In daylight, the human eye is exposed to long wavelength ultraviolet radiation (UVR), visible radiation and short wavelength infrared radiation (IRR). Almost all the UVR and a fraction of the IRR waveband, respectively, left over after attenuation in the cornea, is absorbed in the lens. The time delay between exposure and onset of biological response in the lens varies from immediate-to-short-to-late. After exposure to sunlight or artificial sources, generating irradiances of the same order of magnitude or slightly higher, biological damage may occur photochemically or thermally. Epidemiological studies suggest a dose-dependent association between short wavelength UVR and cortical cataract. Experimental data infer that repeated daily in vivo exposures to short wavelength UVR generate photochemically induced damage in the lens, and that short delay onset cataract after UVR exposure is photochemically induced. Epidemiology suggests that daily high-intensity short wavelength IRR exposure of workers, is associated with a higher prevalence of age-related cataract. It cannot be excluded that this effect is owing to a thermally induced higher denaturation rate. Recent experimental data rule out a photochemical effect of 1090 nm in the lens but other wavelengths in the near IRR should be investigated.
The present review covers effects of moderate intensities of ultraviolet and infrared radiation in the crystalline lens that may occur after exposures to the sun or artificial sources causing a comparable irradiance on the eye. If the lens is exposed to high-intensity sources, additional action mechanisms not covered here have to be considered.
Spectral radiation from the sun on the earth
Because of the high temperature of the sun, electromagnetic radiation within a broad waveband is emitted. At the sun temperature, there is a peak emission of visible radiation (VIR) that tapers off towards shorter than visible UVR wavelengths, and towards longer than visible infrared wavelengths as described by Planck’s radiation. The radiation emitted from the sun is spectrally attenuated in the atmosphere before reaching the surface of the earth, so that wavelengths below 290 nm and above 2500 nm are essentially blocked out (Figure 1). The ocular spectral exposure additionally depends on solar elevation and background reflection1 and the exposure geometry of the eye.2
The spectral sensitivity of the visual system depends on the irradiance on the retina but typically VIR is defined as wavelengths between 400–760 nm. Electromagnetic radiation with wavelengths shorter than VIR but longer than X-rays is referred to as ultraviolet radiation (UVR), and the waveband with wavelengths longer than VIR but shorter than microwaves is denoted as infrared radiation (IRR). UVR from the sun reaching the surface of the earth is commonly split into a spectral band with short wavelengths, UVR-B, or intermediate UVR, and a spectral band with long wavelengths, UVR-A, or near UVR.
Attenuation of solar radiation in the anterior part of the eye
The human cornea blocks solar radiation with wavelengths shorter than 290 nm (Figure 2).3 The lens absorbs essentially all the UVR and, age dependently, shorter VIR wavelengths that are transmitted by the cornea, and then absorbs with a characteristic spectrum in the near IRR. It has been demonstrated with in vivo measurements using intrinsic lactate dehydrogenase as a sensor that UVR in the 300 nm wavelength region has a penetration depth of around 0.5 mm.4
Time delay between exposure to electromagnetic radiation and response in the lens
The time delay between exposure to electromagnetic radiation and the response in the lens provides information on the biological consequence of the absorption of electromagnetic energy (Figure 3).
An immediate onset of cataract after the exposure, occurs if the molecular absorption event has a vast impact on the lens. If there is a short delay onset of cataract, usually in the interval (days; <1 week) a biological expression of the primary molecular absorption event is required for cataract to develop. If there is a late onset of cataract, >week, the damage is only expressed when sufficient molecular absorption events are accumulated in relation to biological repair. Typically, experimental data on a potential hazard of UVR or near IRR in the lens are derived from observation of immediate and short delay onset damage. Late onset experimental data are scarce. Epidemiological strategy focuses on associating potential risk factors with late onset cataract.
The lens like any matter has the capacity to store incident photon energy by resonance absorption. If the photon energy corresponds to a specific absorption band in a molecule, absorption occurs as a binary event with a probability defined by the conformity between the incident photon energy and the energy gap available for the molecule to resonate. UVR and short wavelength VIR photon energy corresponds to electron configurations in matter with narrow absorption band. IRR photon energy corresponds to vibration of molecules in matter with broad non-specific absorption bands. Absorption of UVR or short wavelength VIR photons therefore typically alters specific chemical reactivity, photochemical damage, whereas absorption of IRR photons increases vibration that is observed as increased temperature. Large important biomolecules such as protein tend to lose their space structure when vibrating, denaturation. The rate of protein denaturation is determined by a rate constant that is temperature dependent as described by the Arrhenius equation. Damage to biological tissue owing to the high rate of vibration damage is called thermal damage.
Evidence for UVR damage to the lens
Ever since the 19th century there has been reports on the possibility that long-term exposure to UVR from the sun causes cataract.5 Several early epidemiological studies indicated an association between exposure to UVR from the sun and cataract. However, all these studies suffered from incomplete characterization of the ocular exposure. In 1988, Taylor et al6 published individual dose estimates by combining meteorological data with interviews of individual sun exposure and found a dose–response relationship between prevalence for cortical cataract and relative individual dose of UVR-B. A careful review of studies on UVR-induced cataract concluded that there was substantial evidence for an association between UVR-B and cortical cataract.7 In year 2000, an epidemiological study based on personal UVR-dose estimates found that UVR-B was the most important attributable risk factor for cortical cataract possible to prevent.8 In 2003, the Reykavik Eye study showed that the ratio for prevalence of cortical cataract in the lower nasal quadrant in relation to the upper temporal was associated with UVR dose (Figure 4).9
Experimental in vivo exposure of rat lenses to just above the threshold dose UVR in the 300-nm wavelength range (UVR-300 nm) induces short delay onset cataract with asymptotically increasing forward light scattering up to a week after the exposure.10, 11 Using observations of induced light scattering after in vivo exposure to UVR-300 nm, it was shown that UVR-induced cataract has a continuous dose–response function (Figure 5).12
In order to estimate threshold dose despite the fact that there is no absolute threshold for in vivo UVR-induced cataract, it was suggested to use the maximum tolerable dose, (MTD2.3:16), as a meaningful estimate of toxic dose.13
It was demonstrated that reciprocity largely holds for in vivo UVR-300 nm exposures in the exposure time interval 7.5–120 min, but there is a slightly higher sensitivity with exposure times of around 15 min (Figure 6).14 The slightly higher sensitivity for exposures around 15 min was attributed to the depletion of pre-existing anti-oxidation defense.
It was shown experimentally that in vivo UVR exposure has a characteristic action spectrum typical for photochemical damage, both with qualitative-15, 16 and with quantitative-estimation17 of cataract (Figure 7).
Recent in vivo UVR-300 nm experimental daily exposures cumulated for incrementing number of days demonstrated that the threshold dose increases slightly with the length of the number of days during which the dose was cumulated (Figure 8).18 These are the first data that demonstrate that cumulated in vivo exposures to a spectrally well-defined source of UVR-300 nm at calibrated irradiance, are additive with a slight impact of biological repair, strongly indicating a photochemical damage in daily exposures.
IRR cataract, photochemical or thermal?
Several investigations at the end of the 19th century and beginning of the 20th century demonstrated that if IRR is incident on the eye at high irradiance, damage will occur immediately or possibly with short delay onset.19 Vogt proposed that cataract after IRR exposure is owing to direct absorption in the lens20 but Goldman21 was of the opinion that cataract developed owing to heat increase secondary to IRR absorption in the iris.
Near IRR is absorbed in the lens (Figure 2) and thermal damage in the lens after high irradiance IRR exposure is carefully considered in the current safety guidelines.22 However, in 1977, Wolbarsht et al23 argued that a photochemical effect of near IRR below threshold for thermal damage could not be excluded based on current knowledge and investigated exposures with a CW 1064 nm Nd:Yag laser on rabbits (Figure 9).24 At the same time, Pitts and Cullen25 exposed rabbit eyes using a filtered broad band source. Both Wolbarsht24 and Pitts and Cullen25 claimed to have shown a possible irradiance-exposure time reciprocity for threshold dose for near IRR cataract indicating a photochemical effect. However, in both investigations a tendency for reciprocity was only seen in a few data points from single animals and the data could also be interpreted as support for thermal damage.
Epidemiology and IRR cataract
The observations of Wolbarsht24 and Pitts and Cullen25 triggered Eva Lydahl26 to investigate a possible association between cataract and exposure to IRR in glass- and steel works in two case control studies with over 200 cases and controls, respectively, in each study. On the basis of irradiance measurements and patient history of exposure, personal doses were estimated. No dose–effect correlation was found but the exposure to IRR in the cases were reported to facilitate development of age-related cataract.
In the 1980s, there were very few sources present in near IRR and guidelines typically concluded that bulk heat exposure of the human body in some extreme industrial applications that radiate near IRR would exclude toxic exposure. In addition, there is a possibility that a slight temperature increase owing to near IRR absorption thermally increases the rate of denaturation, thus facilitating development of late onset age-related cataract, but this is then a thermal effect.
The current frequent use of near IRR for remote control and sensing demands verification that near IRR does not cause cataract photochemically.27 If IRR causes damage photochemically, repeated below threshold exposures could accumulate over time to cause cataract.
Recent experimental investigation of near IRR cataract
Recent experimental in vivo exposures at 1090 nm with a CW glass fiber laser where the beam was projected in a 2 mm spot within the dilated pupil defined the minimum exposure time, at a high irradiance, required to thermally induce cataract and demonstrated a short delay onset cataract (Figure 10).28
In a follow-up experiment with the same exposure conditions, temperature measurements at the limbus and close to the optic nerve outside the sclera during the exposure demonstrated that the temperature increase at the limbus was around 10 °C, supporting a thermally induced short delay onset damage.29
In a subsequent experiment, exposures with the 1090 nm beam at 96 W/cm2 in a 2 mm spot inside the dilated pupil of a living rat eye was delivered to different groups of animals with incrementing exposure time in the interval 10–60 min, the maximum radiant exposure corresponding to a radiant exposure dose of 340 kJ/cm2. One eye was exposed and the contralateral eye was kept not exposed as a control.30 In all these exposures, the temperature at the limbus increased exponentially within a fraction of a minute to an asymptote below 8 °C on the exposed side whereas there was no temperature increase on the contralateral side. Light-scattering measurements at 1 week after the exposure did not reveal any significant increase of forward light scattering in the exposed lens or any difference in forward light scattering between the lens from the exposed and the contralateral not exposed lens as measured quantitatively. Thus despite a radiant exposure dose of more than two orders of magnitude higher than that claimed to be the threshold dose for photochemical damage by Wolbarsht24 and Pitts and Cullen25 there was no sign of cataract. It was concluded that there is no experimental evidence for a photochemical effect at 1090 nm and that the cataract observed by Wolbarsht24 and Pitts and Cullen25 was probably because of heating of the iris. However, before a photochemical effect can be safely ignored, other wavelengths should be investigated.
We thank Enping Chen, Wen Qian, Stefan Löfgren, Ralph Michael, John Merriam, Linda Meyer, Marcelo Ayala, Xiuquin Dong, Jing Wang, Martin Kronschläger, and Karl Schulmeister who all contributed to several of the investigations cited. This review was made possible by grants from Carmen och Bertil Regnérs fond för forskning, Föreningen Synskadades Vänner i Uppsala Län, Gun och Bertil Stohnes Stiftelse, Konung Gustav V:s och Drottning Victorias Frimurarstiftelse, Kronprincessan Margaretas Arbetsnämnd för synskadade, Ögonfonden, The Uppsala university/Uppsala Läns Landsting’s ALF Research grants and Erik Funks Minnesfond.
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European Journal of Epidemiology (2018)