ICD-10 Diagnosis Code:
Tritan Color Vision Defect
A genetic blue-yellow color vision deficiency that results from inherited blue cone pigment abnormalities.
People with an inherited tritan color vision have an abnormal or functionally absent blue cone photopigment.
Color is perceived because objects selectively absorb certain wavelengths of light while transmitting the other wavelength; and, the object will take on the color of the wavelength of light it transmits.
The perception of color is defined by three variables:
- Hue — the dominant wavelength of the light the object transmits
- Saturation — the absence of white
- Brightness — the intensity of the color
The retina contains two types of photoreceptors:
- Rods — used for vision in low light
- Cones — used for vision in bright light and for color vision
Color vision is a function of the retinal cones and each photoreceptor cell contains a specific type of photopigment. Normal color vision is trichromatic and is based on three types of cones that are maximally sensitive to light at certain wavelengths.
- Blue cones — sensitive to light rays of short wavelength (approx. 420 nm)
- Green cones — sensitive to light rays of middle wavelength (approx. 530 nm)
- Red cones — sensitive to light rays of long wavelength (approx. 560 nm)
Genetic tritan color vision defects appear in early infancy and once fully expressed, the defect remains stable throughout life. The defect is caused by a mutation of the gene encoding the blue retinal cone pigment. Blue-yellow color vision defects are not accompanied by any other ocular abnormalities and the retina appears normal. The defects are divided into subclasses based on severity and the type of missing or anomalous color cone receptor.
Structural Damage to the Eye
- Tritanomaly — normal blue and green cones plus anomalous red-like cones
- Tritanopia — blue and green cones only; no functional red cones
Tritanomaly is the milder form of the disease while protanopia reflects the severe form.
Functional Damage to the Eye
- Decreased color vision
- Most people with tritanomalous defects have no problem naming colors
People with tritan defects may be excluded from a variety of industrial, marine, air, rail, and military occupations that require the ability to distinguish blue and yellow colors. Although people with mild defects may be able to discriminate color, they may fail the strict requirements of color discrimination on extended color vision examinations.
The goal of the diagnostic evaluation in a patient with an tritan color vision deficiency is to accomplish the following:
- Differentiate whether the color vision defect is genetic or acquired
- Determine if the color vision defect is unilateral, asymmetric, or transient
- Prescribe a treatment program
- Most people with tritanopia perceive the visible spectrum as lacking blue, green, and yellow
- There is marked difficulty in selecting colored articles, materials, and foods
- Colors of the blue family may appear green
- Most people with tritanomaly can perceive colors but color saturation is weakened
- Color discrimination deficits vary widely in severity
Clinical Appearance of the Retina
There are no retinal changes associated with a genetic tritan color vision deficiency.
Color Vision Examination
Extended color vision testing divides people into two groups:
- The first group consist of people with normal color vision and slight color deficiency
- The second group consists of people with moderate or severe color deficiency
The most common test performed in clinical practice is the Farnsworth D-15 and the procedure can be accomplished using Konan’s ColorDx software. The test consists of fifteen colored bars and one fixed bar. The hue of each bar has been chosen so that adjacent bars have approximately equal hue differences. When the bars are arranged in order they form a hue circle. As a result, errors in hue discrimination can be made across the hue circle.
Acquired Color Vision Deficiency
Several eye diseases and clinical conditions affect a person’s color vision. These acquired color vision deficiencies are characterized by a reduction in a person’s ability to discriminate between different wavelengths of visible light. In contrast to genetic color vision defects, which are always bilateral, acquired color vision deficiencies can be monocular.
Common conditions that can affect a person’s color vision include the following:
- Normal age-related deterioration in chromatic discrimination ability
- Yellowing caused by cataract results in a loss of hue discrimination
- Diseases that result in a loss of foveal function
- Optic nerve disease
- Retinal dystrophies
- Neurologic disease
- Neurologic injury
- Visual field defects
- Common drugs and substances
The goals of treating a patient with a tritan color vision deficiency include the following:
- Differentiate between congenital and acquired color vision deficiency
- Differentiate between tritanomaly and tritanopia
- Prescribe a program to treat the manifestations associated with tritan color vision defects
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