European Journal of Epidemiology

, Volume 33, Issue 12, pp 1179–1191 | Cite as

Occupational radiation exposure and risk of cataract incidence in a cohort of US radiologic technologists

  • Mark P. LittleEmail author
  • Cari M. Kitahara
  • Elizabeth K. Cahoon
  • Marie-Odile Bernier
  • Raquel Velazquez-Kronen
  • Michele M. Doody
  • David Borrego
  • Jeremy S. Miller
  • Bruce H. Alexander
  • Steven L. Simon
  • Dale L. Preston
  • Nobuyuki Hamada
  • Martha S. Linet
  • Craig Meyer


It has long been known that relatively high-dose ionising radiation exposure (> 1 Gy) can induce cataract, but there has been no evidence that this occurs at low doses (< 100 mGy). To assess low-dose risk, participants from the US Radiologic Technologists Study, a large, prospective cohort, were followed from date of mailed questionnaire survey completed during 1994–1998 to the earliest of self-reported diagnosis of cataract/cataract surgery, cancer other than non-melanoma skin, or date of last survey (up to end 2014). Cox proportional hazards models with age as timescale were used, adjusted for a priori selected cataract risk factors (diabetes, body mass index, smoking history, race, sex, birth year, cumulative UVB radiant exposure). 12,336 out of 67,246 eligible technologists reported a history of diagnosis of cataract during 832,479 person years of follow-up, and 5509 from 67,709 eligible technologists reported undergoing cataract surgery with 888,420 person years of follow-up. The mean cumulative estimated 5-year lagged eye-lens absorbed dose from occupational radiation exposures was 55.7 mGy (interquartile range 23.6–69.0 mGy). Five-year lagged occupational radiation exposure was strongly associated with self-reported cataract, with an excess hazard ratio/mGy of 0.69 × 10−3 (95% CI 0.27 × 10−3 to 1.16 × 10−3, p < 0.001). Cataract risk remained statistically significant (p = 0.030) when analysis was restricted to < 100 mGy cumulative occupational radiation exposure to the eye lens. A non-significantly increased excess hazard ratio/mGy of 0.34 × 10−3 (95% CI − 0.19 × 10−3 to 0.97 × 10−3, p = 0.221) was observed for cataract surgery. Our results suggest that there is excess risk for cataract associated with radiation exposure from low-dose and low dose-rate occupational exposures.


Ionising radiation Cataract Cataract surgery Threshold Tissue reaction effects Diabetes Low dose rate Questionnaire-based assessment 



The authors thank the two referees for their detailed and helpful comments. The authors thank the radiologic technologists who participated in the study, Dr. Jerry Reid of the American Registry of Radiologic Technologists for continued support, and Diane Kampa and Allison Iwan of the University of Minnesota for study management and data collection.

Author contributions

MPL, CMK and MSL conceived and designed the study, and produced an analytical plan. MSL, MMD, BHA, MPL and JSM were responsible for acquisition and processing of data (including questionnaire, mortality, and cancer validation data). SLS, DLP, MMD, JSM, MSL, BHA, MPL and DB were responsible for dose estimation and validation. MPL was responsible for data analysis. MPL, CMK, MSL, DB, NH and CM interpreted the results. MPL produced a first draft of the manuscript. All authors reviewed the manuscript and provided intellectual input. MPL, CMK and MSL are guarantors.


This work was funded by the Intramural Research Program of the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health. CM was supported by a training grant from Midwest Center for Occupational Safety and Health CDC/NIOSH 2T42 OH008434. The views expressed herein by the authors are independent of all funding agencies.

Compliance with ethical standards

Conflict of interest

All authors declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.

Data sharing

The data and all code used for the analysis are available from the lead author on application.

Ethical approval

This study has been approved annually by the National Cancer Institute Special Studies Institution Review Board and by the University of Minnesota Institutional Review Board.

Supplementary material

10654_2018_435_MOESM1_ESM.pdf (283 kb)
Supplementary material 1 (PDF 283 kb)


  1. 1.
    Steinberg EP, Javitt JC, Sharkey PD, et al. The content and cost of cataract surgery. Arch Ophthalmol. 1993;111(8):1041–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Söderberg PG, Talebizadeh N, Yu Z, Galichanin K. Does infrared or ultraviolet light damage the lens? Eye (Lond). 2016;30(2):241–6. Scholar
  3. 3.
    Christen WG, Manson JE, Seddon JM, et al. A prospective study of cigarette smoking and risk of cataract in men. JAMA. 1992;268(8):989–93.CrossRefPubMedGoogle Scholar
  4. 4.
    Hodge WG, Whitcher JP, Satariano W. Risk factors for age-related cataracts. Epidemiol Rev. 1995;17(2):336–46.CrossRefPubMedGoogle Scholar
  5. 5.
    Floud S, Kuper H, Reeves GK, Beral V, Green J. Risk factors for cataracts treated surgically in postmenopausal women. Ophthalmology. 2016;123(8):1704–10. Scholar
  6. 6.
    Cruickshanks KJ, Klein BEK, Klein R. Ultraviolet light exposure and lens opacities: the Beaver Dam Eye Study. Am J Public Health. 1992;82(12):1658–62.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Edwards AA, Lloyd DC. Risks from ionising radiation: deterministic effects. J Radiol Prot. 1998;18(3):175–83.CrossRefPubMedGoogle Scholar
  8. 8.
    International Commission on Radiological Protection. ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs: threshold doses for tissue reactions in a radiation protection context. ICRP publication 118. Ann ICRP. 2012;41(1–2):1–322. Scholar
  9. 9.
    Minamoto A, Taniguchi H, Yoshitani N, et al. Cataract in atomic bomb survivors. Int J Radiat Biol. 2004;80(5):339–45. Scholar
  10. 10.
    Neriishi K, Nakashima E, Akahoshi M, et al. Radiation dose and cataract surgery incidence in atomic bomb survivors, 1986–2005. Radiology. 2012;265(1):167–74. Scholar
  11. 11.
    Neriishi K, Nakashima E, Minamoto A, et al. Postoperative cataract cases among atomic bomb survivors: radiation dose response and threshold. Radiat Res. 2007;168(4):404–8. Scholar
  12. 12.
    Worgul BV, Kundiyev YI, Sergiyenko NM, et al. Cataracts among Chernobyl clean-up workers: implications regarding permissible eye exposures. Radiat Res. 2007;167(2):233–43.CrossRefPubMedGoogle Scholar
  13. 13.
    Chylack LT Jr, Peterson LE, Feiveson AH, et al. NASA study of cataract in astronauts (NASCA). Report 1: cross-sectional study of the relationship of exposure to space radiation and risk of lens opacity. Radiat Res. 2009;172(1):10–20. Scholar
  14. 14.
    Chylack LT Jr, Feiveson AH, Peterson LE, et al. NASCA report 2: longitudinal study of relationship of exposure to space radiation and risk of lens opacity. Radiat Res. 2012;178(1):25–32. Scholar
  15. 15.
    Ainsbury EA, Bouffler SD, Dörr W, et al. Radiation cataractogenesis: a review of recent studies. Radiat Res. 2009;172(1):1–9. Scholar
  16. 16.
    Hammer GP, Scheidemann-Wesp U, Samkange-Zeeb F, Wicke H, Neriishi K, Blettner M. Occupational exposure to low doses of ionizing radiation and cataract development: a systematic literature review and perspectives on future studies. Radiat Environ Biophys. 2013;52(3):303–19. Scholar
  17. 17.
    Little MP. A review of non-cancer effects, especially circulatory and ocular diseases. Radiat Environ Biophys. 2013;52(4):435–49. Scholar
  18. 18.
    International Commission on Radiological Protection. The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007;37(2–4):1–332. Scholar
  19. 19.
    Chodick G, Bekiroglu N, Hauptmann M, et al. Risk of cataract after exposure to low doses of ionizing radiation: a 20-year prospective cohort study among US radiologic technologists. Am J Epidemiol. 2008;168(6):620–31. Scholar
  20. 20.
    Bernier MO, Journy N, Villoing D, et al. Cataract risk in a cohort of U.S. radiologic technologists performing nuclear medicine procedures. Radiology. 2018;286(2):592–601. Scholar
  21. 21.
    Simon SL, Preston DL, Linet MS, et al. Radiation organ doses received in a nationwide cohort of U.S. radiologic technologists: methods and findings. Radiat Res. 2014;182(5):507–28. Scholar
  22. 22.
    Doody MM, Mandel JS, Lubin JH, Boice JD Jr. Mortality among United States radiologic technologists, 1926-90. Cancer Causes Control. 1998;9(1):67–75.CrossRefPubMedGoogle Scholar
  23. 23.
    Sigurdson AJ, Doody MM, Rao RS, et al. Cancer incidence in the US radiologic technologists health study, 1983–1998. Cancer. 2003;97(12):3080–9. Scholar
  24. 24.
    Mohan AK, Hauptmann M, Freedman DM, et al. Cancer and other causes of mortality among radiologic technologists in the United States. Int J Cancer. 2003;103(2):259–67. Scholar
  25. 25.
    Preston DL, Kitahara CM, Freedman DM, et al. Breast cancer risk and protracted low-to-moderate dose occupational radiation exposure in the US Radiologic Technologists Cohort, 1983-2008. Br J Cancer. 2016;115(9):1105–12. Scholar
  26. 26.
    Carroll RJ, Ruppert D, Stefanski LA, Crainiceanu CM. Measurement error in nonlinear models. A modern perspective. Boca Raton: Chapman and Hall/CRC; 2006. p. 1–488.Google Scholar
  27. 27.
    Doody MM, Freedman DM, Alexander BH, et al. Breast cancer incidence in U.S. radiologic technologists. Cancer. 2006;106(12):2707–15. Scholar
  28. 28.
    Simon SL. Organ-specific external dose coefficients and protective apron transmission factors for historical dose reconstruction for medical personnel. Health Phys. 2011;101(1):13–27. Scholar
  29. 29.
    Linetsky M, Raghavan CT, Johar K, et al. UVA light-excited kynurenines oxidize ascorbate and modify lens proteins through the formation of advanced glycation end products: implications for human lens aging and cataract formation. J Biol Chem. 2014;289(24):17111–23. Scholar
  30. 30.
    Sliney DH. Estimating the solar ultraviolet radiation exposure to an intraocular lens implant. J Cataract Refract Surg. 1987;13(3):296–301.CrossRefPubMedGoogle Scholar
  31. 31.
    Cox DR. Regression models and life-tables. J R Stat Soc Ser B. 1972;34(2):187–220.Google Scholar
  32. 32.
    R Project version 3.4.4. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2018.
  33. 33.
    Risk Sciences International. Epicure version 55 Metcalfe, K1P 6L5, Canada: Risk Sciences International; 2015.Google Scholar
  34. 34.
    Hall P, Granath F, Lundell M, Olsson K, Holm L-E. Lenticular opacities in individuals exposed to ionizing radiation in infancy. Radiat Res. 1999;152(2):190–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Little MP, Kwon D, Doi K, et al. Association of chromosome translocation rate with low dose occupational radiation exposures in U.S. radiologic technologists. Radiat Res. 2014;182(1):1–17. Scholar
  36. 36.
    Rafnsson V, Olafsdottir E, Hrafnkelsson J, Sasaki H, Arnarsson A, Jonasson F. Cosmic radiation increases the risk of nuclear cataract in airline pilots: a population-based case-control study. Arch Ophthalmol. 2005;123(8):1102–5. Scholar
  37. 37.
    Jacob S, Donadille L, Maccia C, et al. Eye lens radiation exposure to interventional cardiologists: a retrospective assessment of cumulative doses. Radiat Prot Dosim. 2013;153(3):282–93. Scholar
  38. 38.
    O’Connor U, Walsh C, Gallagher A, et al. Occupational radiation dose to eyes from interventional radiology procedures in light of the new eye lens dose limit from the International Commission on Radiological Protection. Br J Radiol. 1049;2015(88):20140627. Scholar
  39. 39.
    Nakashima E, Neriishi K, Minamoto A. A reanalysis of atomic-bomb cataract data, 2000-2002: a threshold analysis. Health Phys. 2006;90(2):154–60. Scholar
  40. 40.
    Mrena S, Kivela T, Kurttio P, Auvinen A. Lens opacities among physicians occupationally exposed to ionizing radiation: a pilot study in Finland. Scand J Work Environ Health. 2011;37(3):237–43. Scholar

Copyright information

© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2018

Authors and Affiliations

  • Mark P. Little
    • 1
    Email author
  • Cari M. Kitahara
    • 1
  • Elizabeth K. Cahoon
    • 1
  • Marie-Odile Bernier
    • 1
    • 2
  • Raquel Velazquez-Kronen
    • 1
  • Michele M. Doody
    • 1
  • David Borrego
    • 1
  • Jeremy S. Miller
    • 3
  • Bruce H. Alexander
    • 4
  • Steven L. Simon
    • 1
  • Dale L. Preston
    • 5
  • Nobuyuki Hamada
    • 6
  • Martha S. Linet
    • 1
  • Craig Meyer
    • 4
  1. 1.Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer InstituteNational Institutes of HealthBethesdaUSA
  2. 2.Laboratory of EpidemiologyInstitut de Radioprotection et de Sûreté NucléaireFontenay aux RosesFrance
  3. 3.Information Management ServicesSilver SpringUSA
  4. 4.Division of Environmental Health Sciences, School of Public HealthUniversity of MinnesotaMinneapolisUSA
  5. 5.Hirosoft InternationalEurekaUSA
  6. 6.Radiation Safety Research Center, Nuclear Technology Research LaboratoryCentral Research Institute of Electric Power Industry (CRIEPI)KomaeJapan

Personalised recommendations