Intermediate risk factors in ionising radiation cataractogenesis

Recent reports indicate a new concept of low-dose ionising radiation cataractogenesis. In 2020, a two-stage aetiology of initiation and maturation was proposed by Richardson and colleagues for posterior subcapsular cataract (PSC) and perhaps cortical cataract development. The mechanisms involve various oxidative stress and biochemical factors, some of which are relevant to A-bomb survivors, such as ocular ion imbalance, inflammation, and maybe oxygen level changes. An example of a known, specific cataractogen is hypoparathyroidism and associated hypocalcaemia. However, a recent report indicated calcium overload in situ is also a cataractogen. In fact, Neriishi and colleagues in 2003 reported a preliminary analysis of the serum in A-bomb survivors, finding persistent inflammation and calcium levels that were statistically significant as indirect systemic effects in the dose response of PSC and cortical cataract. Therefore, the above reports linking cataractogenesis to 'intermediate variables' and perhaps insulin resistance strongly support the preliminary results in A-bomb survivors. US astronauts display similar excess cataracts and serum-derived biomarkers. Thus, further analyses of updated datasets from A-bomb survivors and astronauts allowing for these intermediate risk factors and retinal/uveal pathologies are required to test these new concepts in ionising radiation cataractogenesis.