{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T14:10:10Z","timestamp":1789567810013,"version":"build-2803163510"},"reference-count":18,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["High Altitude Medicine &amp; Biology"],"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Patyal, Sagarika, Jasdeep Singh, Kanika Bhardwaj, and Uday Yanamandra. Determination of color vision in school children in high altitude, Leh, India.\n                      <jats:italic toggle=\"yes\">High Alt Med Biol.<\/jats:italic>\n                      00:00\u201300, 2026.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Color vision deficiency (CVD) is a heritable condition predominantly affecting males due to its X-linked recessive inheritance. High altitude may exacerbate color discrimination impairment through hypobaric hypoxia-mediated depression of retinal function, particularly affecting short-wavelength cone pathways. Population-based data on CVD from high-altitude Indian communities are absent from the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted at Lamdon School, Leh, Ladakh, India (11,400 ft\/3,474 m above sea level). A total of 505 schoolchildren (204 boys; 301 girls) aged 11\u201318 years underwent a structured ophthalmical examination and color vision testing using the 38-plate Ishihara pseudoisochromatic plate test under standardized conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      CVD was detected in 53 of 505 children (10.50%): 22 boys (10.78%) and 31 girls (10.30%). No statistically significant sex difference in CVD prevalence was detected (Fisher\u2019s exact test,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.883). Severity analysis revealed a significant sex interaction: girls predominated in mild (21\/33) and moderate (9\/12) CVD categories, while boys constituted 7 of 8 severely color-deficient children (\u22655 plate errors). CVD prevalence rose with age, peaking at 20.7% in 18-year-olds. Plates 9 and 17 generated the highest error frequencies; plate 9 elicited errors exclusively in boys, and plate 17 elicited errors exclusively in girls. Plate-specific misidentification patterns deviated from standard Ishihara predictions in both sexes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The overall CVD prevalence in this high-altitude Ladakhi population substantially exceeds rates reported at sea level in India and most global populations, mirroring the altitude-related pattern documented in Nepal. The severity paradox, girls dominating mild CVD while boys dominate severe CVD, suggests that carrier females heterozygous for CVD-associated alleles may be expressing phenotypically detectable color discrimination impairment at altitude, possibly through hypoxia-mediated amplification of their marginal trichromatic capacity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15578682261489792","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T15:00:50Z","timestamp":1789398050000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Determination of Color Vision in School Children in High Altitude, Leh, India"],"prefix":"10.1177","author":[{"given":"Sagarika","family":"Patyal","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Glaucoma and Cataract Services, Centre for Sight Eye Institute, New Delhi, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasdeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Clinical Optometrist, Centre for Sight Eye Institute, New Delhi, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanika","family":"Bhardwaj","sequence":"additional","affiliation":[{"name":"Cataract and Refractive Surgery, Centre for Sight Eye Institute, New Delhi, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uday","family":"Yanamandra","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Armed Forces Medical College, Pune, India."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"issue":"1","key":"e_1_3_3_2_1","first-page":"20","article-title":"Prevalence of color-vision deficiency among male high-school students","volume":"35","author":"Cruz EM","year":"2010","unstructured":"Cruz EM, , Cerdana HGS, , Cabrera AMB, et al. 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