Interventional Cardiologists at Risk of Developing Cataracts

September 03, 2009

September 3, 2009 (Barcelona, Spain) — A study examining the incidence of radiation-induced lens injuries in interventional cardiologists has shown that almost 40% had eye damage consistent with exposure to ionizing radiation. Dr Ariel D Duran (Sociedad Latinoamericana de Cardiología Intervencionista [SOLACI], Buenos Aires, Argentina) reported the findings of the Retrospective Evaluation Study of Lens Injuries and Dose (RELID) at the European Society of Cardiology 2009 Congress yesterday.

"Interventionalists often remain in proximity to patients and therefore may be within the high-scatter X-ray field during procedures," Duran explained. "The eye lens has high radio sensitivity, and the ionizing radiation can cause protein coagulation, producing opacity in the lens that can eventually lead to cataracts."

The results indicate that more care needs to be taken by interventionalists and that "national authorities need to apply more recommendations and a regulatory framework concerning radiation safety in cardiology laboratories," he said.

Ocular Deterioration in Docs Significantly Worse Than in Controls

In their retrospective evaluation, which was the largest sample of professionals ever screened, Duran said, three independent ophthalmologists performed papillary dilatation and slit lamp exams for cataract staging on the eyes of 59 interventional cardiologists and 59 paramedical personnel during two recent regional meetings of SOLACI.

The participants also filled in a detailed questionnaire including information on their medical history and workload, the fluoroscopy time, number of cine series, and type of X-ray systems and radiation protection tools (ceiling suspended screen and protective eyewear) used so that radiation doses to the lens could be estimated. A control group of 93 nonexposed people of similar age was employed.

The mean age of the interventionalists was 46 years, and they had been working in that field for an average of 14 years. The nurses and technicians (paramedical personnel) were 38 years old, on average, and had been working with interventionalists for a mean of seven years.

Duran explained that a parameter known as the Merriam-Focht score is used to record lens opacity, with a score of 0 being normal and 4 being a full cataract.

Of the interventionalists, 37.9% had opacities in one or both eyes, compared with 12% of the controls (p<0.005). There were 12 interventional cardiologists who had a Merriam-Focht score of between 0.5 and 2, and 13 had never or infrequently used eye protection or leaded ceiling screens, Duran noted. Of the nurses and technicians, 21% also had opacities in one or both eyes, with a Merriam-Focht score of 0.5 (nonsignificant compared with control group).

Use of Radiation-Protection Tools Must Be Promoted

He said it was difficult to predict exactly how many of these doctors would go on to develop cataracts in the future, but the results indicate that the training of interventionalists with regard to radiation procedures must be improved, he noted, and "we must promote the use of radiation-protection tools."

In addition, the increased number of lens opacities seen in interventional nurses and technicians, when compared with controls, also suggests ocular risk in these workers, although he acknowledged this finding was not statistically significant.

Duran said that his team is going to continue to study more subjects and hopes to have results on 200 personnel next year "so we can have stronger conclusions."

With regard to the promotion of good working practice, he said the strategies required will differ from country to country, and that it is hard to apply one set of rules to all.

However, "people are becoming more conscious and taking more care with radiation," he noted, adding, "We are particularly trying to get our message out to young doctors: we want to teach people to take care of themselves."


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