Radiation-Induced Eye Lens Changes and Risk for Cataract in Interventional Cardiology

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Abstract

Background: Recent studies have reported a significant increase in eye lens opacities among staff in the cardiac catheterization laboratory but indicated further studies are needed to confirm the findings. Objective: To evaluate the prevalence of opacities in eyes of cardiologists, radiographers and nurses working in interventional cardiology. Methods: The eyes of 52 staff in interventional cardiology facilities and 34 age- and sex-matched unexposed controls were screened in a cardiology conference held in Kuala Lumpur by dilated slit-lamp examination, and posterior lens changes were graded. Individual cumulative lens X-ray exposures were calculated from responses to a questionnaire in terms of workload and working practice. Results: The prevalence of posterior lens opacities among interventional cardiologists was 53%, while in nurses and radiographers it was 45%. Corresponding relative risks were 2.6 (95% CI: 1.2–5.4) and 2.2 (95% CI: 0.98–4.9), for interventional cardiologists and support staff, respectively. Conclusions: This study confirms a statistically significant increase in radiation-associated posterior lens changes in the eyes of interventional cardiology staff.

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Radiation cataract risk in interventional cardiology personnel.

Ariel Durán, Madan M Rehani, Eliseo Vano … (2010)

The lens of the eye is one of the most radiosensitive tissues in the body, and exposure of the lens to ionizing radiation can cause cataract. Cumulative X-ray doses to the lenses of interventional cardiologists and associated staff can be high. The International Commission on Radiological Protection recently noted considerable uncertainty concerning radiation risk to the lens. This study evaluated risk of radiation cataract after occupational exposure in interventional cardiology personnel. Comprehensive dilated slit-lamp examinations were performed in interventional cardiologists, associated workers and controls. Radiation exposures were estimated using experimental data from catheterization laboratories and answers to detailed questionnaires. A total of 116 exposed and 93 similarly aged nonexposed individuals were examined. The relative risk of posterior subcapsular opacities in interventional cardiologists compared to unexposed controls was 3.2 (38% compared to 12%; P < 0.005). A total of 21% of nurses and technicians had radiation-associated posterior lens changes typically associated with ionizing radiation exposure. Cumulative median values of lens doses were estimated at 6.0 Sv for cardiologists and 1.5 Sv for associated medical personnel. A significantly elevated incidence of radiation-associated lens changes in interventional cardiology workers indicates there is an urgent need to educate these professionals in radiation protection to reduce the likelihood of cataract.

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Risk for radiation-induced cataract for staff in interventional cardiology: is there reason for concern?

Kui-Hian Sim, Olivera Ciraj-Bjelac, Madan M Rehani … (2010)

To examine the prevalence of radiation-associated lens opacities among interventional cardiologists and nurses and correlate with occupational radiation exposure. Interventional cardiology personnel are exposed to relatively high levels of X-rays and based on recent findings of radiation-associated lens opacities in other cohorts, they may be at risk for cataract without use of ocular radiation protection. Eyes of interventional cardiologists, nurses, and age- and sex-matched unexposed controls were screened by dilated slit lamp examination and posterior lens changes graded using a modified Merriam-Focht technique. Individual cumulative lens X-ray exposure was calculated from responses to a questionnaire and personal interview. The prevalence of radiation-associated posterior lens opacities was 52% (29/56, 95% CI: 35-73) for interventional cardiologists, 45% (5/11, 95% CI: 15-100) for nurses, and 9% (2/22, 95% CI: 1-33) for controls. Relative risks of lens opacity was 5.7 (95% CI: 1.5-22) for interventional cardiologists and 5.0 (95% CI: 1.2-21) for nurses. Estimated cumulative ocular doses ranged from 0.01 to 43 Gy with mean and median values of 3.4 and 1.0 Gy, respectively. A strong dose-response relationship was found between occupational exposure and the prevalence of radiation-associated posterior lens changes. These findings demonstrate a dose dependent increased risk of posterior lens opacities for interventional cardiologists and nurses when radiation protection tools are not used. While study of a larger cohort is needed to confirm these findings, the results suggest ocular radio-protection should be utilized. Copyright © 2010 Wiley-Liss, Inc.

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External factors in the development of cataract.

L Robman, H. Taylor (2005)

To provide an update on the risk factors for cataract development. Review of the literature. Age and heredity are the most important risk factors associated with the different types of cataract. While the hereditary component is self-explanatory, increasing age serves as a surrogate for a number of potential external risk factors, the effect of which is cumulative. Identification of the risk factors that have a causal effect on cataract development may provide means for cataract prevention. There are only a few risk factors that satisfy the criteria for causal effect: smoking, which results in the increased risk of nuclear cataract, excessive UV-B exposure and diabetes that increase the risk of cortical cataract, and steroidal treatment, diabetes and ionising radiation that lead to the formation of posterior subcapsular opacity. The effect of medications on cataract development requires further study, since the effect of the diseases should be distinguished from that of treatment. 'Stop Smoking' and 'UV-B protection' campaigns are gaining momentum as preventative measures, while the attempts to actively prevent cataract with antioxidants have not been successful. Cataract research has been facilitated lately by improvements of precision and standardisation in measuring lens opacities. However, measurement precision on its own cannot give us a solution to this problem. The major studies repeatedly measure the exposure to the traditional health hazards, while the missing parts in the equation are those risk factors that we do not know about and therefore do not measure. New approaches and new hypotheses are needed.

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Author and article information

Journal

Journal ID (publisher-id): CRD

Journal ID (nlm-ta): Cardiology

Journal ID (doi): 10.1159/issn.0008-6312

Title: Cardiology

Publisher: S. Karger AG

ISSN (Print): 0008-6312

ISSN (Electronic): 1421-9751

Publication date Subscription-year: 2012

Publication date (Print): November 2012

Publication date (Electronic): 31 October 2012

Volume: 123

Issue: 3

Pages: 168-171

Affiliations

^aVinca Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia; ^bInternational Atomic Energy Agency, Vienna, Austria; ^cDepartment of Ophthalmology, Hiroshima University, Hiroshima, Japan; ^dDepartment of Cardiology, Sarawak General Hospital, Kuching, Malaysia; ^eRadiology Department, Complutense University, Madrid, Spain

Author notes

*Madan M. Rehani, PhD, International Atomic Energy Agency, Vienna International Center, PO Box 100, AT–1400 Vienna (Austria), E-Mail M.Rehani@iaea.org

Article

Publisher ID: 342458 Other ID: Cardiology 2012;123:168–171

DOI: 10.1159/000342458

PubMed ID: 23128776

SO-VID: 8ac03596-a285-457e-b30e-95fc5ccce70b

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 06 May 2012

Date accepted : 01 August 2012

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Radiation-Induced Eye Lens Changes and Risk for Cataract in Interventional Cardiology

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Abstract

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Karger: Cardiovascular System

Most cited references 10

Radiation cataract risk in interventional cardiology personnel.

Risk for radiation-induced cataract for staff in interventional cardiology: is there reason for concern?

External factors in the development of cataract.

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Cited by 22

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