The scientific basis of a threshold dose for radiation cataract and its underlying issues

Radiation cataract has been classified as tissue reactions (formerly known as deterministic effects or non-stochastic effects) with a threshold dose. In 1984, the International Commission on Radiological Protection (ICRP) suggested the threshold dose of >8 Sv for vision-impairing cataracts in highly fractionated or protracted exposures. Such a threshold was used to recommend an occupational dose limit for the lens of 150 mSv/year in 1990 and 2007, but was reduced to 0.5 Sv in 2011 for all exposure scenarios irrespective of the rate of dose delivery. New threshold was determined on the basis of the limited human evidence, with various hypotheses not supported by the present knowledge of biological mechanisms. Examples of untested hypotheses include: radiation cataract is a tissue reaction; radiation damage to the large number of cells acts as a triggering event for radiation cataract; detectable minor opacities progress into vision-impairing cataracts with time; and the lower the dose, the longer the latency. This paper discusses the issues behind the scientific basis for the new threshold, and provides directions for future epidemiological and biological studies to establish the reasonably modeled dose-response relationship for radiation cataract. (author)