Which tuberculosis drug requires baseline testing for red-green color blindness?

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Ethambutol carries a distinctive risk of optic neuritis that can impair color discrimination, particularly red-green vision. Because this toxicity is dose- and duration-related and can lead to permanent vision changes if not caught early, a baseline color-vision assessment is done before starting therapy. By establishing how the patient normally perceives red and green, clinicians can later detect any new deficits promptly and adjust or discontinue ethambutol to prevent permanent damage. A simple color-vision test, such as Ishihara plates, is commonly used for this purpose. The other standard TB drugs don’t have this specific red-green color-vision toxicity, so baseline color-vision testing isn’t routinely required for them.