

[email protected]