2015, Volume 31, Number 3, Page(s) 194-199
Ocular Diseases Among Pathologists and Pathologists' Perceptions on Ocular Diseases: A Survey Study
Orkun AKMAN, Kemal KÖSEMEHMETOĞLU
Department of Pathology, Hacettepe University Faculty of Medicine, ANKARA, TURKEY
Keywords: Visual disorders, Refractive errors, Conjunctivitis, Color blindness, Pathology
The impact of visual disorders and color vision deficiency
on the occupational life has been previously investigated by several
studies. In this study, we aimed to evaluate the prevalence of visual
disorders among Turkish pathologists and their perceptions on visual
Material and Method: A survey composed of 14 questions about
ocular diseases and perceptions to these diseases has been introduced
to the volunteering pathologists or pathology residents, participating
in the 23rd Congress of Pathology.
Results: Ninety-three pathologists or pathology residents
participated in the survey. Of the participants, 25 (26.9%) were
residents, 30 (32.3%) were pathology specialists, and 36 (38.7%) were
academicians. The mean duration for working as a pathologist was 15
years. The vast majority (%93.5) of the participants had at least one
type of refractive error; the two most common disorders were myopia
(77.0%) and astigmatism (64.4%). Sixty-four of the participants
(68.8%) claimed an increase in their refractive error after working in
the pathology department. Eyeglasses (56/87, 64.4%), contact lenses
(14/87, 16.1%), or both (9/87, 10.3%) were used in order to correct
the refractive error; however, only 31 of the participants (33.3%)
preferred using eyeglasses during microscopy. While 65 participants
(69.9%) never had conjunctivitis, 26 participants (28.0%) had at least
one conjunctivitis attack. None of the participants claimed to be color
Conclusion: Conjunctivitis and refractive errors are quite prevalent
among pathologists. Refractive errors were also found to increase
during the pathology practice. Most of the pathologists do not
consider visual disorders (mostly refractive errors) as a negative factor
during their career decision making, except a color vision defect.
The impact of ocular disorders such as refractive errors
and particularly color vision defects on occupational life
has been a subject to many studies1-7
. Similar studies
were also conducted on medical professionals8-11
more specifically pathologists or microscopists12-15
this study, we investigated the prevalence of some ocular
disorders such as refractive errors, conjunctivitis and color
vision deficiencies among pathologists, and evaluated
the perceptions of pathologists regarding ocular diseases,
particularly color vision defects.
A survey composed of 14 questions (Table I
ocular diseases has been introduced to the pathologists
or pathology residents participating in the 23rd Congress
of Pathology. Ninety three pathologists responded to the
survey. The calculations of frequencies and means and
comparison between groups with Chi square test were all
performed using SPSS 15.0. A p value less than 0.05 was
regarded as significant.
The mean age of the responders was 41.5 years (range 24-
68). The distribution of participants among different age
groups was as follows: 22 (23.7%) in the 21-30, 18 (19.4%)
in the 31-40, 33 (35.5%) in the 41-50, 16 (17.2%) in the
51-60, and 3 (3.2%) in the 61-70 years age group; one of
the responders did not claim age (Figure 1
(76.3%) were female and 22 (23.7%) were male. The
numbers of the academicians, specialists and residents were
evenly distributed (Figure 2
). Two (2.2%) of the responders
did not assign a job title. The mean working duration was
15.1 years; 26 (28.0%) had worked for less than 5 years,
while 46 (46.5%) had worked over 15 years.
The answers to some of the questions are summarized
in Table II. Sixty-five of the participants (69.9%) had not
experienced conjunctivitis before, whereas 26 (28.0%)
suffered from at least one attack of conjunctivitis. Of
these 26 participants, 13 (59.1%) had 1 attack, 6 (27.3%)
had 2 attacks, and 3 (13.5%) had more than 2 attacks. The
conjunctivitis prevalence was the same between participants
equal to or below the age of 40 and those over the age of 40
(p=0.317). Just over one third of the participants regularly
used eyeglasses during microscopy. Use of eyeglasses
during microscopy was likely to decrease the occurrence of conjunctivitis (19.4% vs. 33.3%, p=0.162), although the
difference did not reach the level of significance (Figure 3).
Click Here to Zoom
|Figure 3: Presence of conjunctivitis attack among pathologists
and its correlation with the use of eyeglasses.
Refractive errors were reported by 87 participants (93.5%,
Figure 4). The most common disorder was myopia
(67, 77.0%) followed by astigmatism (56, 64.4%) and
hypermetropia (22, 25.3%). Thirty-seven of 67 (55.2%)
participants with myopia had both astigmatism and myopia
together. Medians for severity of myopia, astigmatism and
hypermetropia were 2.5 D (0.5-8), 1 D (0.3-2) and 1.5 D
(0.3-2), respectively. In order to correct refractive errors,
participants preferred eyeglasses (56, 64.4%) more than
contact lenses (14, 16.1%). Nine or the participants (10.3%)
used both contact lenses and eyeglasses together, whereas
7 responders (8.0%) with refractive error did not use any
correction. Sixty-four participants (68.8%) claimed an
increase in refractive error of a median value of 1 D (0.3-5)
after working in the pathology department. The majority
(92.5%) affirmed that the presence of a visual disorder had
no effect on their career decision as a pathologist; 7 (7.5%)
did not answer this question.
None of the participants claimed to have any type of
color vision deficiency. However, only 65 (69.9%) of them
previously undergone a color vision test, and 2 participants
did not answer this question. Two female pathologists
(2.2%), one of whom was not screened for a color vision
defect, specified that they have difficulty in interpretation
of special stains such as Ziehl-Neelsen or amyloid stains
(Congo red/Crystal violet). Regarding the question about
acceptance of a color blind pathologist, 57 (61.3%) of the
participants claimed that a color blind pathologist should
not perform pathology; five (5.5%) did not comment on
Ametropia is the second most common health problem
. Similarly, we showed that
refractive errors are quite common among Turkish
pathologists. The prevalence of ametropia among Turkish
pathologists is higher than the prevalence among the overall
Turkish population (3%) as reported by the Ministry of
Health in 199017
and the prevalence among Turkish
primary school children (10%)18
. Moreover, myopia is
found to be responsible for the most of the refractive errors.
A high prevalence of myopia among certain occupations
using microscopy is also reported elsewhere, and mainly
attributed to the higher education level and close work14,15
. Adams et al. also demonstrated the progression
of preexisting myopia and new onset myopia among
clinical microscopists in their study. Our results are also in agreement with Adams et al. and Fritzsche et al. that
over two thirds of the responders claimed an increase in
refractive error of a median 1 D15,16
. More investigations
by McBrien and Adams elucidated the structural cause of
adult-onset and adult-progression of myopia as vitreous
which may occur due to certain
occupational tasks during the use of microscopy. Other
proposed reasons for the high level of myopia among
pathologists are long time spent on microscope or computer
and selection bias of the ametropic medical students16
Conjunctivitis, particularly adenoviral conjunctivitis, is
known as a dreadful disease among pathologists, as it
results in loss of work and spreads quickly due to frequent
use of the microscope. In our series, over one third of the
participants had suffered at least one conjunctivitis attack.
Interestingly, conjunctivitis among pathologists who do
not use eyeglasses during microscopy was almost 2 times as
common as that of pathologists who wear eyeglasses (19.4%
vs. 33.3%), although the difference did not reach statistical
level of significance. Further studies with larger groups are
needed to prove the protective effect of eyeglasses on the
prevention of conjunctivitis.
Color blindness is relatively common with a worldwide
prevalence of 5-8% among males and 0.4-1.0% among
females20. The prevalences reported from Turkey are
slightly lower than these figures: 3.7-5.5% for men and
0-0.8% for women21,22. Color vision deficiency may
be either inherited (mostly deutan) or acquired (mostly
tritan) as a result of aging or other diseases such as diabetes,
high myopia and multiple sclerosis. While the prevalence
of inherited color vision deficiency is greater in males
than in females, the prevalence of acquired deficiencies
will expected to be the same in both sexes. Moreover, the
prevalence of acquired defects is also expected to increase
with age23,24. In our group composed of 93 pathologists
or pathology residents, none claimed to suffer from color
blindness. The absence of neither inherited nor acquired
color vision deficiency in our group could be explained
by predominance of young pathologists, in whom an
acquired color vision defect is not expected. Absence of
color vision deficiency might also be due to the so-called
mutually exclusive nature of pathology practice and color
blindness. As an indicative of this, nearly two thirds of the
pathologists took the view that color blind people should
not perform pathology practice. Common sense and some
vivid examples may suggest that color vision deficiency
may have an impact on doctors’ medical skills, including
those in ophthalmology, ear nose and throat, pediatrics,
gastroenterology, and pathology11. In pathology practice, this belief could be justified by misevaluation of
special stains, such as Ziehl-Neelsen, periodic acid Schiff,
crystal violet, and even routine hematoxylin and eosin
stain. Indeed, there is some evidence that color blind
pathologists may experience some difficulties in evaluating
several special stains such as Ziehl-Neelsen12. However,
it is also suggested that these complications can be easily
overcome by self-awareness of the color blindness and its
diagnostic limits; therefore, color blindness should not
be a ground for concern in the selection and training of
histopathologists25,26. The essence of pattern analysis,
knowledge and judgment rather than color perception in
order to reach the correct pathological diagnosis, and the
presence of journals and textbooks printed with black and
white images also supports the latter statement. Moreover,
it is reported that there are some skillful pathologists who
are color blind and work without inconvenience13,26.
Lastly showing the prejudice towards color blindness, none
of the pathologists having any degree of visual disturbances
other than color vision defect claimed that this had an
influence on the selection of pathology subspecialty.
Recently, the statement “the candidates should fulfill
medical conditions requested by specialties. For example …
not to have color blindness for pathology, biochemistry and
microbiology…” in the application form of examination for
specialty in medicine (TUS) have been removed after the
Fall Examination in 2009. In the light of evidence-based
medicine, specialties such as pathology or microbiology
should not be forbidden for medical students with color
blindness. However, it is highly recommended that medical
students and doctors be checked for color vision deficiency
before they decide ontheir subspecialty12. Only 70%
of our study group were being checked for color vision
deficiency. Also, 1 of the 2 female pathologists complained
of having difficulty in the evaluation of special stains but had
not undergone a color blindness test before. This finding
indicates that there may be potential color blind subjects
among the pathologists not tested for the condition.
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