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Occupational exposure to low doses of ionizing radiation and cataract development: a systematic literature review and perspectives on future studies

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Abstract

Ionizing radiation is a well-known but little understood risk factor for lens opacities. Until recently, cataract development was considered to be a deterministic effect occurring at lens doses exceeding a threshold of 5–8 Gy. Substantial uncertainty about the level and the existence of a threshold subsists. The International Commission on Radiation Protection recently revised it to 0.5 Gy. Based on a systematic literature review of epidemiological studies on exposure to low levels of ionizing radiation and the occurrence of lens opacities, a list of criteria for new epidemiological studies was compiled, and a list of potential study populations was reviewed. Among 24 publications finally identified, six report analyses of acute exposures in atomic bomb survivors and Chernobyl liquidators, and the others report analyses of protracted exposures in occupationally, medically or accidentally exposed populations. Three studies investigated a dose threshold: in atomic bomb survivors, the best estimates were 1 Sv (95 % CI <0–0.8 Sv) regarding lensectomies; in survivors exposed as children, 0.6 Sv (90 % CI <0.0–1.2 Sv) for cortical cataract prevalence and 0.7 Sv (90 % CI 0.0–2.8 Sv) for posterior subcapsular cataract; and in Chernobyl liquidators, 0.34 Sv (95 % CI 0.19–0.68 Sv) for stage 1 cataract. Current studies are heterogeneous and inconclusive regarding the dose–response relationship. Protracted exposures and high lens doses occur in several occupational groups, for instance, in physicians performing fluoroscopy-guided interventional procedures, and in accidentally exposed populations. New studies with a good retrospective exposure assessment are feasible and should be initiated.

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Acknowledgments

The authors are grateful to Prof. Pfeiffer, Priv.-Doz. Dr. Voßmerbäumer, Prof. Düber, Prof. Müller-Forell, Prof. Kampmann, Dr. Franz (University Medical Center Mainz) and Dr. Wegener (University Eye Hospital Bonn) for their helpful information on cataract assessment as well as interventional radiology procedures and dose registration, to Dr. Frasch and Dr. Kammerer (German Radiation Protection Register) for additional information, and to Priv.-Doz. Dr. Kreuzer and Dr. Schnelzer (German Federal Office for Radiation Protection) and their colleagues, Dr. Jacob (IRSN, France), and Dr. Petoussi-Henss (Helmholtz Center Munich, Germany) for the fruitful discussions. This work was supported by the German Federal Office for Radiation Protection, contract 3609S30004. Kazuo Neriishi received partial support from the Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan.

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The authors declare that they have no conflict of interest.

Ethical standard

This study did not involve any contact to patients or other study subjects, nor did it use data from individuals. Therefore, it did not require ethical approval.

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Correspondence to Gaël P. Hammer.

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Hammer, G.P., Scheidemann-Wesp, U., Samkange-Zeeb, F. et al. Occupational exposure to low doses of ionizing radiation and cataract development: a systematic literature review and perspectives on future studies. Radiat Environ Biophys 52, 303–319 (2013). https://doi.org/10.1007/s00411-013-0477-6

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Keywords

  • Ionizing radiation
  • Cataract
  • Interventional radiology
  • Occupational exposure