Color Vision Deficiency May Affect Diagnosis of Choroidal Conditions

An international study led by Dr. Yacoub A. Yousef, an ocular oncologist at King Hussein Cancer Center, reveals that color vision deficiency (CVD) can affect an ophthalmologist’s ability to differentiate between choroidal melanoma and choroidal nevus, potentially leading to misdiagnoses.

The study included 41 participants who were shown both simulated and non-simulated fundus images of a normal eye, choroidal nevus, and choroidal melanoma. These images were modified for the three primary types of CVD: protanopia (red color blindness), deuteranopia (red-green deficiency), and tritanopia (blue-yellow deficiency). While all participants were confirmed to have normal color vision, the study simulated CVD conditions to analyze how it would impact their diagnostic accuracy.

The study found that the participants had significantly lower success in identifying orange pigments in protanopia-simulated images and reduced accuracy in detecting melanotic lesions in deuteranopia-simulated images. This resulted in a high rate of misdiagnosing benign choroidal nevi as malignant choroidal melanoma in both simulated protanopia (37%) and deuteranopia (41%) images. Despite this, almost all simulated images of choroidal melanoma were accurately referred for oncological treatment, demonstrating that CVD primarily affected the diagnosis of benign lesions.

Implications for Ophthalmology

The findings emphasize the unique challenges CVD presents in ophthalmology, where accurate color perception is critical for clinical diagnosis and imaging interpretation. Misdiagnosis due to CVD could lead to unnecessary referrals and potentially increased morbidity for patients with benign conditions. Importantly, the study highlights the need for further research into the clinical implications of CVD in eye care professionals to better understand how it may affect diagnosis and treatment in real-world settings.

The researchers stressed that while CVD impacted the ability to distinguish between benign and malignant conditions, eyes with choroidal melanoma were still correctly identified and referred for specialized treatment in most cases. Further investigation is needed to assess the broader clinical significance of these findings and to explore solutions that may help ophthalmologists with CVD make accurate diagnoses.

Conclusion

This study highlights the potential challenges that color vision deficiency may pose for eye care professionals, especially when distinguishing between conditions such as choroidal melanoma and choroidal nevus. While CVD remains an often overlooked issue in ophthalmology, its impact on clinical decision-making could lead to unnecessary interventions and emphasize the importance of further research in this area.