ABC | Volume 112, Nº4, April 2019

Original Article Barbosa et al Prevalence of lens opacity Arq Bras Cardiol. 2019; 112(4):392-399 Methods Subjects Eligible participants were recruited at health conferences health. Inclusion criteria were conference attendance and signing of the consent form. Exclusion criteria were – previous ocular surgeries, including cataract, glaucoma, refractive and retina surgeries; chronic use of ocular topical medication; diabetes mellitus; chronic use of corticosteroids and systemic arterial hypertension. Logistics All individuals included in the study were volunteers who self-referred to the investigators expressing their willingness to participate in the study. The investigators built an exhibition stand at two medical conferences, so that the attendees had easy, fast access to it. The individuals included in the study were allocated into one of two groups – exposed to ionizing radiation (G1) and not exposed to ionizing radiation (G2). G1 was composed of ICs and health professionals in the field of cardiac hemodynamics from several regions of Brazil, who attended the annual congress of the Latin American Society of Interventional Cardiology (SOLACI) and the Brazilian Society of Hemodynamics and Interventional Cardiology (SBHCI) that was held in Rio de Janeiro on June 08 th -10 th , 2016. G2 was composed of cardiologists not exposed to ionizing radiation, attending the annual congress of the Brazilian Society of Cardiology held in Fortaleza on September 23 rd -25 th , 2016. Clinical assessment and ophthalmologic examination All participants were interviewed by one of the investigators who used a detailed questionnaire on demographic data, occupational practices that may be subjected to radiation exposure (use of radiation protection devices, number of years of work, types of procedures performed, among others) and coexisting diseases. Ophthalmologic examination was performed using slit lamp examination by two experienced ophthalmologists, after the instillation of topical ocular medication (mydriacyl), which allows examination of the whole lens. The findings were described and classified by opacity pattern and degree according to the Lens Opacities Classification System III (LOCS III). 20 It consists of the classification of lens opacity by its pattern as cortical, nuclear, and posterior subcapsular, and by its severity as grade 1-6. Statistical analysis A convenience sample was used in the study. Continuous variables were described as mean and standard deviation or median. The Kolmogorov-Smirnov test and the Shapiro‑Wilk test were used to test the normality of data distribution. Categorical variables were compared by the chi‑square test. When more than 20% of the cells had expected frequency lower than 5, we used the Fisher's exact test (2 x 2 table) or the likelihood ratio test. The level of significance was set at 5% (p < 0.05). The SPSS ( Statistical Package for the Social Sciences) version 19.0 was used of the analysis. Results A total of 278 volunteers agreed to participate in the study, 156 in the radiation-exposed group (G1) and 122 in the non‑exposed group (G2). Forty-four volunteers of G1 and 34 of G2were excluded, and thus 112 participants inG1 and 88 inG2 were included (Figure 1). Mean age was 44.95 ± 10.23 years in the G1 and 48.07 ±12.18 years in the G2 (p = 0.0264). Sociodemographic data are described in Table 1. Regarding the ophthalmologic findings, 37 volunteers (33%) in G1 and only 14 (16%) in G2 had some degree of lens opacity (p = 0.0058). When analyzed by the type of cataract, no difference was found in the frequency of cortical cataract, with 15 individuals in G1 (13%) and 8 in G2 (9%) (p = 0.3438). However, PSC cataract was significantly more frequent in G1 (n = 14, 13%) than in G2 (n = 2, 2%) (p = 0.0081). Lens opacity in cortical + subcapsular was found in 28 volunteers in G1 (25%) and 10 in G2 (11%) (p = 0.0147). Analysis by occupational category showed a mean age of 46.76±9.99 years among ICs and 48.75±12.32 in the control group, with no difference between the groups (p = 0.1358). Lens opacity was found in 32 ICs (38%) and 11 clinical cardiologists (CCs) (15%) (p = 0.0011). PSC cataract was found in 11 ICs (13%) and 2 CCs (3%) (p = 0.0176). The presence of cortical cataract + subcapsular cataract was found in 28% of ICs (n = 24) and 9% of CCs (n = 7) (p = 0.0025). No statistically significant difference was found in the frequency of cortical cataract (15% versus 7%, p = 0.0848). In the group of non-physicians exposed to radiation, 5 participants showed some degree of lens opacity (18%), which was also detected in 3 control non-physicians (23%) (p = 0.7357). Subcapsular cataract was found in 3 radiation-exposed non-physicians, and in none control non-physicians (p = 0.2114). Regarding the eye affected, cataract in the left eye was more common, with SCP cataract observed in 50% of the exposed individuals, whereas cataract in the right eye was identified in 14% of exposed participants. Cataract in both eyes was affected in 36% of these individuals. Cortical cataract was also more frequent in the left eye (46% of exposed subjects), whereas the right eye was affected in 27% of the cases. In the control group, no eye was more prevalent than the other in the cases of cataract, with similar frequency in both eyes as well as cataract type – cortical and subcapsular – both bilateral in 60% of cases. Most ICs reported to perform 50 procedures per month (38.1%) and from 50 to 100 procedures (43.7%) per month. Eighty-two percent of the ICs reported to perform diagnostic procedures within 30 minutes, using from four to six X-ray energy projections (46.5%) and 15 frames per second (70.9%). For therapeutic procedures, 66.1% of ICs reported that the procedures lasted 30-60 minutes, with delivery of x-ray energy in pulses (rather than in a continuous dose). The number of years of work in hemodynamics was not a statistically significant determinant for the occurrence of 393