Form DD Form 2489 DD Form 2489 DoD Medical Examination Review Board (DoDMERB) Farnswort

DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB)
FARNSWORTH LANTERN AND
RED/GREEN COLOR VISION TESTS

OMB No. 0704-0396
OMB approval expires
Sep 30, 2006

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and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0396). Respondents should be aware that notwithstanding any other provision of
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PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO DODMERB/DR, 8034 EDGERTON
DRIVE, SUITE 132, USAF ACADEMY CO 80840-2200.
PRIVACY ACT STATEMENT
AUTHORITY: Title 10, USC 133, 3012, 5031, 8013, and Executive Order 9397.
PRINCIPAL PURPOSE: To determine medical acceptability or update a medical file as part of the application process to a United States
Service Academy, Reserve Officer Training Corps (ROTC) Scholarship Program, or the Uniformed Services University of the Health
Sciences (USUHS).
ROUTINE USES: This information may be disclosed to the Coast Guard Academy and Merchant Marine Academy for applications to
their Academies.
DISCLOSURE: Voluntary; however, failure to furnish the requested information will impede the selection process and hamper your
candidacy. Use of the Social Security Number (SSN) is used for positive identification of records.
1. NAME OF APPLICANT (Last, First, Middle Initial)

2. SOCIAL SECURITY NUMBER

FARNSWORTH LANTERN
IMPORTANT: This test MUST be performed or verified and countersigned by an optometrist, flight surgeon,
or by a physician experienced in performing the FALANT test.
INSTRUCTIONS TO EXAMINERS
READ REVERSE SIDE OF THIS FORM BEFORE ADMINISTERING TEST.

Indicate by letter the applicants' responses,

reminding them at the beginning of the test that there are only three responses: Red, Green, or White.

G/R

W/G

G/W

G/G

R/G

W/R

W/W

R/W

R/R

NUMBER OF ERRORS
PER RUN

1st RUN

2nd RUN

3rd RUN

NOTES: Farnsworth Dichotomous or other variations are not acceptable.
The examiner must alter the sequence of lights on the 2nd and 3rd runs.

RED/GREEN COLOR VISION TEST
3. I CERTIFY THAT APPLICANT
CAN

CANNOT

DISTINGUISH AND IDENTIFY OBJECTS THAT ARE BRIGHT RED AND BRIGHT GREEN.

4. EXAMINER
NAME (Last, First, Middle Initial)

TITLE

EXAMINER SIGNATURE

PHYSICIAN SIGNATURE

DD FORM 2489, MAR 2004

PREVIOUS EDITION IS OBSOLETE.

5. FACILITY NAME AND COMPLETE
ADDRESS (Street, City, State, ZIP Code)

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FARNSWORTH LANTERN AND RED/GREEN COLOR VISION TESTS - INSTRUCTIONS
PREPARATION FOR TESTING
1. Give the test in a normally lighted room; screen
from glare; exclude sunlight. Examinee should not
face the source of room illumination.
2. Only one person should be tested at a time.
(Others shall not be allowed to watch.)

3. Station examinee eight feet from lantern.
4. If examinee ordinarily wears contact lenses or
glasses for distance, they should be worn. Color
correcting lenses, if worn, must be removed prior to
testing.

ADMINISTRATION AND SCORING
1. Instruct examinee," The lights you will see in
this lantern are either red, green, or white. They
look like signal lights at a distance. Two lights are
presented at a time - in any combination. Call out
the colors as soon as you see them, naming first
the color at the top and then the color at the
bottom. Remember, only three colors - red, green,
and white. Name which light color combination
exists, top one first."
2. Turn knob at top of lantern to charge lights;
depress button in center of knob to expose lights.
Maintain regular timing of about two seconds per
light.
3. Expose the lights in random order starting with
a R/G or G/R combination, continuing until each of
the nine combinations has been exposed.
4. If no errors are made on this first run of nine
pairs of lights, examinee is passed.
5. If any errors are made on this first run, give two
more complete runs.

6. Average the errors of these last two runs. If an
average of more than one error per run is made,
examinee is failed. If an average of one, or less
than one error per run is made, examinee is passed.
7. An error is considered the miscalling of one or
both of a pair of lights; if an examinee changes
his/her response before the next light is presented,
record the second response only.
8. If an examinee says "yellow," "pink," etc., you
should say, "There are only three colors - red,
green, and white."
9. If an examinee takes over 3 seconds to respond,
you should say, "As soon as you see the lights, call
them."
10. Do not discuss passing/failing scores with
applicant. Under no circumstances will an applicant
receive more than 3 total runs.

6. REMARKS (Attach additional pages if necessary.)

DD FORM 2489 (BACK), MAR 2004

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