Turkish Journal of Pathology

2015, Vol 31, Num, 3 (Pages: 194-199)

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Ocular Diseases Among Pathologists and Pathologists' Perceptions on Ocular Diseases: A Survey Study

Orkun AKMAN ¹, Kemal KÖSEMEHMETOĞLU ¹

¹ Department of Pathology, Hacettepe University Faculty of Medicine, ANKARA, TURKEY

DOI: 10.5146/tjpath.2015.01326

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Summary

Objective: 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 disorders.

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 blind.

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.

Introduction

The impact of ocular disorders such as refractive errors and particularly color vision defects on occupational life has been a subject to many studies[1-7]. Similar studies were also conducted on medical professionals[8-11] and more specifically pathologists or microscopists[12-15]. In 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.

Methods

A survey composed of 14 questions (Table I) about 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.

Table I: Questionnaire

Results

Demographical Features
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). Seventyone (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.

Figure 1: Distribution of age.

Figure 2: Distribution of job titles.

Ocular Disorders
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).

Table II: Answers to some of the questions

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.

Figure 4: Distribution of refractive errors among pathologists.

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 this question.

Discussion

Ametropia is the second most common health problem among pathologists[16]. 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 1990[17] 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 work[14,15]. 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 D[15,16]. More investigations by McBrien and Adams elucidated the structural cause of adult-onset and adult-progression of myopia as vitreous chamber elongation[19], 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 students[16].

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 females[20]. The prevalences reported from Turkey are slightly lower than these figures: 3.7-5.5% for men and 0-0.8% for women[21,22]. 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 age[23,24]. 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 pathology[11]. 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-Neelsen[12]. 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 histopathologists[25,26]. 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 inconvenience[13,26]. 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 subspecialty[12]. 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.