Kathryn Albany-Ward, Founder of Colour Blind Awareness
You might be surprised to learn that colour blindness can be considered both a disability and a Special Educational Need but despite this it is an under-recognised and poorly understood condition.
Let’s start by being honest. Do you screen children for CVD on first visit as a matter of course? If you do screen, once you’ve given a patient a diagnosis of colour blindness, how often do you think about the impact this will really have on their everyday life? Do you think it’s condition which isn’t really that important?
Have you ever wondered how the street outside your premises might appear or the immediate challenges they might face just to get home? If they are a child, how might they see their classroom? How might their confidence and even their mental health be affected?
I’ll be honest. When I found out my brother-in-law was severely colour blind I didn’t give it more than a passing thought. But when my son was given the same diagnosis, boy did I sit up straight and take notice! Why? Because I’d gone straight to Google and looked it up. When I saw the world through my son’s eyes, I was horrified to realise what he would be missing throughout his entire life. At the time he was just 7 and I was especially worried about the potential impact upon him in school.
As we’re in December I thought it might be good to theme this blog around Christmas. Of course, people with CVD have problems with many other colour confusions, but as so much of Christmas for colour ‘normals’ relies on the ability to see the difference between red and green, what better time of year could there be to consider colour blindness?
We received our son’s diagnosis in December. Just afterwards I asked him what colour Father Christmas’s outfit was, and he replied ‘Brown, why?’. I must admit to having a little tear in my eye. At the best time of year for little children I was sad to realise my son couldn’t experience it in the same way as most children.
Normal colour vision Deuteranopia simulation
Here’s my (lucky) son aged 4 meeting the ‘real’ Father Christmas at his home in Lapland. The simulation is very close to how my son sees. He’s 16 now and I’m still sad to think he’ll never see Santa in the same way I do.
What is colour blindness?
At the risk of teaching grandmothers to suck eggs, in simple terms colour blindness is (usually) an inherited condition affecting ability to perceive colours normally. It’s caused by ‘faulty’ gene-sequencing in the DNA of the X-chromosome.
We have 3 types of nerve (cone) cells in our retinas. Each cone type is responsible for detecting either red, green or blue light. In colour blindness the faulty gene sequencing means one cone type is unable to decipher light wavelengths correctly. Consequently, the brain receives incorrect information and can’t properly interpret colour, so someone with CVD is not able to distinguish between colours normally. There are different types (depending upon the cone type affected) and severities of CVD, ranging from mild anomalous trichromacy – protanomaly (red deficiency), deuteranomaly (green deficiency) and tritanomaly (blue deficiency) – to dichromatic vision (where one of the cone types is completely missing) – protanopia, deuteranopia and tritanopia.
Approximately 25% of people with red/green types of CVD have dichromatic vision, 25% have a mild anomalous condition and the remaining 50% can have a severity ranging somewhere between the two extremes.
The rare forms of colour vision deficiency – tritan (blue) deficiencies and monochromacy affect just one person in approximately 40,000-50,000 people, but red and green deficiencies are very common, affecting almost 5% of the population.
Colour blindness can also be acquired as a side effect of some diseases e.g. diabetes, sickle cell anaemia, some drugs and due to general aging. Depending upon the cause acquired CVD can sometimes be reversed. There is no cure for inherited CVD.
What Do Colour Blind People See?
The visual acuity of people with inherited CVD isn’t affected, so because they see clearly and in focus and have never seen any other way, people with CVD are often shocked to discover they are colour blind. It’s not unusual for people to be diagnosed well into adulthood. A common time to receive this unwelcome diagnosis is having a medical for a dream job, perhaps for the Forces or the Fire Service.
It’s a common misconception that people with CVD only confuse reds and greens – in fact plenty of people either believe people with colour blindness only see in greyscale or that a colour blind person sees red as green and green as red! In fact, some very common mix-ups include blue with purple, red with black, lime green with orange and pink with grey.
In short, many different colour combinations can cause confusions and this can cause problems across all aspects of daily life, but in school and careers it can be a serious issue. For this reason, it is vital that children with CVD are diagnosed as early as possible.
Colour vision screening in schools
You may not be aware that colour vision screening is no longer undertaken in schools, having been removed from the Healthy Child Screening Programme in 2009, following the Hall review.
Screening was removed with no notice, no fanfare, no attempt to ask optometrists to take up the slack. No-one told schools about the implications for undiagnosed children and no-one told parents this screening would cease. Bizarrely this decision was undertaken based upon ‘evidence’ gleaned from the cohort of children born in 1958 who went to school in a time of blackboards and white chalk, black and white TV, no internet, before exam papers had colour insets, before interactive whiteboards, and before the widespread use of educational resources in full colour.
In the summer of 2018 the Association of Optometrists launched their #ABSee campaign to encourage parents to take their children for vision tests over the summer holidays. The campaign revealed that (according to the AOP’s research)
- approximately 25% of children have never had an eyesight test, and
- over 50% of parents mistakenly believe that children have a full eyesight test in school
but this research did not appear to consider how many children have had a colour vision test.
We were delighted to discover that the research confirmed findings from our (Colour Blind Awareness) ongoing study of pupils. Our study involves over 1,200 children from Key Stage 2 (approximate age 7) upwards, across all school types and all socio-economic backgrounds. Our study consistently shows that by the time they are starting secondary school at age 11, 80% of pupils have never had a colour vision test.
The conclusion, as three quarters of children have had an NHS eye test, must be that many optometrists are not screening children for CVD on first visit as a matter of course.
Combine this information with the fact that most teachers have never received any training in colour blindness and so don’t have the skills to spot pupils who might be colour blind and we have a whole generation of children with colour blindness who are not receiving any support at all in school.
The modern classroom is usually not adapted for colour blind pupils. Simple techniques such as ensuring all colour pencil crayons are labelled with their colour name could make life easier for colour blind children and avoid confusions such shown in this Christmas worksheet below. Making fundamental mistakes like this can affect confidence and wellbeing at a young age. The effect of being colour blind on wellbeing for education and careers has recently been proven by Dr John Barry (see below).
Normal colour vision Deuteranopia simulation
The Association of Teachers and Lecturers union surveyed their Members in 2015 to find out how aware they were of colour blindness and its effect upon ability to learn. The results were surprising because they revealed only 15% of respondents said they had one or more pupils in their setting requiring support because of colour blindness.
This is clearly at odds with the statistical occurrence of (inherited) colour blindness which affects 1 in 12 boys and 1 in 200 girls or, put another way, at least one child in every UK (co-educational) class (of 30).
Statistics
- Colour vision deficiency (CVD) affects 8% 0f boys but only 0.5% of girls
- Boys are up to 16 times more likely to have CVD than girls
- CVD affects approximately 3m people in the UK
- There are about 450,000 CVD pupils in UK schools
Unfortunately, as parents and teachers are not advised that their children are no longer screened for CVD, they don’t think to look out for the tell-tale signs. For a parent a child’s CVD diagnosis can come as a nasty shock. It was certainly a shock for us!
Normal colour vision Protanopia simulation
Christmas time offers a perfect opportunity for parents and teachers to spot young children with CVD as they often made mistakes with Christmas colours - painting a brown Santa or Christmas tree, colouring a purple sky over a snowman with a green carrot nose, or not realising their Rudolph mask has a black nose instead of a red one.
Why colour matters in school
In education colour is an important tool, but for colour blind students it can be a nightmare. As well as undermining confidence, it encourages basic errors, making children slower to follow instructions and causing frustration and even anger.
When children start school they are asked to describe the big brown dog, fill in colouring sheets and sing songs about the rainbow. If children don’t understand some of what is being said, then can’t learn properly.
As they progress through school, they must interpret coloured maps and graphs; colour is used to highlight information in Science, Art, Maths, Food Technology, IT, Economics, even in languages/History/English. It’s a big problem in sport (see football guidance link here).
In 2018 you might be surprised to learn that many GCSE and A Level exam papers had colour insets which colour blind pupils could not decipher properly. This can cost them the grades they need to get into their chosen University course or career. Without a diagnosis a CVD pupil won’t be able to access the support they are entitled to for their exams.
So, we need to see a widespread movement towards optometrists recognising the importance of screening everyone for colour blindness on first visit and to provide those diagnosed as CVD with some simple advice to take home. Did you know, for example, that many children diagnosed as ‘colour blind’ worry that they are going to lose their sight entirely over time? This means terminology used at the point of diagnosis is extremely important.
One final point on the Christmas theme. Tins of chocolates can put a colour blind child with a nut allergy at serious risk. Many manufacturers use confusing for chocolate wrappers and the issue comes up on our Twitter feed with annual regularity – colour blind adults venting their frustration about picking out chocolates they don’t like because they can’t tell the difference. But imagine if a colour blind child with a severe nut allergy picked one out which contained nuts. No one wants that on their conscience!
Normal colour vision Protanopia simulation
Resources
www.colourblindawareness.org –general information - advice for parents and teachers, articles etc.
Sport – The FA’s Guidance Notes and a The Colourful Game video mini-documentary here
Dr John Barry’s research on impact of colour blindness upon quality of life
NHS: Colour vision deficiency (colour blindness)
Twitter @colourblindorg
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