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Know About Congenital Red–green Color Blindness

Omar Setty

[Reading Time : 5 min | Date : 23, February 2023 | Author : Omar Setty ]

Many people aware of Red-green color blindness. Most people with this type of color blindness inherit it from their mothers. Children are more likely to inherit red-green color blindness because only their mother can pass it on. Girls to have this type she must inherit this trait from her mother and have a red-green colorblind father.

You can also develop red-green deficiency due to eye diseases that damage the retina or optic nerve. There are variety of blindness test that helps you to know about your color blindness.

Red-green blind people tend to confuse violet and blue as well as green, orange and red. Deuteranomaly, protanomaly, protanopia, and deuteranopia are types of red-green color blindness. We will learn about red-green color blindness in detail in this article.

Congenital red–green color blindness is an inherited condition that is the root cause of the majority of cases of color blindness. It has no significant symptoms aside from its minor to moderate effect on color vision. It is caused by variation in the functionality of the red and/or green opsin proteins, which are the photosensitive pigment in the cone cells of the retina, which mediate color vision.

Males are more likely to inherit red–green color blindness than females, because the genes for the relevant opsins are on the X chromosome. Screening for congenital red–green color blindness is typically performed with the Ishihara or similar color vision test. There is no cure for color blindness.

This form of colorblindness is sometimes referred to historically as daltonism after John Dalton, who had congenital red–green color blindness and was the first to scientifically study it. In other languages, daltonism is still used to describe red–green color blindness, but may also refer colloquially to color blindness in general.


The only significant symptom of congenital red–green color blindness is deficient color vision (color blindness or discromatopsia). Colorblindness is caused by congenital red–green colorblindness, so the condition and symptom are often difficult to untangle.[citation needed] A red–green color blind subject will have decreased (or no) color discrimination along the red–green axis. This commonly includes the following colors of confusion:

  1. Cyan and Grey
  2. Rose-Pink and Grey
  3. Blue and Purple
  4. Yellow and Neon Green
  5. Red, Green, Orange, Brown
  6. Black and Red (protans)


Congenital red–green color blindness is classified into 1 of 4 groups:

  • Protanopia
  • Protanomaly
  • Deuteranopia
  • Deuteranomaly

Each of these groups comprises a prefix and a suffix. The prefix indicates the cone (photopsin) that is affected, with lexemes from Greek, "first" (prot-) or "second" (deuter-) referring to the L- and M-opsins respectively. The suffix indicates the dimensionality of color vision:

  • Dichromacy gives the suffix -anopia (from the Greek for "no sight")
  • Anomalous trichromacy gives the suffix anomaly (from the Greek for "irregular").


The dimensionality of normal color vision is trichromatic. This references that a visual system with three distinct cone classes and therefore a three dimensional gamut. Dichromatic color vision only has two distinct cone classes and therefore a two dimensional gamut.

With red–green dichromacy, it is the dimension representing the red–green opponent channel that is lost. Anomalous trichromacy is also trichromatic, but the spectral sensitivity of at least one of the cone cells is altered, leading to a gamut that is a different size or shape.

In the case of congenital red–green color blindness, the dynamic range of the red–green dimension is decreased when compared to normal color vision.

The dimensionality of the defect is related to the strength/severity, but it is usually much easier clinically to define the severity empirically as mild, moderate and strong (or severe). Anomalous trichromacy can vary in severity from indistinguishable from normal color vision (mild) to indistinguishable from dichromacy (strong).

Therefore, the differential diagnosis between anomalous trichromacy and dichromacy is difficult. An example clinical diagnosis would be strong deutan, which could correspond to either deuteranomaly or deuteranopia.

Protan vs. deutan

The two types of congenital red–green color blindness as based on the affected cone are:

Protan: (2% of males): lacking, or possessing anomalous L-opsins for long-wavelength-sensitive cone cells.

Deutan: (6% of males): lacking, or possessing anomalous M-opsins for medium-wavelength-sensitive cone cells.

Despite often being called red-blind and green-blind respectively, protan and deutan varieties have very similar phenotypes (color vision), especially when compared to tritan color blindness.

The condition is not called red–green color blindness because red and green are indicative colors of confusion, nor because the "red" and "green" cones are affected, but because the red–green opponent process channel is affected. In dichromacy, that channel is equally deactivated regardless of which cone (LWS or MWS) is missing.

In anomalous trichromacy, that channel is equally affected regardless of which cone effectively moves towards the other. The starkest difference is the scoterythrous effect, where reds appear dimmer to protans.

This is why protans often confuse red with black, while deutans do not. The protan luminous efficiency function is narrower at long wavelengths, which causes the reds to be darker. This is due to the red cones (which normally cover the red side of the spectrum) either shifting to shorter wavelengths or being missing.

The two are difficult to differentiate with color vision tests, but is most reliably performed with an Anomaloscope. This device measures the proportion of red and green light that must be mixed to perceptually match a yellow reference. Protans add more red than color normals, and deutans add more green.



The mechanism of congenital red–green color blindness relates to the functionality of cone cells, specifically to the expression of photopsins, the photopigments that 'catch' photons and thereby convert light into chemical signals.

A typical human has three distinct photopsins: S-, M- and L-opsins expressed by distinct genes, respectively OPN1SW, OPN1MW or OPN1LW. OPN1MW and OPN1LW are located in a gene cluster (along with a locus control region gene) at position Xq28, at the end of the q arm of the X chromosome in a tandem array.OPN1SW is unrelated to the condition and located on a different chromosome.

Differentiating from a duplication event 30-40 MYA, the two opsins are highly homologous (very similar), having only 19 dimorphic sites (amino acids that differ),and are therefore 96% similar. In comparison, either of these opsin genes are only 40% homologous to OPN1SW (encoding the SWS photopsin and located on chromosome 7) or "RHO" (encoding rhodopsin, and located on chromosome 3).

While the two genes share 19 dimorphic sites (amino acids that differ), only 7 of them lead to a functional difference between the genes, i.e. tune the opsin's spectral sensitivity. These 7 functionally dimorphic sites will tune the opsin to a higher (redshift) or lower (blueshift) wavelength.

The typical (most common) allele for the OPN1MW gene is blueshifted at every one of these dimorphic sites. Likewise, the typical allele for the OPN1LW gene is redshifted at every one of these dimorphic sites. In other words, the most common alleles of each gene that contribute to normal color vision are as far as part as they can be in the spectrum (about 30 nm) without novel point mutations.

Homologous recombination

During meiosis, homologous recombination between chromosomes of the same type may occur where they exchange a portion of their genes. The exchanged portions are generally equivalent (have the same genes) and this process is called equal homologous recombination.

Unequal homologous recombination occurs when the exchanged portions of the chromosomes are not equal, i.e. they don't break in the same spot. This recombination happens often at this locus because the OPN1LW and OPN1MW genes are adjacent and 96% similar.

When unequal recombination happens with breaks between the genes (depicted by blue lines), a gene can be essentially deleted from one of the chromosomes. This gene deletion leads to protanopia or deuteranopia (congenital red–green dichromacy).

When unequal recombination happens with breaks in the middle of a gene (e.g. between exons), chimeric genes can be created that contain portions of each of the OPN1LW/OPN1MW genes.

Chimeric gene

A chimeric gene contains exons contributed from the typical alleles of each of the OPN1MW and OPN1LW genes. Due to the similarity between the genes, these chimeras are always functional, but experience a spectral tuning, i.e. a change to the spectral sensitivity.

A chimera's spectral sensitivity will lie somewhere between the typical allele peaks (530~560 nm). These chimeric alleles are indicated with an asterisk, either M* or L*. Whether a chimeric gene is described as M* or L* is not based on whether they are closer in the spectrum to the typical M or L allele, but rather is the opposite of the other expressed gene.

This means the same chimeric gene could be labeled M* or L* depending on what other genes are in the gene cluster. An individual with protanomaly will have M and L* opsins and an individual with deuteranomaly will have L and M* opsins.

Gene duplications

Gene duplications are one result of the unequal homologous recombination. Either the OPN1LW or OPN1MW can be duplicated, though it is much more commonly the latter. Only 5% of X chromosomes contain multiple OPN1LW genes, but 55% contain multiple OPN1MW genes, sometimes as many as 4.

The duplicate genes are sometimes referred to with numerical suffixes, where the OPN1MW gene in the second position is called OPN1MW2. The duplicated genes are always in sequence and can consist of different alleles of the gene, but only the first gene of a duplicate series is ever expressed.

Blue-cone monochromacy

While blue-cone monochromacy exhibits much stronger symptoms than the congenital red–green color blindness (including total color blindness), it follows a very similar mechanism.

In most cases, unequal homologous combination must first occur to generate a genotype with a single L/M-opsin gene. Then that gene must experience a nonsense mutation to entirely deactivate it.

Omar Setty
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