Assessment of Radiation Risks of Cataract Morbidity Among Liquidators of the Consequences of the Accident at the Chernobyl Nuclear Power Plant, Allowing for Impact of Concomitant Diseases

Purpose: To assess the radiation risk of cataracts among the Chernobyl clean-up workers (liquidators), considering the impact of concomitant diseases on this risk and to determine the dose threshold for the development of cataracts. Material and methods: Radiation risks of cataract incidence were studied in the cohort of liquidators of the consequences of the accident at the Chernobyl nuclear power plant, observed in the system of the National Radiation and Epidemiological Register (NRER) from 1986 to 2021. Among the 62,828 male liquidators, 9,461 new cases of cataracts were detected. The average age of the liquidators at the beginning of exposure was 34 years, the average absorbed dose of external gamma exposure of the whole body was 0.132 Gy, the maximum dose was 1.5 Gy, and the average duration of exposure was 2.5 months. To analyze the relationships of cataract incidence with other diseases and with the dose, a statistical method of link analysis, free from the type of distribution, as well as logistic regression models, were used. Results: The radiation risk of cataracts in the cohort of liquidators who did not have diagnoses of diabetes mellitus, hypoparathyroidism, malnutrition and myotonic disorders depends on the presence of concomitant diseases in the patient: glaucoma (ICD-10 H40–H42), hyperopia (H52.0), myopia (H52.1) or presbyopia (H52.4). For liquidators with comorbidities, radiation risk is statistically significant only 15 years after exposure, with an excess relative risk of ERR/Gy=0.46 with 90 % CI (0.06; 0.90). For liquidators without comorbidities, ERR/Gy decrease over time: from 4.42 with 90 % CI (0.72; 13.41) in the first 5 years, to zero risk 15 years after exposure. Nonparametric estimates of the relative risk (RR) of cataracts for the dose groups of liquidators are consistent with the estimates of ERR/Gy in the linear non-threshold (LNT) model. The determination of the dose threshold for cataracts according to the LNT model, in accordance with the recommendations of the ICRP, leads to estimates from 1.2 Gy to 13.3 Gy, depending on the presence or absence of cataract concomitant diseases in the liquidators. Conclusions: At present, there are no epidemiological evidence for reducing the equivalent dose limit for the lens of the eye for occupational exposure in planned exposure situations at the level of 150 mSv per year, previously established by the recommendations of the ICRP in 2007 and the current Russian radiation safety standards NRB-99/2009.