Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
권호 표지

Assessment of Acquired Color Vision Impairment in Inhalant Abusers

화학물질 흡입자의 후천성 색각이상 평가

  • Kim, Myeong-Hyo (Bugok National Hospital) ;
  • Kim, Yeon-Cheol (Department of Occupational and Environmental Medicine, Yeungnam University Hospital) ;
  • Lee, Kyu-Hwa (Department of Occupational and Environmental Medicine, Yeungnam University Hospital) ;
  • Jeon, Man-Joong (Department of Occupational and Environmental Medicine, Yeungnam University Hospital) ;
  • SaKong, Joon (Department of Occupational and Environmental Medicine, Yeungnam University Hospital)
  • 김명효 (국립부곡병원) ;
  • 김연철 (영남대학교병원 산업의학과) ;
  • 이규화 (영남대학교병원 산업의학과) ;
  • 전만중 (영남대학교병원 산업의학과) ;
  • 사공준 (영남대학교병원 산업의학과)
  • Published : 2011.12.31
⟨ Previous Next ⟩

Abstract

Objectives: This study was conducted in order to evaluate the effects of inhalants on color vision impairment. Methods: The inhalation group consisted of 81 neurotoxic chemical substance abusers at Bugok National Hospital and Institute of Forensic Psychiatry, Ministry of Justice. The control group consisted of 41 employees of Bugok National Hospital. The Lanthony D-15 desaturated hue test was administered to both groups. For the qualitative analysis, we classified the results by the morphological characteristics of color vision impairment. For the quantitative analysis, we calculated the total color distance score (TCDS) and the color confusion index (CCI) and determined that the individual was abnormal if the TCDS was over 65.0 or the CCI was over 1.25. Results: The TCDS of the inhalation group was 75.58${\pm}$21.07 and the CCI was 1.34${\pm}$0.37 in the right eye, and 75.47${\pm}$23.63 and 1.34${\pm}$0.42, respectively in the left eye. These results are higher than those found for the control group. In regards to the TCDS, 50 (61.8%) of the abusers in the inhalation group had color vision impairment in the right eye and 48 (59.2%) had impairment in the left eye. 11 (26.8%) of the employees in the control group had color vision impairment in the right eye and 13 (31.7%) had impairment in the left eye. In regards to the CCI, 38 (46.9%) of the abusers in the inhalation group had color vision impairment in the right eye and 35 (43.2%) had impairment in the left eye. 4 (9.8%) of the employees in the control group had color vision impairment in the right eye and 7 (17.0%) had impairment in the left eye. The results of multiple logistic regression analysis for acquired color vision impairment showed that the inhalation period (OR=1.20, 95% CI: 1.03~1.40) was the significant variable. Conclusions: These findings indicate that the inhalation of neurotoxic substances may impair the color vision, and the period inhaled with neurotoxic substances is significant variable affecting on the acquired color vision impairment.

목적: 국립부곡병원과 국립법무병원에 입원한 신경독성 화학물질 흡입자를 대상으로 흡입제 노출이 후천성 색각이상에 미치는 영향을 평가하고자 하였다. 방법: 국립부곡병원과 국립법무병원에 입원한 신경독성 화학물질 흡입자 총 81명을 흡입군으로 하고, 비슷한 연령대의 국립부곡병원 사무직 직원 41명을 대조군으로 총 122명을 대상으로 2009년 6월부터 12월까지 색각검사를 수행하였다. 면접조사로 대상자의 일반적 특성, 음주력, 흡연력, 화학물질 흡입 시작시기, 흡입제 종류, 일회 흡입량 및 빈도, 흡입기간에 대해 조사하였다. 색각이상은 Lanthony D-15 desaturated 색각검사를 이용하여 정성분석으로 색각이상을 형태적으로 분류하고, 정량분석으로 총색채차점수를 Bowman법으로 지수화하고, 총색채차점수 65.1 또는 색혼란지수 1.26 이상일 때 색각이상으로 판정하였다. 결과: 화학물질 흡입제 흡입군 우안의 총색채차점수 75.58${\pm}$21.07, 색혼란지수 1.34${\pm}$0.37은 대조군 총색채차점수 61.25${\pm}$6.79, 색혼란지수 1.09${\pm}$0.12에 비해 유의하게 높았고, 흡입군 좌안의 총색채차점수 75.47${\pm}$ 23.63, 색혼란지수 1.34${\pm}$0.42는 대조군 총색채차점수 62.49${\pm}$7.14, 색혼란지수 1.11${\pm}$0.13에 비해 유의하게 높았다(p<0.001). 색각이상자는 흡입군 우안 50명 (61.8%), 좌안 48명(59.2%), 대조군 우안 11명 (26.8%), 좌안 13명(31.7%)으로 흡입군에서 유의하게 많았고, 색혼란지수에 의한 색각이상자도 흡입군에서 우안 38명(46.9%) 좌안 35명(43.2%), 대조군에서 우안 4명(9.8%), 좌안 7명(17.0%)으로 흡입군이 유의하게 많았다(p<0.01). 제3색형 색각이상의 색혼란지수는 흡입군 우안 1.38${\pm}$0.25로 대조군 우안 1.25${\pm}$0.12보다 유의하게 높았다(p<0.05). 흡입군에서는 망막손상이 더 진행되었음을 반영하는 제1색형(적록색각이상)이 4명(4.9%), 제2색형(적록청황색각이상) 11명(13.6%), 복합형 12명 (14.8%)이었으나, 대조군은 없었다. 후천적 색각이상 유무를 종속변수로 한 다중 로지스틱 회귀분석에서 흡입기 간(OR=1.20, 95% CI: 1.03~1.40)이 유의한 변수로 나타났다. 결론: 신경독성 화학물질 흡입은 색각이상을 발생할 수 있으며, 흡입제의 흡입과 관련된 조건 중 흡입기간이 후천성 색각이상에 유의한 영향을 주는 변수이다.

Keywords

References

  1. Chang JK. The literature review of inhalant abuse. Journal of Korean Home Management Association 1995;13(1):168-78. (Korean)
  2. Cheon KS. A war against crime and violence: Story about a policeman for crime prevention (translated by Kim MH). Light and Salt. Seoul. 1994. (Korean)
  3. Nicholi AM. Recent patterns of psychoactive drug use among college students: The inhalants. J Am Coll Health 1983;32(1):41-3. https://doi.org/10.1080/07448481.1983.9936137
  4. Park MY. Countermeasure and state for drug abuse of adolescents (translated by Kim MH). Studies on Korean Youth. 1990;1(3):115-6. (Korean)
  5. Korea Food and Drug Administration. Introduction to education about drug abuse (translated by Kim MH). Korea Food and Drug Administration. Seoul. 2009. pp 52-68. (Korean)
  6. Massengale ON, Glaser HH, LeLievre RE, Dodds JB, Klock ME. Physical and psychologic factors in glue sniffing. N Engl J Med 1963;269:1340-4. https://doi.org/10.1056/NEJM196312192692503
  7. Ministry of Health and Welfare. A white book of 2007 adolescent. Ministry of Health and Welfare. Seoul. 2008. pp 371-408. (Korean)
  8. An YC. Study on way on stop the realities of juveniles substance abuse and preventional method. Graduate school of venture, Hoseo university. Asan. 2006. pp 51-76. (Korean)
  9. Sakong J. Neurobehavioral assessment of the workers exposed to organic solvents. Korean J Occup Health 2002;41(1):8-15. (Korean)
  10. Campagna D, Mergler D, Huel G, Belanger S, Truchon G, Ostiguy C, Drolet D. Visual dysfunction among styrene-exposed worker. Scand J Work Environ Health 1995;21(5):382-90. https://doi.org/10.5271/sjweh.53
  11. Mergler D, Huel G, Belanger S, Bowler RM, Truchon G, Drolet D, Ostiguy C. Surveillance of early neurotoxic dysfunction. Neurotoxicology 1996;17(3-4):803-12.
  12. Mergler D, Blain L, Lagace JP. Sovent related colour vision loss: an indicator of neural damage? Int Arch Occup Environ Heath 1987;59(4):313-21. https://doi.org/10.1007/BF00405275
  13. Gobba F, Galassi C, Imbriani M, Ghittori S, Candela S, Cavalleri A. Acquired dyschromatopsia among styreneexposed workers. J Occup Med 1991;33(7): 761-5. https://doi.org/10.1097/00043764-199107000-00006
  14. Grant WM. The peripheral visual system as a target. In Schaumberg HH, Spencer P(eds) Neurotoxicology. Willians and Wilkins. London. 1980.
  15. Lee EH, Choi KH, Chae HH, Paek DM. Usefulness of color vision test for early detection of neurological damages by neurotoxic substances. J Prev Med Public Health 2008;41(6):397-406. (Korean) https://doi.org/10.3961/jpmph.2008.41.6.397
  16. Kang MJ, Kang SH, Suh SK, Shin DH, Lee JY. The assessment of acquired dyschromatopsia among organic- solvents exposed workers. J Prev Med Public Health 1996;29(3):529-38. (Korean)
  17. Kim SS, Cheong HK, Kwon YW. Evaluation of early neurologic abnormalities on the workers exposed to acrylamide. Korean J Occup Environ Med 2000;12(3):367-83. (Korean)
  18. Byun JH, Lee KY, Kim YK, Ko KW, Lee YH. Acquried dyschromatopsia in women workers in shoe manufacturing who were exposed to organic solvents. Korean J Occup Environ Med 2001;13(3):232-41. (Korean)
  19. Lee EH, Cho SI, Cheong HK, David AA, Paek DM. Acquired color vision impairment among solventexposed workers in petrochemical industry. J Korean Ophthalmic Opt Soc 2004;9(2):257-67. (Korean)
  20. Hahn CS. Color test using the Hahn pseudoisochromatic plates. J Korean Ophth Soc 1980;21(3):239-46. (Korean)
  21. Lanthoney P. The desaturated Panel D-15. Doc Ophthalomol 1978;46:185-9.
  22. Lanthoney P. Evaluation of the desaturated panel D-15. III. Evaluation of the validity of desaturated Panel D-15. J Fr Ophtalmol 1994;17(1):15-21.
  23. Verriest G. Further studies on acquired deficiency of color discrimination. J Opt Soc Am 1963;53:185-95. https://doi.org/10.1364/JOSA.53.000185
  24. Bowman KJ. A method for quantitative scoring method of the Farnsworth Panel D-15. Acta Ophthalmol 1982;60(6):907-16.
  25. Kim JH, Park JS, Shin HH. A review of color defielancy among the industrial workers. J Soonchunhyang Univ 1986;9(2):1279-84. (Korean)
  26. Hart WM Jr. Acquired dyschromatopsias. Surv Ophthalmol 1987;32(1):10-31. https://doi.org/10.1016/0039-6257(87)90070-1
  27. Han CS. Aptitude of congenital color - defectives for school and occupation. J Korean Ophthalmol Soc 1985;26(2):185-91. (Korean)
  28. Lee KC, Lee JH, Jung WS. A case of withdrawal epileptic attack after the discontinuation of the volatile solvent abuse (glue sniffing). J Korean Neuropsychiatr Assoc 1992;30(2):414-8. (Korean)
  29. Gobba F, Cavalleri A. Color vision impairment in workers exposed to neurotoxic chemicals. Neurotoxicology 2003;24(4-5):693-702. https://doi.org/10.1016/S0161-813X(03)00037-8
  30. Urban P, Gobba F, Nerudova J, Lukas E, Cabelkova Z, Cikrt M. Color discrimination impairment in workers exposed to mercury vapor. Neurotoxicology 2003;24(4-5):711-6. https://doi.org/10.1016/S0161-813X(03)00036-6
  31. Westermeyer J. The psychiatrist and solvent inhalant abuse: recognition, assessment, and treatment. Am J Psychiatry 1987;144(7):903-7.
  32. Kim H, Kim SM, Cho SH. Effects of glue sniffing on weight increase or central nervous system of young rat. J Prev Med Public Health 1993;26(2):222-30. (Korean)
  33. Arena JM, Drew RH. Miscellaneous compounds. In toxicology. 5th ed. Charies C Thomas. Illinois. 1986. pp 875-8.
  34. Park SH, Choi HJ, Chun SM, Ha NR, Park SL, Kim GH, Im TH. Glue sniffing presenting with severe hypokalemia and metabolic acidosis - A case report -. J Korean Soc Emerg Med 2005;16(5):595-600. (Korean)
  35. Kaufman DM. Peripheral nerve disorders. In clinical neurology for psychiatrists. 3rd ed. Library of Congress. New York. 1990.
  36. Borne J, Riascos R, Cuellar H, Vargas D, Rojas R. Neuroimaging in drug and substance abuse part II: opioids and solvents. Top Magn Reson Imaging 2005;16(3):239-45. https://doi.org/10.1097/01.rmr.0000192154.34563.6b
  37. Kamran S, Bakshi R. MRI in chronic toluene abuse: low signal in the cerebral cortex on T2-weighted images. Neuroradiology 1998;40(8):519-21. https://doi.org/10.1007/s002340050637
  38. Cavalleri A, Gobba F, Nicali E, Fiocchi V. Dose-related color vision impairment in toluene-exposed workers. Arch Environ Health 2000;55(6):399-404. https://doi.org/10.1080/00039890009604037
  39. Raitta C, Teir H, Tolonen M, Nurminen M, Helpio E, Malmstrom S. Impaired color discrimination among viscose rayon workers exposed to carbon disulfide. J Occup Med 1981;23(3):189-92.
  40. Wyse DG. Deliberate inhalation of volatile hydrocarbons: a review. Can Med Assoc J 1973;108(1):71-4.
  41. Triebig G, Stark T, Ihrig A, Dietz MC. Intervention study on acquired color vision deficiencies in styreneexposed workers. J Occup Environ Med 2001;43(5):494-500. https://doi.org/10.1097/00043764-200105000-00010
  42. Paramei GV, Meyer-Baron M, Seeber A. Impairments of colour vision induced by organic solvents: A metaanalysis study. Neurotoxicology 2004;25(5):803-16. https://doi.org/10.1016/j.neuro.2004.01.006
  43. Nakatsuka H, Watanabe T, Takeuchi Y, Hisanaga N, Shibata E, Suzuki H, Huang MY, Chen Z, Qu QS, Ikeda M. Absence of blue-yellow color vision loss among workers exposed to toluene or tetrachloroethylene, mostly at levels below occupational exposure limits. Int Arch Occup Environ Health 1992;64(2):113-7. https://doi.org/10.1007/BF00381478
  44. Pokomey J, Smith VC, Verriest G, Pinkers AJ. Congenital and acquired colour vision defects. Grune and Stratton. New York. 1979.
  45. Zavalic M, Mandic Z, Turk R, Bogadi-Sare A, Plavec D. Quantitative assessment of color vision impairment in workers exposed to toluene. Am J Ind Med 1998;33(3):297-304. https://doi.org/10.1002/(SICI)1097-0274(199803)33:3<297::AID-AJIM12>3.0.CO;2-V
  46. Valic E, Waldhor T, Konnaris C, Michitsch A, Wolf C. Acquired dyschromatopsia in combined exposure to solvents and alcohol. Int Arch Occup Environ Health 1997;70(6):403-6. https://doi.org/10.1007/s004200050236