Assessing color vision loss among solvent-exposed workers

Prevalence of color vision deficiency among arc welders

PURPOSE

This study was performed to investigate whether occupationally related color vision deficiency can occur from welding.

METHODS

A total of 50 male welders, who had been working as welders for at least 4 years, were randomly selected as case group, and 50 age matched non-welder men, who lived in the same area, were regarded as control group. Color vision was assessed using the Lanthony desatured panel D-15 test. The test was performed under the daylight fluorescent lamp with a spectral distribution of energy with a color temperature of 6500K and a color rendering index of 94 that provided 1000lx on the work plane. The test was carried out monocularly and no time limit was imposed. All data analysis were performed using SPSS, version 22.

RESULTS

The prevalence of dyschromatopsia among welders was 15% which was statistically higher than that of nonwelder group (2%) (p=0.001). Among welders with dyschromatopsia, color vision deficiency in 72.7% of cases was monocular. There was positive relationship between the employment length and color vision loss (p=0.04). Similarly, a significant correlation was found between the prevalence of color vision deficiency and average working hours of welding a day (p=0.025).

CONCLUSIONS

Chronic exposure to welding light may cause color vision deficiency. The damage depends on the exposure duration and the length of their employment as welders.

Ability of Bottle Cap Color to Facilitate Accurate Patient-Physician Communication Regarding Medication Identity in Patients with Glaucoma

PURPOSE

To determine the accuracy of patient-physician communication regarding topical ophthalmic medication use based on bottle cap color, particularly among individuals who may have acquired color vision deficiency from glaucoma.

DESIGN

Cross-sectional, clinical study.

PARTICIPANTS

Patients aged ≥18 years with primary open-angle, primary angle-closure, pseudoexfoliation, or pigment dispersion glaucoma, bilateral visual acuity of ≥20/400, and no concurrent conditions that may affect color vision.

METHODS

A total of 100 patients provided color descriptions of 11 distinct medication bottle caps. Color descriptors were then presented to 3 physicians. Physicians matched each color descriptor to the medication they thought the descriptor was describing.

MAIN OUTCOME MEASURES

Frequency of patient-physician agreement, occurring when all 3 physicians accurately matched the color descriptor to the correct medication. Multivariate regression models evaluated whether patient-physician agreement decreased with degree of better-eye visual field (VF) damage, color descriptor heterogeneity, or color vision deficiency, as determined by the Hardy-Rand-Rittler (HRR) score and Lanthony D15 color confusion index (D15 CCI).

RESULTS

Subjects had a mean age of 69 (±11) years, with VF mean deviation of -4.7 (±6.0) and -10.9 (±8.4) decibels (dB) in the better- and worse-seeing eyes, respectively. Patients produced 102 unique color descriptors to describe the colors of the 11 bottle caps. Among individual patients, the mean number of medications demonstrating agreement was 6.1/11 (55.5%). Agreement was less than 15% for 4 medications (prednisolone acetate [generic], betaxolol HCl [Betoptic; Alcon Laboratories Inc., Fort Worth, TX], brinzolamide/brimonidine [Simbrinza; Alcon Laboratories Inc.], and latanoprost [Xalatan; Pfizer, Inc., New York, NY]). Lower HRR scores and higher D15 CCI (both indicating worse color vision) were associated with greater VF damage (P < 0.001). Extent of color vision deficiency and color descriptor heterogeneity significantly predicted agreement in multivariate models (odds of agreement = 0.90 per 1 point decrement in HRR score, P < 0.001; odds of agreement = 0.30 for medications exhibiting high heterogeneity [≥11 descriptors], P = 0.007).

CONCLUSIONS

Physician understanding of patient medication use based solely on bottle cap color is frequently incorrect, particularly in patients with glaucoma who may have color vision deficiency. Errors based on communication using bottle cap color alone may be common and could lead to confusion and harm.

Chronic solvent-induced encephalopathy: European consensus of neuropsychological characteristics, assessment, and guidelines for diagnostics

INTRODUCTION

The presence of neuropsychological impairment is a hallmark of chronic solvent-induced encephalopathy (CSE), and using clinical neuropsychological procedures to generate a valid assessment of the condition is crucial for its diagnosis. The goals of this consensus document are to provide updated knowledge of the neuropsychological characteristics of CSE and to provide internationally acceptable guidelines for using neuropsychological assessments in the process of diagnosing patients who are suspected of having CSE.

MATERIALS AND METHODS

A European working group that was composed of experts in the field of the clinical diagnosis of CSE met at several round-table meetings and prepared this report. The first section of the consensus paper addresses a review of the relevant literature that was published between 1985 and March 2012. The second section addresses recommendations for the clinical neuropsychological assessment of patients who are suspected of having CSE.

RESULTS

The literature review indicates that the most common neuropsychological impairments in CSE patients are within the domains of attention, particularly the speed of information processing, memory, and motor performance. It appears that the influence of CSE on memory processes mainly involves immediate recall and generally involves verbal, visual and visuospatial material. In the second section, six recommendations are presented regarding important functional domains for the neuropsychological diagnostic process of CSE that relate to the evaluation of neuropsychological impairment, the assessment and evaluation of symptoms, differential diagnostic considerations, the reliability and validity of neuropsychological test results, and the retesting of patients.

DISCUSSION AND CONCLUSIONS

These recommendations will contribute to the improvement of the process for accurately diagnosing CSE, better counselling for CSE patients, the comparability of epidemiological data between countries, and finally, by raising awareness, these recommendations will contribute to combating the adverse health effects of occupational exposure to solvents.

Psychophysical evaluation of achromatic and chromatic vision of workers chronically exposed to organic solvents

The purpose of this paper was to evaluate achromatic and chromatic vision of workers chronically exposed to organic solvents through psychophysical methods. Thirty-one gas station workers (31.5 ± 8.4 years old) were evaluated. Psychophysical tests were achromatic tests (Snellen chart, spatial and temporal contrast sensitivity, and visual perimetry) and chromatic tests (Ishihara's test, color discrimination ellipses, and Farnsworth-Munsell 100 hue test—FM100). Spatial contrast sensitivities of exposed workers were lower than the control at spatial frequencies of 20 and 30 cpd whilst the temporal contrast sensitivity was preserved. Visual field losses were found in 10–30 degrees of eccentricity in the solvent exposed workers. The exposed workers group had higher error values of FM100 and wider color discrimination ellipses area compared to the controls. Workers occupationally exposed to organic solvents had abnormal visual functions, mainly color vision losses and visual field constriction.

Avaliação visual de sujeitos expostos de forma ocupacional a solventes orgânicos através de métodos psicofísicos

Os solventes orgânicos são substâncias neurotóxicas que podem causar efeitos danosos sobre as funções visuais. É comum a exposição ocupacional a esses tipos de substâncias, pois elas apresentam grande aplicabilidade em inúmeras atividades. Os efeitos podem ser quantificados por testes psicofísicos. Os testes mais usados nesse tipo de avaliação são de ordenamento de matizes, como o Teste D15 Dessaturado de Lanthony e o Teste dos 100 Matizes de Farnsworth-Munsell, e avaliação de sensibilidade ao contraste espacial de luminância, como MCT 8000 Vistech, VCTS 6500 Vistech e FACT 101. Em geral esses testes descrevem perda de discriminação de cores, afetando tanto o eixo azul-amarelo quanto o eixo verde-vermelho, e diminuição da sensibilidade ao contraste de luminância principalmente para as frequências espaciais mais baixas. Existe correlação positiva entre os resultados da avaliação psicofísica e vários marcadores biológicos e ambientais, mas essa correlação depende do marcador e do tipo de solvente ao qual os indivíduos são expostos. Fatores como alcoolismo crônico e tabagismo inveterado podem interferir no processo de correlacionar esses resultados.

Colour vision and light sensitivity in tunnel workers previously exposed to acrylamide and N-methylolacrylamide containing grouting agents

OBJECTIVES

The aim of the study was to examine possible persisting visual system effects in tunnel workers previously exposed to acrylamide and N-methylolacrylamide during grouting work.

MATERIAL AND METHODS

Visual field light sensitivity threshold and colour vision has been examined among 44 tunnel workers 2-10 years after exposure to acrylamide and N-methylolacrylamide containing grouting agents. Forty-four tunnel workers not involved in grouting operations served as control group. Information on exposure and background variables was obtained for all participants from a questionnaire. Visual light sensitivity threshold was measured using Humphrey Visual Field Static Perimeter 740, program 30-2 Fastpack, with red stimuli on white background, and colour vision, using Lanthony D-15 Desaturated Color test. Based on D-15d test results, colour confusion index (CCI), and a severity index (C-index) was calculated.

RESULTS

The exposed group had a significantly higher threshold for detecting single stimuli in all parts of the inner 30 degrees of the visual field compared to the control group. The foveal threshold group difference was 1.4 dB (p=0.002) (mean value, both eyes). On the Lanthony 15 Hue Desaturated test, the exposed subjects made more errors in sorting blue colours, and a statistically significant increase in C-index was observed. Surrogate measures for duration and intensity of exposure gave no further improvement of the model.

CONCLUSIONS

The results indicate slightly reduced light sensitivity and reduced colour discrimination among the exposed subjects compared to the controls. The findings may be due to previous exposure to acrylamide containing grouts among the tunnel workers.

Vision abnormalities in young children exposed prenatally to organic solvents

Despite an accumulating body of evidence demonstrating that the visual system is an important target for organic solvent toxicity in adults, little attention has been paid to the visual functioning of children with prenatal exposure to organic solvents. The present study aimed to: (1) determine prospectively whether prenatal solvent exposure increases the risk of visual deficits in infants and (2) assess the relationship between estimates of exposure level and integrity of visual responses. A sample of 21 infants born to women who were occupationally exposed to solvents during pregnancy was compared with 27 non-exposed age-matched control infants. All mothers were recruited from Motherisk, an antenatal counseling service in Toronto, Canada. Contrast sensitivity and grating acuity were assessed using a sweep visual evoked potential (VEP) technique whereas chromatic- and achromatic mechanisms were assessed using a transient VEP technique. Exposure level was estimated from questionnaire data obtained during pregnancy. Testers were masked to exposure status. Results showed a significant reduction in contrast sensitivity in the low and intermediate spatial frequency range in solvent-exposed infants compared to controls (p<0.001). With respect to grating acuity, there was a significant effect of exposure level, with children in the high exposed having reduced grating acuity compared with children in the low exposed group (p<0.025) and controls (p=0.02). Regarding color vision, 26.3% of infants in the exposed group versus 0% of the controls produced abnormal VEP responses to the red-green onset stimulus (p<0.01), but not to either blue-yellow or achromatic stimuli. No differences were found with respect to latency or amplitude of chromatic and achromatic response. These findings suggest that prenatal solvent exposure is associated with selective visual deficits, including reduced contrast sensitivity and abnormal red-green vision. Increasing levels of exposure may lead to further visual deficits affecting grating acuity. These findings support the need for a re-evaluation of current occupational exposure standards for pregnant women.

Tetrachloroethylene (PCE, Perc) levels in residential dry cleaner buildings in diverse communities in New York City

Fugitive tetrachloroethylene (PCE, perc) emissions from dry cleaners operating in apartment buildings can contaminate residential indoor air. In 1997, New York State and New York City adopted regulations to reduce and contain perc emissions from dry cleaners located in residential and other buildings. As part of a New York State Department of Health (NYSDOH) study, indoor air perc levels were determined in 65 apartments located in 24 buildings in New York City where dry cleaners used perc on site. Sampling occurred during 2001-2003, and sampled buildings were dispersed across minority and nonminority as well as low-income and higher income neighborhoods. For the entire study area, the mean apartment perc level was 34 microg/m3, 10-fold lower than mean apartment levels of 340-360 microg/m3 documented before 1997. The maximum detected perc level was 5,000 microg/m3, 5-fold lower than the maximum of 25,000 microg/m3 documented before 1997. Despite these accomplishments, perc levels in 17 sampled apartments still exceeded the NYSDOH residential air guideline of 100 microg/m3, and perc levels in 4 sampled apartments exceeded 1,000 microg/m3. Moreover, mean indoor air perc levels in minority neighborhoods (75 microg/m3) were four times higher than in nonminority households (19 microg/m3) and were > 10 times higher in low-income neighborhoods (256 microg/m3) than in higher income neighborhoods (23 microg/m3). Logistic regression suitable for clustered data (apartments within buildings) indicated that perc levels on floors 1-4 were significantly more likely to exceed 100 microg/m3 in buildings located in minority neighborhoods (odds ratio = 6.7; 95% confidence interval, 1.5-30.5) than in nonminority neighborhoods. Factors that may be contributing to the elevated perc levels detected, especially in minority and low-income neighborhoods, are being explored.

Impairments of Colour Vision Induced by Organic Solvents: A Meta-Analysis Study

The impairment of colour discrimination induced by occupational exposure to toluene, styrene and mixtures of organic solvents is reviewed and analysed using a meta-analytical approach. Thirty-nine studies were surveyed covering a wide range of exposure conditions. Those studies using the Lanthony Panel D-15 desaturated test (D-15d) were further considered. From these for 15 samples data on colour discrimination ability (Colour Confusion Index, CCI) and exposure levels were provided, required for the meta-analysis. In accordance with previously reported higher CCI values for the exposed groups, the computations yielded positive effect sizes for 13 of the 15 samples, indicating that in the great majority of the studies the exposed groups showed inferior colour discrimination. However, the meta-analysis showed great variation in effect sizes across the studies. Possible reasons for inconsistency among the reported findings are discussed. These pertain to exposure-related parameters, as well as to confounders such as conditions of test administration and characteristics of subject samples. Those factors vary considerably among the studies and might have greatly contributed to divergence in measured colour vision capacity, thereby obscuring consistent effects of organic solvents on colour discrimination.

Colour vision and occupational toluene exposure: results of repeated examinations

Potential effects of human occupational exposures to toluene on colour vision were investigated in a follow-up study over 4 years with three repeated examinations. Colour vision was measured with the Lanthony desaturated colour vision test D-15d, and the colour confusion index (CCI) was calculated. The mean current exposures were 26+/-21 ppm for printers (high toluene level) and 3+/-4 ppm for end-processors (low toluene level). The mean exposure durations were 23+/-6 years for "long-time exposed" and 7+/-2 years for "short-time exposed" subjects. Repeated analyses (n=162) and multiple regressions (maximum available n=267) did not reveal significant effects of toluene with respect to intensity or duration of current or long-term exposure. Age and occupational qualification were significantly associated with CCI in both kinds of analysis, whereas alcohol consumption (carbohydrate-deficient transferrin, CDT) and smoking habits (cigarettes per day) were not. It is concluded that current industrial exposure limits of toluene provide sufficient protection against possible disturbance of colour vision.

Does Occupational Exposure to Organic Solvents Affect Colour Discrimination?

This review assesses the evidence regarding the effects of occupational exposure to organic solvents on colour discrimination and investigates exposure-response relationships and reversibility. This review also considers the current state of knowledge of the possible mechanisms underlying changes in colour vision, and the human health significance of any reported changes. Among the commonly used organic solvents, styrene has been investigated the most thoroughly. Studies of styrene-exposed workers in Germany, Italy and Japan provide a sufficiently consistent body of evidence to support a robust conclusion that styrene does cause an impairment of colour discrimination relative to age-matched controls. Generally, the impairment of colour discrimination observed in styrene-exposed workers tends to be of the tritan (blue-yellow) type, although some cases of red-green impairment have also been found. The limited information available on exposure-response relationships indicates that the effects on colour discrimination would not be expected at 8-hour time weighted average (8 h TWA) exposures <20 ppm, although a precise threshold cannot be determined. The data on reversibility are limited and inconclusive. The results from the most rigorous study in which this aspect was investigated point to a reversibility of effects after a 4-week exposure-free period, whereas results from a study with limitations suggest a persistence of effect. The effects of toluene, tetrachloroethylene or mixed solvent exposure have also been investigated, although the information available is generally less reliable than for styrene. For toluene, it can be confidently concluded that this solvent does not have an acute effect on colour discrimination, even when exposures are relatively high (50-150 ppm 8 h TWA, and 290-360 ppm 30 minutes TWA). However, studies are inconclusive on whether long-term or repeated exposure to toluene can cause a persistent impairment of colour discrimination. There are few studies that have specifically investigated the effects of tetrachloroethylene on colour discrimination. Among these studies, none has examined the potential for any acute effects of this solvent vapour. A large-scale study in Japanese workers showed no effects of long-term exposure to tetrachloroethylene concentrations in the region of 12-13 ppm. However, the test methodology used was relatively insensitive to changes in colour discrimination, hence the results do not provide reassurance for an absence of subtle effects. A study in Italian dry-cleaners suggested a slight impairment of colour discrimination relative to controls, associated with relatively low exposures to tetrachloroethylene (mean 8 h TWA exposure approximately 6 ppm). The studies concerning the effects of mixed solvent exposure on colour discrimination are based on workers exposed to solvents in paints and lacquers, workers from the printing and petrochemical industries, people working in or living near to microelectronics factories and children exposed to solvents prenatally. However, these studies are subject to design limitations or methodological irregularities, such that no conclusions regarding the effects of mixed solvent exposure on colour discrimination can be drawn. Overall, the only credible evidence for an effect of solvents on colour discrimination derives from the studies on styrene. Because of limitations in the data for other solvents it is not possible to determine whether the evidence for styrene reflects a generic property of solvents. The mechanisms of styrene-induced effects on colour discrimination have not been properly investigated and can only be the subject of speculation. One conclusion that can be drawn is that pathological changes to the ocular system, such as changes to the lens, are unlikely to be involved. This is because there is an absence of convincing evidence for such changes from medical examinations conducted in epidemiological studies of solvent-exposed workers. Also, it seems unlikely that effects on colour discrimination are a nonspecific consequence of more generalised CNS depression, given that styrene-induced effects on colour discrimination appear to occur below the threshold for narcotic effects. The effects of styrene on colour discrimination are subtle and involve an impairment of the ability to discriminate accurately between closely related shades of the same colour rather than 'colour blindness'. There is no valid basis for using colour discrimination as a marker for other forms of solvent-induced neurotoxicity.

Visual dysfunction in workers exposed to a mixture of organic solvents

The aim of this study was to investigate the relationship between the workers occupationally exposed to a mixture of organic solvents and their visual functions. Here the visual functions included color vision (CV), visual contrast sensitivity (CS) and visual evoked potentials (VEP). Test subjects were 182 workers at 53 furniture factories in the same industrial area of Japan. As control, a group consisted of 96 workers without exposure to any organic solvent was also tested. Exposure assessments were made both by the environmental concentration and biological monitoring. CV and CS tests were carried out for all the subjects. VEP was measured for 21 exposed subjects who were considered to have impaired CV and CS. In the results, the color confusion index (CCI) values of the exposed subjects were significantly higher than that of the age-matched controls (P<0.01). Their CS values were significantly lower than those in the controls at spatial frequencies of 6 and 12 cycles per degree (cpd) (P<0.01 and <0.05, respectively). A significant correlation between the concentration of urinary methylhippuric acid and contrast sensitivity was found by a multiple regression analysis (P<0.05). CCI showed a negative correlation at all spatial frequencies of CS in a simple regression analysis, no abnormal data were found by the VEP test in the exposed subjects who were found to have impaired CV and CS. The results suppose that a low concentration of the mixed organic solvents might affect the retina and optic nerve. However, it needs to be further researched if such an impact affects the Brodmann's areas of visual cortex in the brain.

Color vision impairment in workers exposed to neurotoxic chemicals

Recent research shows that occupational exposure to several solvents, metals and other industrial chemicals can impair color vision in exposed workers. Occupation-related color vision impairment usually results in blue-yellow color discrimination loss or, less frequently, a combination of blue-yellow and red-green loss. The eyes may be unequally involved, and the course is variable depending on exposure and other factors. The pathogenesis of occupational color vision loss has not been elucidated; it may be due to, e.g. a direct action of neurotoxins on receptors, possibly on the cone's membrane metabolism, and/or to an interference with neurotransmitters within the retina. Other possible pathogenetic mechanisms, such as a direct effect to the optic nerve, have also been suggested. Occupational color vision loss is usually sub-clinical, and workers are unaware of any deficit. It can be assessed using sensitive tests, such as the Farnsworth-Munsell 100 Hue (FM-100) or the Lanthony D-15 desaturated panel (D-15 d). The latter is the most widely used for studies in groups of exposed workers, and offers the possibility of a quantitative evaluation of the results by calculation of the Bowman's Color Confusion Index (CCI), or of the Vingrys' and King Smith's Confusion Index (CI). Other advantages of D-15 d are the possibility to perform the test directly at the workplace, and the reproducibility when performed in standardized conditions. In most cases, occupation-related color vision impairment is correlated to exposure levels, and has often been observed in workers exposed to environmental concentrations below the current occupational limit proposed by the ACGIH. Progression with increasing cumulative exposure has been reported, while reversibility is still discussed. Acquired color vision impairment related to occupational exposure to styrene, perchloroethylene (PCE), toluene, carbon disulfide, n-hexane, solvent mixtures, mercury and some other chemicals are discussed. Results show that color vision testing should be included in the evaluation of early neurotoxicity of chemicals in exposed workers. The D-15 d would be useful in the surveillance of workers exposed to solvents and other chemicals toxic to the visual system.

Occupational exposure to chemicals and sensory organs: a neglected research field

The effect of industrial chemicals on the sensory perception of exposed workers has received scant attention from the medical community to date, and the scientific literature is mainly limited to some case-reports or isolated studies. Possible explanations for this include the complexity of sensory perception, and the lack of agreement among researchers on methods for testing large groups of subjects. Nevertheless, some published studies showed that vision, hearing and olfactory function can be affected by various industrial metals and solvents, and some data exist also for touch and taste. This review discusses the main industrial chemicals involved. The pathogenesis of the toxicity of chemicals to sensory perception may be related to an action on receptors, nerve fibers, and/or the brain; probably, different pathogenetic mechanisms are involved. One of the main problems in this research field is that most of the studies to date evaluated the effect of a single industrial chemical on a single sense: as an example, we know that styrene exposure can impair smell and also hearing and vision but we have little idea whether different senses are impaired in the same worker, or whether each impairment is independent. In addition, workers are frequently exposed to different chemicals: co-exposure may have no effect, or result in both an increase or a decrease of the effect, as was observed for hearing loss, but studies on this aspect are largely insufficient. Research shows that both occupational and environmental exposure to industrial chemicals can affect sense organs, and suggests that the decline of perception with age may be, at least partly, related to this exposure. Nevertheless, available evidence is incomplete, and is largely inadequate for an estimation of a "safe" threshold of exposure. Good quality further research in this field is needed. This is certainly complex and demands adequate resources, but is justified by the ultimate result: the possibility to prevent an avoidable part of the decline in sensory function with age.

Assessment of visual functions following prenatal exposure to organic solvents

Prenatal exposure to organic solvents has been previously associated with increased risk of color vision deficits and reduced visual acuity in young children. These findings prompted us to evaluate visual functioning in solvent-exposed infants using more sensitive non-invasive visual evoked potential (VEP) techniques. VEP techniques are described in the context of an ongoing prospective longitudinal cohort study of infants exposed to organic solvents in utero. VEPs are recorded via three active electrodes fitted over the occipital cortex while infants view changing visual stimuli. The sweep VEP is used to assess contrast detection and visual acuity by presenting sinusoidal gratings that "sweep" across a range of contrasts and spatial frequencies. Transient VEPs are used to assess responses to equiluminant chromatic- and luminance-modulated sinusoidal gratings presented in pattern onset-offset format. A single case study is presented showing abnormal chromatic responses and reduced contrast sensitivity in a 2.5-year-old boy following prenatal exposure to perchloroethylene (PCE). These VEP techniques therefore appear promising for the clinical assessment of visual toxicity in pediatric populations.

Color discrimination impairment in workers exposed to mercury vapor

OBJECTIVE

To study color discrimination impairment in workers exposed to elemental mercury (Hg) vapor.

SUBJECTS

Twenty-four male workers from a chloralkali plant exposed to Hg vapor, aged 42+/-9.8 years, duration of exposure 14.7+/-9.7 years, were examined. The 8h TWA air-borne Hg concentration in workplace was 59 microg/m(3); mean Hg urinary excretion (HgU) was 20.5+/-19.3 microg/g creatinine; mean Hg urinary excretion after the administration of a chelating agent, sodium 2,3-dimercapto-1-propane-sulfonate (DMPS), was 751.9+/-648 microg/48h. Twenty-four age- and gender-matched control subjects were compared. Visual acuity, alcohol intake, smoking habits, and history of diseases or drugs potentially influencing color vision were registered.

METHODS

The Lanthony 15-Hue desaturated test (L-D15-d) was used to assess color vision. The results were expressed quantitatively as Bowman's Color Confusion Index (CCI), and qualitatively according to Verriest's classification of acquired dyschromatopsias.

RESULTS

The CCI was significantly higher in the exposed group than in the control (mean CCI 1.15 versus 1.04; P=0.04). The proportion of subjects with errorless performance on the Lanthony test was significantly lower in the Hg exposed group compared to referents (52% versus 73%; P=0.035). The exposed group showed higher frequency of type III dyschromatopsias (blue-yellow confusion axis) in comparison with the control group (12.5% versus 8.3%), however, the difference did not reach statistical significance. Multiple regression did not show any significant relationship between the CCI, and age, alcohol consumption, or measures of exposure.

CONCLUSION

In agreement with previous studies by Cavalleri et al. [Toxicol. Lett. 77 (1995) 351; Environ. Res. Sec. A 77 (1998) 173], the results of this study support the hypothesis that exposure to mercury vapor can induce sub-clinical color vision impairment. This effect was observed at an exposure level below the current biological limit for occupational exposure to mercury. This raises doubts on the actual protection afforded by this limit concerning the effect of mercury on color vision.

Color vision and occupational chemical exposures: I. An overview of tests and effects

The paper presents a summary of the literature published until December 2000 on effects from some industrial chemical exposures on color perception, as well as short descriptions of the tests applied. Several different tests have been used to study acquired alterations of color vision. These changes are frequently found in the blue-yellow axis. Many of the tests were originally designed to detect congenital alterations in the red-green axis, and thus have relatively low sensitivity when studying chemically induced deficits in color perception. At present, the Lanthony D15-desaturated panel seems most suitable for application in industrial settings, since it is clearly the most sensitive and easily administered test. Color vision seems to be a physiological function very sensitive to several chemicals. The potency of industrial chemicals to induce color vision deficiencies has often been investigated during the last two decades. The chemicals most frequently studied are different solvents and mercury. Pronounced effects on color perception have been reported following chronic exposure to organic solvents such as styrene, carbon disulphide, perchloroethylene, n-hexane and solvent mixtures, and to organic as well as inorganic mercury. The effect of occupational toluene exposure seems not as well established, since only slight effects and several negative studies have been reported. For some of these compounds the effect on color vision has been further established through the finding of clear dose-effect relationships. In a few cases, even acute exposure situations, e.g. exposure to toluene for a few hours or acute alcohol intake, seem to affect color perception. Follow-up studies are needed to investigate the possible reversibility of effects in relation to discontinued or reduced exposures.

Color vision and occupational chemical exposures. II. Visual functions in non-exposed subjects

This paper presents data on visual functions (visual acuity, contrast sensitivity, and several tests of color vision), in a group of 199 non-exposed healthy subjects with an even distribution over the age range 18-65 years, and sex. Although subjects with obvious congenital color vision deficiencies were removed from the analyses (four males), females were superior to males on several of the color vision tests applied. Age influenced visual acuity and contrast sensitivity, while color discrimination was less affected. Correlations between functions of the right and the left eye in the individual subjects were rather low, ranging from 0.40 to 0.73. Correlations between visual acuity and contrast sensitivity on the one hand and color discrimination ability on the other hand were still lower (r < 0.20). These low correlations between functions in the two eyes support the need for testing each eye separately.

Color vision and occupational toluene exposure

We examined the relationship between acquired color vision loss and exposure to toluene and total hydrocarbons among 125 male workers. Seventy-two toluene-exposed printers were compared with 34 workers from the same photogravure plant with ambient background exposure, and with 19 workers from a bookbinding plant located in the same town (nonexposed). Environmental mean toluene exposure level at workstation was estimated from individual 8-h sampling. Historic exposure data from the last 30 years were used to construct two cumulative exposure indices, one for toluene and one for total hydrocarbons. Airborne toluene levels were overall lower than the current Threshold Limit Value (TLV) of 50 ppm. Color vision was assessed by the Lanthony D-15 desaturated panel. Color vision loss was quantitatively established by the Color Confusion Index (CCI) and classified by type of acquired dyschromatopsia according to Verriest's classification. CCI was positively related to current airborne toluene levels, and cumulative exposure indices for toluene and total hydrocarbons (.18< or =r< or =.35). Odds ratios of acquired dyschromatopsia were significant for current airborne toluene, toluene, and total hydrocarbon past exposure (1.27 [1.02-1.58], 1.21 [1.04-1.39], 1.15 [1.02-1.31], respectively). In conclusion, this study suggests that the Lanthony D-15 desaturated panel detects early neurotoxic effects among workers exposed to toluene.

Dose-related color vision impairment in toluene-exposed workers

Occupational exposure to various neurotoxic chemicals can impair color vision. We evaluated this possibility in toluene-exposed workers. Thirty-three rubber workers and 16 referents were studied. We estimated toluene exposure by measuring urinary excretion of the unmodified form of the solvent (i.e., TolU). Color vision was tested with the Lanthony D-15 desaturated panel, and the outcomes were expressed quantitatively with the Color Confusion Index and the Total Confusion Index. Toluene-exposed workers had a subclinical reduction in color vision, compared with referents. We related this effect to solvent cumulative exposure--estimated as the product of urinary excretion of unmodified toluene by previous toluene exposure duration. This approach supports the hypothesis that impairment progresses as exposure continues. In the examined group of workers, toluene exposure was within the occupational limit proposed by the American Conference of Governmental Industrial Hygienists. The observed loss in color vision raises doubts on the real protection afforded by this limit--at least for effects of the solvent on the eyes. Finally, the Total Confusion Index was a more sensitive index than the Color Confusion Index in the evaluation of toluene-related color-vision impairment, suggesting that this index should be adopted in future studies of the effects of chemicals on color perception.

Neurological deficits in solvent-exposed painters: a syndrome including impaired colour vision, cognitive defects, tremor and loss of vibration sensation

Five individuals are described who had participated in a study of former dockyard painters. All had worked between 16 years and 45 years as industrial painters, much of the time inside ships. All underwent structured neurological examination, colour vision testing (allowing calculation of a colour confusion index corrected for age and alcohol), and detailed psychometric testing. An occupational history sufficient to allow estimation of past exposure to solvents was taken. All gave a history of exposure to high concentrations of solvents at work, and several described episodes of acute narcosis. All showed neurological deficits and some had overt neurological disease, although in no case had this previously been linked to their work. The most striking features, sufficient to constitute a syndrome, were acquired blue-yellow colour vision deficits, coarse tremor, impaired vibration sensation in the legs and cognitive impairment. Their estimated cumulative exposures to solvents ranged between the equivalent of 13 and 37 calendar years working at the Occupational Exposure Standard concentration (OES years). This study for the first time gives an indication of the concentrations of solvents likely to lead to serious neurological disease in humans. It serves as a reminder to physicians to take an occupational history from patients with obscure neurological or psychological impairment.

Impairment of colour vision in workers exposed to organic solvents

OBJECTIVES

To investigate loss of colour vision related to exposure to solvents and the role of three enzyme polymorphisms in modifying the risk in exposed workers.

METHODS

A sample was studied of 68 male dockyard workers and 42 male community controls with and without neuropsychological symptoms from a previous cross sectional study. Indices of cumulative and intensity based exposure to solvents were calculated for all subjects. Alcohol, drug, and smoking histories were obtained. Colour vision was tested by Lanthony D15d colour vision test. Genotype of glutathione S-transferase M1 and T1 and N-acetyltransferase 2 polymorphisms were determined.

RESULTS

The relation between impairment of colour vision and exposure to solvents was investigated with multiple regression techniques. Increasing annual exposure to solvents was significantly associated with reduced colour vision (p=0.029). Impairment of colour vision was not associated with neuropsychological symptoms as measured by the Q16 solvent symptom questionnaire. No significant association was found between acquired impairment of colour vision and genetic polymorphisms when GSTM1, GSTT1 or NAT2 phenotypes were included in the analyses.

CONCLUSIONS

Exposure to mixed solvents is associated with impairment in colour vision, the risk increases with increasing exposure. The risk of impairment of colour vision was not altered in this study by the presence of different GSTM1, GSTT1 or NAT2 polymorphisms.

Mechanism of neurobehavioral alteration

Behavioral toxicology is an emerging field which is becoming increasingly important in risk assessment of exposure to neurotoxic substances, due to the high sensitivity of behavior towards neurotoxic action and the integration in behavioral functions of several underlying processes and neurofunctions, such as motor, sensory, attention, motivational. Whenever it is difficult to isolate the relative contribution of sensory, motor, arousal, or cognitive factors that contribute to an observed behavioral change, possible mechanism of behavioral alteration may rely on the involvement of neurotransmitters, such as the dopaminergic system and catecholamines metabolism. Examples are given of different behavioral types of changes induced in humans by organic solvents (styrene), metals (manganese) and anaesthetic gases, based on a possible common underlying mechanism of toxicity.

Effects of high doses of toluene on color vision

High exposure to toluene may cause optic neuropathy and retinopathy, both associated with dyschromatopsia. Another solvent, ethanol, is known to induce acute blue-yellow dyschromatopsia. This study investigated the acute effects of high doses of toluene on color vision. Eight male printshop workers were examined before and after cleaning printing containers with pure toluene. After cleaning, concentrations of toluene in blood were between 3.61 and 7.37 mg/l. Color vision was tested with the Farnsworth panel D-15 test, the Lanthony desaturated panel D-15 test, and the Standard Pseudoisochromatic Plates part 2. For control of possible acute effects, eight workers of a metal-working factory without any neurotoxic exposure were tested according to the same procedure. Acute exposure to toluene did not cause impairment of color vision. However, statistical power is limited due to the small number of exposed subjects. Color vision of the printshop workers tested before cleaning was slightly impaired (statistically not significant) when compared with unexposed subjects.

Reversible color vision loss in occupational exposure to metallic mercury

Color vision was evaluated in twenty-one mercury exposed workers and referents matched for sex, age, tobacco smoking, and alcohol habits. The Lanthony 15 Hue desaturated panel (D-15 d) was applied. In the workers, mean urinary Hg (HgU) was 115+/-61.5 microg/g creatinine; in all but one the values exceeded the biological limit (BEI) proposed by the American Conference of Governmental Industrial Hygienists. A dose-related subclinical color vision impairment was observed in Hg-exposed workers compared to the referents. Just after the survey, working conditions were improved. Twelve months later the workers were reexamined. Mean HgU was 10.0 microg/g creatinine and in no subjects was the BEI exceeded. Color perception was significantly improved compared to the first examination and, furthermore, no differences were observed between exposed workers and referents. The results add evidence that the color vision loss observed during the first part of the study was related to Hg exposure and, moreover, show that this effect is reversible. These data indicate that metallic Hg can induce a reversible impairment in color perception. This suggests that color vision testing should be included in studies on the early effects of Hg. The possibility of applying the D-15 d as an early effect index in the biological monitoring of Hg exposed workers should also be entertained.

Reappraisal of a short-wavelength-sensitive (S-cone) recording technique in routine clinical electroretinography

The recording of blue cone (S-cone) responses as described by Gouras and MacKay was slightly modified and incorporated into our routine ganzfeld electroretinogram protocol. We found a mean S-cone amplitude of 5.0 microV (range 2.9-6.9 microV) and a mean S-cone implicit time of 41.5 msec (range 40-46 msec). Separation between the combined red and green cone (L-M-cone) response and the S-cone response was obtained with blue flash stimuli on a yellow adapting background.

Impaired colour discrimination among workers exposed to styrene: relevance of a urinary metabolite

OBJECTIVES

To survey the loss of colour vision among Japanese workers who have been exposed to styrene concentrations currently considered low (about 20 ppm). Also to assess the effects of styrene by examination of the nature of the relation between disorder of colour vision and age, alcohol consumption, and other variables.

METHODS

Colour discrimination was examined in 64 male workers exposed to styrene (mean age; 38.0, mean exposed years; 7.0) and in 69 controls (mean age; 38.0). A standardised questionnaire was adopted to collect work history, occupational or non-occupational solvent exposure, alcohol consumption, and drug use. Colour vision was evaluated by the Lanthony desaturated panel D-15 test. The results of the test were expressed as the colour confusion index (CCI).

RESULTS

The mean atmospheric styrene concentration was about 20 ppm. The mean urinary concentration of mandelic acid was 0.22 g/l. There was a significant difference in CCI between exposed workers and age matched controls. Colour vision of workers whose concentration of urinary mandelic acid was > or = 0.42 g/l was significantly impaired when compared with workers whose concentration was < 0.42 g/l. Multiple linear regression analysis that controlled confounding variables such as age, alcohol consumption, smoking, and educational attainment showed that the CCI was significantly related to the concentration of urinary mandelic acid. In both exposed workers and controls, the types of defects were mostly blue-yellow loss, although a few subjects showed complex loss. No one showed only red-green loss.

CONCLUSIONS

These findings suggest that exposure to moderate styrene concentrations can lead to impairment of colour vision, and that there is a significant correlation with the urinary metabolite of styrene.

Colour vision loss in workers exposed to elemental mercury vapour

We evaluated colour vision in 33 workers exposed to elemental mercury (Hg) vapour and in 33 referents matched for sex, age, alcohol consumption and cigarette smoking. The results were expressed as colour confusion index (CCI). In the workers urinary excretion of Hg (HgU) ranged from 28 to 287 micrograms/g creatinine. Subclinical colour vision loss, mainly in the blue-yellow range, was observed in the workers. This effect was related to exposure, as indicated by the correlation between HgU and CCI (r = 0.488, P < 0.01). In the workers whose HgU exceeded 50 micrograms/g creatinine, mean CCI was significantly increased compared to the matched referents. The results suggest that exposure to elemental Hg inducing HgU values exceeding 50 micrograms/g creatinine can induce a dose-related colour vision loss.

Work-site clinical and neurobehavioral assessment of solvent-exposed microelectronics workers

Twenty-five workers, five currently and 20 formerly involved in the manufacture of hybrid microcircuits, underwent clinical evaluations at the request of a management-union committee concerned about chronic solvent exposures in a research and development laboratory. A battery of neurobehavioral tests was administered to compare the solvent-exposed group with 32 age-, gender-, ethnicity-, and education-matched controls. The tests included: MMPI-I, hand grip strength, tactile sensitivity, dexterity, color discrimination, visual acuity and contrast sensitivity, and tests selected from the computerized Neurobehavioral Evaluation System (NES2). Clinical narratives and retrospective exposure assessments in the study group suggested chronic low-level exposure to solvents, with intermittent acute excursions. Work-related diagnoses included upper respiratory mucosal irritation and sinusitis (44%), lower respiratory reactive airway disease (12%), and dermatitis (5%). Three workers (12%) had findings consistent with a solvent-induced encephalopathy. Significant differences (after Bonferroni correction) were found between the two groups on 5 of 11 NES subtests: symptom scale, mood scale, finger tapping, simple reaction time, and symbol-digit substitution. Differences also reached significance for overall vibration sensitivity thresholds, visual contrast sensitivity, and grip strength. The MMPI average clinical scale elevation was significantly higher in the exposed group than controls. These results support an association between chronic low-dose solvent exposure and measurable neurobehavioral changes.

Occupational and environmental exposure to perchloroethylene (PCE) in dry cleaners and their family members

Perchloroethylene exposure in 28 dry-cleaning establishments and in 25 homes occupied by dry cleaners in Modena, Italy, was investigated. Environmental air samples and alveolar air samples from dry cleaners (n = 60) and from their family members (n = 23) were collected. The degree of perchloroethylene on the dry-cleaning premises varied widely from establishment to establishment. Spot sampling ranged from 0.6 to 75 mg/m3, whereas sampling by personal passive dosimeters ranged from 2.6 to 221.5 mg/m3 (8-h time weighted average values). Perchloroethylene in alveolar air samples collected at the end of the work day correlated closely with the 8-h time weighted average values (r = .750, p = .001), and correlated also with alveolar air samples collected at home in the evening (r = .665, p = .001) and the following morning (r = .549, p < .001). Perchloroethylene levels inside the homes of dry cleaners appeared significantly higher than in 29 houses selected as controls (Mann Whitney U test, p < .001). Perchloroethylene in alveolar air samples collected at home suggests that nonoccupational exposure to perchloroethylene for family members of dry cleaners exists.

Impairment of color vision among workers exposed to low concentrations of styrene

A field study was conducted among 21 male workers exposed to styrene of concentration below 30 ppm in a fiber-reinforced plastic boat manufacturing plant. Twenty-one male workers with similar age groupings, years of education, and social and occupational state served as referents. The mean end-of-shift urinary mandelic acid (MA) and phenylglycoxylic acid (PGA) for the exposed workers were 84 mg/g creatinine and 66 mg/g creatinine, respectively. The Lanthony D-15 Hue Desaturated Panel was used to evaluate color discrimination of the exposed and referent groups. The results of the test were expressed as total color difference score (TCDS). The exposed workers' mean TCDS (a higher score denotes poorer color discrimination ability) was significantly (p < 0.0006) higher than the referents'. Neurobehavioral tests were also conducted, using the World Health Organization's Neurobehavioral Core Test Battery (NCTB). All the results of the NCTB were poorer for the exposed than for the referents. However, significant differences were observed only for Digit Span, Digit Symbol, and Benton Visual Retention tests. These results suggest that low exposure to styrene could affect some psychometric performance and may impair color vision.

Perchloroethylene exposure can induce colour vision loss

We evaluated colour vision in 35 dry-cleaners exposed to perchloroethylene (PCE) and in a paired number of controls matched for sex, age, alcohol consumption and cigarette smoking. A subclinical colour vision loss, mainly in the blue-yellow range, was present in dry-cleaners. This effect was related to PCE exposure levels, and appeared at environmental concentrations of the solvent well below the current exposure limits for exposed workers. The results suggest that PCE exposure, even at low environmental levels, can induce a dose-related impairment of colour vision.

Neuropsychological toxicology of methylene diphenyl diisocyanate: a report of five cases

The neuropsychological functioning of five men suffering alleged physical, cognitive and behavioural changes following exposure to methylene diphenyl diisocyanate (MDI), an industrial chemical, was investigated in the present study. At the time of assessment, four of the five patients remained symptomatic despite having no contact with MDI for periods ranging from 5 to 9 months. All patients reported experiencing subjective symptoms consisting of respiratory distress, headaches, depression, irritability, forgetfulness, decreased calculating ability, word-finding problems and reduced concentration. While the pattern of neuropsychological deficits varied among the patients, common findings for the group included intact psychomotor, psychosensory, visuographic and language functions accompanied by deceased concentration, mental efficiency, rate of information processing, learning ability and abstract reasoning. All five patients also revealed significant emotional distress on an objective personality measure. In general, the neuropsychological test data support the presence of behavioural and cognitive correlates of CNS injury following exposure to MDI.

Effect of exposure to 2,5-hexanediol in light or darkness on the retina of albino and pigmented rats. II. Electrophysiology

Albino (Sprague-Dawley) and pigmented (Norwegian Brown) male rats were exposed to 2,5-hexanediol (H; 1%) in their drinking water for 5 or 8 weeks, respectively. Half of the rats of each strain were housed in light (average 30 cd/cm2 inside cage, 12 h/day); the other half was kept in constant darkness. Control groups were studied in parallel under identical conditions but without H. Electrophysiological recordings were made 2-5 days and 13 weeks after the end of the exposure to H. Alterations in the visual system, as measured by electroretinography and visual evoked response, were found in groups of albino rats exposed to H and/or light. The pupillary diameter was enlarged in the albino group exposed to both H and light. Among the pigmented rats, alterations were recorded only in the visual evoked response of the H exposed groups. The results demonstrate that simultaneous exposure to H and light can lead to alterations in visual function that are more severe than those induced by each agent alone, and may exceed a simple summation.

Effect of exposure to 2,5-hexanediol in light or darkness on the retina of albino and pigmented rats. I. Morphology

Male albino (Sprague Dawley) and pigmented (Norwegian Brown) rats received 1% 2,5-hexanediol (H) in their drinking water for 5 or 8 weeks, respectively. The rats were housed either in 12 h light (average 30 cd/cm2 inside cage) and 12 h darkness (group LH) or in total darkness (group DH). Two control groups (Light only, LC; Darkness only, DC) were studied in parallel under identical conditions. The animals were sacrificed at the end of H exposure or after an ensuing 13-week period without H but under the same lighting conditions. The retinas of albino rats in the LH group showed a reduction (compared to the LC, DH and DC groups) in the number of nuclei per unit area of the outer nuclear layer (ONL; p < 0.05) and degeneration of the outer segment and the inner segment layers (photoreceptor cells). A less pronounced loss of nuclei was seen in the LC group. No decrease in the number of nuclei, or signs of degeneration, were demonstrated in the albino DH or DC groups. Thirteen weeks after exposure to H, the albino LH rats had lost about 50% of the nuclei in the ONL (p < 0.05) and the outer plexiform layer (OPL) had almost disappeared. At the corresponding time, in the pigmented rats the LH and DH groups differed from the LC and DC groups. The degenerative process resulted in no inflammatory changes in the retina. The results imply an interaction exceeding simple summation after exposure to light and H, in destroying photoreceptors and OPL (p < 0.001) in albino rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Absence of blue-yellow color vision loss among workers exposed to toluene or tetrachloroethylene, mostly at levels below occupational exposure limits

Possible color vision loss was examined with Lanthony's new color test and Ishihara's color vision test in 261 solvent workers and 120 controls (48 men and 72 women). The solvent workers were exposed to either predominantly toluene [46 ppm as geometric mean (GM); 63 men and 111 women], tetrachloroethylene alone (13 ppm; 30 men and 34 women), or a mixture (14 men and 9 women) of tetrachloroethylene (12 ppm) and trichloroethylene (7 ppm). The only instances of color vision loss that were detected in either the exposed workers or the controls were six cases of red-green loss (all in men). These six cases of red-green loss showed an unbiased distribution between the exposed workers and the nonexposed controls.

Neurotoxic effects of methylene chloride: are they long lasting in humans?

The neurotoxicity of methylene chloride (MC) is of special interest because of its acute effects on the central nervous system (CNS) and its metabolic conversion to carbon monoxide. A cohort study of retired airline mechanics was conducted to examine the hypothesis that long term exposure to MC results in lasting effects on the CNS. Retirees were studied to eliminate effects of current occupational exposures. The total retiree population (n = 1758) was surveyed to identify mechanics who met specific occupational, demographic, and medical criteria. A group of eligible retirees having long term exposure to MC and another group with low probability of exposure to solvents were given a comprehensive battery of physiological and psychological tests. The exposure groups were similar for all potential confounders that were measured. No statistically significant differences between groups were detected on outcome measures, although subtle differences in attention and memory were identified. Thus no firm evidence was found to support the hypothesis of lasting CNS effects in retired mechanics with long term exposure to MC.

Colour vision loss among disabled workers with neuropsychological impairment

Test performance on a neurobehavioural battery was examined with respect to acquired colour vision loss among patients with a history of neurotoxin exposure. The study group included 14 men and 7 women with clinically diagnosed neuropsychological impairment (mean age: 41.3 +/- 8.1 years; mean educational level: 13.4 +/- 1.4 years). Verbal and visual ability, memory and psychomotor function were assessed with the California Neuropsychological Screening Battery. Colour vision was assessed with the Lanthony D-15 desaturated colour arrangement panel. Acquired dyschromatopsia was present in 17 patients (80.9%), 11 of whom manifested patterns of Type II colour vision loss. Simple regression analysis of neuropsychological test performance with respect to colour vision loss, using age-adjusted Z-scores, revealed significant relationships (p less than or equal to 0.05) solely for tests which rely heavily on the visual system. Significant differences in visual task test scores were also observed with the type of dyschromatopsia (Kruskal-Wallis, p less than or equal to 0.05). These findings suggest that poor performance on visual tasks and colour vision loss may both result from damage to neuro-ophthalmic pathways or that loss of integrity of the peripheral visual pathways may affect visual task performance. The authors propose that visual testing should be incorporated into neurobehavioural test batteries.

Special nerve functions and colour discrimination in workers with long term low level exposure to carbon disulphide

Certain functions of the peripheral and autonomic nervous systems, and colour discrimination were examined in 45 workers (mean age 49; mean exposure to carbon disulphide (CS2) 20 years) and 37 controls (mean age 48). Conduction velocity and refractory period of the peroneal and sural nerves were determined. The conduction velocity of the slower fibres of the peroneal nerve was measured by means of an improved method that makes use of the refractory period. Function of autonomic nerves was assessed by measuring the variation in heart rate during rest, during deep breathing, and during isometric muscle contraction. Colour discrimination was evaluated by the Lanthony desaturated test. Individual cumulative exposure to CS2 was calculated on the basis of exposure in the past and individual job history. Mean cumulative exposure was 165 ppm-years. The peroneal nerves of exposed workers showed a decrease (-1.0 m/s) in conduction velocity of the slow fibres and a prolongation (0.1 ms) of the refractory period (mean 1.6 ms) compared with controls. These effects were related to cumulative exposure. No impairment of function of the sural nerve or of colour discrimination was found. The muscle heart reflex was decreased in the exposed group, but this was not related to cumulative exposure. This study has established more firmly that a decrease in conduction velocity of slow motor fibres occurs at low levels of exposure to CS2. Extrapolation of the results suggests that small effects may occur after 40 years of exposure to concentrations below the present threshold limit value (10 ppm).

Chromal focus of acquired chromatic discrimination loss and solvent exposure among printshop workers

Acquired dyschromatopsia has been associated with exposure to organic solvents. However, the chromal focus of the loss may be indicative of its gravity. According to Kollner's rule, blue-yellow loss reflects changes in external retinal layers, while red-green loss appears to be indicative of internal retinal or optic nerve damage. The objective of the present study was to examine chromatic discrimination capacity of 30 printshop workers exposed to organic solvent mixtures, and of a non-exposed reference group. Colour vision was assessed with a colour arrangement test designed to detect acquired dyschromatopsia, the Lanthony D-15 desaturated panel. Quantitative analysis, using Bowman's colour confusion index, revealed significantly higher scores indicative of colour vision loss among the exposed workers as compared to the non-exposed. Analysis of covariance, with age as co-variate, showed colour confusion index to be significantly associated with job category. Similarly, qualitative analysis showed that the exposed workers presented a significantly higher prevalence of acquired dyschromatopsia as compared to the non-exposed group. However, analysis of the type of chromatic discrimination loss showed that among the nonexposed persons, dyschromatopsia was localized only in the blue-yellow range, while for 35% of the dyschromatopic-exposed persons, red-green loss as well as blue-yellow loss were present. Three-dimensional chi 2-analysis showed that the complex pattern of dyschromatopsia was not related to age, but to job category. These findings suggest that the type of dyschromatopsia, reflecting the gravity of neural alterations, may be a function of exposure level and/or the ophthalmotoxic properties of the particular solvents used.

Colour vision impairment and alcohol consumption

The relationship between alcohol intake and colour discrimination capacity was examined among 136 persons of whom 16 were undergoing treatment in a detoxification centre. Current weekly alcohol consumption (or prior to treatment for those in the centre) was obtained with a detailed questionnaire, which divided week and weekend drinking into types of alcohol (beer, wine, spirits). Alcohol consumption varied from 0-5824 g/week; median: 266 g/week. Qualitative and quantitative assessment of acquired dyschromatopsia was obtained with a colour arrangement test, the Lanthony D-15 desaturated panel. In all age categories, the prevalence of dyschromatopsia increased with alcohol intake. Moreover, all the heavy drinkers (greater than 751 g/week) presented a certain degree of dyschromatopsia, whether or not they were undergoing treatment for alcoholism in a detoxification centre. Colour loss was primarily in the blue-yellow range; however, 4 of the 16 persons from the detoxification centre presented complex dyschromatopsia patterns including red-green loss. This raises the question of possible progressive deterioration. Multiple regression analysis showed that colour vision loss was significantly related to both age (p less than 0.001) and alcohol intake (p less than 0.01). These results underline the importance of taking into account the contribution of alcohol consumption in studies on acquired dyschromatopsia.