Cataract frequency and subtypes involved in workers assessed for their solar radiation exposure: a systematic review

Abstract

Cataract is currently the primary cause of blindness worldwide, and one of its main risk factors is solar ultraviolet radiation exposure. According to the localization of lens opacities, three main subtypes of cataract are recognized: nuclear, cortical and posterior subcapsular cataract. One of the main determinants of individual long-term solar radiation exposure is outdoor work. We systematically reviewed scientific literature from the last 20 years to update the recent development of research on the risk of cataract in outdoor workers and on the specific subtypes involved, also investigating the methods applied to evaluate the occupational risk. A total of 15 studies were included in the review, of which 12 showed a positive association. The studies confirm the relationship of long-term occupational solar radiation exposure with cortical cataract and give new support for nuclear cataract, although no substantial new data were available to support a relation with the posterior subcapsular subtype. In most of the studies, the exposure assessment was not adequate to support a representative evaluation of the ocular risk; however, outdoor work is clearly a relevant risk factor for cataract. Further research providing a better evaluation of the relation between solar radiation exposure levels and lens damage in workers is needed and aimed to establish adequate occupational exposure limits and better preventive measures, studying also their effectiveness.

Skin cancer in outdoor workers exposed to solar radiation: a largely underreported occupational disease in Italy

“…Accordingly, we decided to merge data from Agriculture and Industry & Services sectors, and to create a summarizing variable of the total number of skin cancers reported to INAIL for workers occupationally exposed to sUVR radiation and to other UVR sources. This seems legitimate, as there are no epidemiological data consistently showing an increasing in skin cancer risk for welders, which may be related to better skin cover in welders by, e. g. clothing and total face masks to avoid painful skin burns and other occupational eye injuries and diseases, including UV‐induced photokeratoconjunctivitis and photochemical cataract …”

“…This seems legitimate, as there are no epidemiological data consistently showing an increasing in skin cancer risk for welders, which may be related to better skin cover in welders by, e. g. clothing and total face masks to avoid painful skin burns and other occupational eye injuries 40 and diseases, including UV-induced photokeratoconjunctivitis and photochemical cataract. 6,41 Another possible limit of studying the expected number of occupational skin cancers in sUVR-exposed workers is related to cancer registries: while data on malignant melanoma are largely available since several years, in Italy, as in other countries, data for NMSC vary significantly in quality and coverage of the territory, due to insufficient data harmonization and heterogeneity of methods. The availability of validated questionnaires for the health surveillance of people with suspected occupational dermatoses could be a helpful tool to improve the registration of these diseases.…”

Solar Radiation Exposure and Outdoor Work: An Underestimated Occupational Risk

“…According to the WHO, the upper Population Attributable Fraction of cortical cataract due to solar UVR is 25% [ 38 ]. Furthermore, an increasing body of scientific data supports the role of solar radiation in inducing nuclear and posterior subcapsular cataracts [ 76 , 77 ]. Taken as a whole, these data indicate that a reduction in excessive long-term SR exposure could prevent a significant number of visual impairments and blindness worldwide, and to a consequent parallel reduction in medical costs.…”

“…Table 5 provides a summary of the results from a recently published systematic review on cataract and occupational SR exposure [ 77 ]. Data showed high prevalence of cataracts in OW and a strong association between occupational SR exposure and cataracts.…”

Non-Melanoma Skin Cancer in Outdoor Workers: A Study on Actinic Keratosis in Italian Navy Personnel

“…Therefore, it seems necessary to launch awareness-raising campaigns to mitigate exposure to UV radiation by promoting workers' education and use of personal protective equipment (e.g., use of covering clothes, hats, sunglasses, and sunblock; cessation of exposure in the mid-afternoon). Regarding personal protective equipment (PPE), the use of sunglasses should not be underestimated because solar UV is also a significant risk for eye health in workers exposed especially in high-reflectance environments, such as seafarers [60]. Secondary prevention includes health surveillance performed by occupational physicians and dermatologists [7,59,61].…”