Abstract
Background: Ionising radiation (IR) is an occupational hazard for interventionalists. Dry eye syndrome may develop. There may be damage to the corneal epithelium, causing irritation and ulceration. Radiation-induced cataracts commonly develop in the posterior sub-capsular (PSC) region of the lens and are more common in the left eye.Aim: The aim of this study was to describe the ophthalmological findings in South African interventionalists occupationally exposed to IR.Setting: This study was conducted in South Africa.Methods: A prospective cross-sectional study was conducted. Interventional radiologists (25), adult cardiologists (42) and paediatric cardiologists (31) were recruited at conferences and included in the study. Convenience sampling was used. Participants completed a survey that collected data on their demographics, their cataract risk factors and co-morbid diseases, their occupational history, their radiation safety practices and their training in occupational history. Participants’ eyes were examined using a slit lamp after dilation of the eyes. Ethics clearance was obtained and each participant gave informed consent. A descriptive analysis was done.Results: The median age of the 98 interventionalists screened was 43.5 years. They worked with radiation for a median of 7.5 years. Cataracts occurred in the left eye of 17 (17.3%) participants and in the right eye of nine (9.2%). There were five (5.1%) PSC cataracts in the left eye and one (1%) in the right eye. The vitreous was abnormal in 19.4% of participants. The tear break-up time was abnormal in 48% of participants.Conclusion: Ionising radiation is an occupational hazard posing a risk to interventionalists’ eyes. They are at increased risk of cataracts and dry eye syndrome, which can affect their occupational performance and quality of life. Education can positively influence the radiation safety practices of interventionalists that could reduce the detrimental effects of IR on their eyes.
Highlights
Ionising radiation (IR) is an occupational health risk for radiation healthcare workers (HCWs).[1]
Doctors who routinely use IR to perform fluoroscopic procedures are at increased risk for the health effects because of IR if they are not properly shielded and protected.[1]
Ionising radiation-induced bystander effects (RIBE) occur when the effects of radiation are seen in adjacent nearby cells that were not directly radiated and this results in deoxyribonucleic acid (DNA) molecular damage.[4]
Summary
Ionising radiation (IR) is an occupational health risk for radiation healthcare workers (HCWs).[1]. Radiation-induced injury may be acute where changes are observed immediately post-radiation exposure; consequential effects appear days to weeks later; and late effects emerge months to years after exposure.[2] Ionising radiation causes damage by several mechanisms. There may be direct damage to deoxyribonucleic acid (DNA) molecules, resulting in cell damage and subsequent cell death.[3] Water or other molecules may be energised indirectly to form free radicals that cause cell destruction and necrosis.[3] Ionising radiation-induced bystander effects (RIBE) occur when the effects of radiation are seen in adjacent nearby cells that were not directly radiated and this results in DNA molecular damage.[4] The effects of IR may be stochastic or deterministic.[5] Stochastic effects do not have a threshold limit and include carcinomas, genetic aberrations and cataract formation.[5] Deterministic effects have a threshold limit and include skin changes.[5] The eyes are highly radiosensitive organs and every anatomical structure of the eye may be affected if exposed to enough IR. Radiation-induced cataracts commonly develop in the posterior sub-capsular (PSC) region of the lens and are more common in the left eye
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