Optical radiation safety of medical light sources

Understanding Real-Time Fluorescence Signals from Bacteria and Wound Tissues Observed with the MolecuLight i:XTM

The persistent presence of pathogenic bacteria is one of the main obstacles to wound healing. Detection of wound bacteria relies on sampling methods, which delay confirmation by several days. However, a novel handheld fluorescence imaging device has recently enabled real-time detection of bacteria in wounds based on their intrinsic fluorescence characteristics, which differ from those of background tissues. This device illuminates the wound with violet (405 nm) light, causing tissues and bacteria to produce endogenous, characteristic fluorescence signals that are filtered and displayed on the device screen in real-time. The resulting images allow for rapid assessment and documentation of the presence, location, and extent of fluorescent bacteria at moderate-to-heavy loads. This information has been shown to assist in wound assessment and guide patient-specific treatment plans. However, proper image interpretation is essential to assessing this information. To properly identify regions of bacterial fluorescence, users must understand: (1) Fluorescence signals from tissues (e.g., wound tissues, tendon, bone) and fluids (e.g., blood, pus); (2) fluorescence signals from bacteria (red or cyan); (3) the rationale for varying hues of both tissue and bacterial fluorescence; (4) image artifacts that can occur; and (5) some potentially confounding signals from non-biological materials (e.g., fluorescent cleansing solutions). Therefore, this tutorial provides clinicians with a rationale for identifying common wound fluorescence characteristics. Clinical examples are intended to help clinicians with image interpretation-with a focus on image artifacts and potential confounders of image interpretation-and suggestions of how to overcome such challenges when imaging wounds in clinical practice.

Visible Light-Responsive Platinum-Containing Titania Nanoparticle-Mediated Photocatalysis Induces Nucleotide Insertion, Deletion and Substitution Mutations

Conventional photocatalysts are primarily stimulated using ultraviolet (UV) light to elicit reactive oxygen species and have wide applications in environmental and energy fields, including self-cleaning surfaces and sterilization. Because UV illumination is hazardous to humans, visible light-responsive photocatalysts (VLRPs) were discovered and are now applied to increase photocatalysis. However, fundamental questions regarding the ability of VLRPs to trigger DNA mutations and the mutation types it elicits remain elusive. Here, through plasmid transformation and β-galactosidase α-complementation analyses, we observed that visible light-responsive platinum-containing titania (TiO₂) nanoparticle (NP)-mediated photocatalysis considerably reduces the number of Escherichia coli transformants. This suggests that such photocatalytic reactions cause DNA damage. DNA sequencing results demonstrated that the DNA damage comprises three mutation types, namely nucleotide insertion, deletion and substitution; this is the first study to report the types of mutations occurring after photocatalysis by TiO₂-VLRPs. Our results may facilitate the development and appropriate use of new-generation TiO₂ NPs for biomedical applications.

Standard manual capsulorhexis / Ultrasound phacoemulsification compared to femtosecond laser-assisted capsulorhexis and lens fragmentation in clear cornea small incision cataract surgery

Background

Femtosecond-laser assisted clear cornea cataract surgery may hold promise in safer and more effective procedures. We decided to perform a comparative study to standard manual incision phacoemulsification surgery.

Methods

This is a single-center, single-intervention, and prospective comparative data evaluation of 133 consecutive cases subjected to cataract surgery. Group-A (Phaco), manual capsulorhexis & ultrasound phacoemulsification (n = 66); Group-B femtosecond-laser assisted capsulorhexis and lens fragmentation (n = 67), employing the LenSx laser (Alcon Surgical, Ft. Worth, TX). All cases were evaluated for refraction, visual acuity, keratometry, tomography, pachymetry, endothelial cell counts, intraocular pressure, and type of intraocular lens (IOL) implanted. The groups were matched for age, gender, pre-operative vision metrics, and cataract grade, and were followed up to 1 year.

Results

In group-A post-operative uncorrected distance visual acuity (UDVA) was 20/20 or better in 61.5 % and 20/25 or better in 78.5 % of the eyes. The femtosecond laser group-B had improved outcomes (p = 0.075 and p = 0.042, respectively): post-operative UDVA was 20/20 or better in 62.7 % of the eyes and 20/25 or better in 85.1 %.

Linear regression scatterplots of achieved versus attempted spherical equivalent had excellent regression coefficients (r² = 0.983 in group-A and 0.979 in group-B). There were 75.2 % cases in group-A and 80.6 % in group-B (p = 0.8732) within ±0.50 D of targeted refractive equivalent. Slight trend of under-correction was noted in group-A. Average residual manifest cylinder in the toric subgroup-A was -0.50 D (95 % Limit-of-Agreement (LoA) = -0.78 D), and in toric subgroup-B -0.45 D (LoA = -0.45 D).

Conclusions

Mean spherical equivalent refraction and visual acuity are comparable with laser cataract surgery compared with manual capsulorhexis & ultrasound phacoemulsification. Improved astigmatism correction may be among the benefits of femtosecond laser–assisted cataract surgery. Transient corneal edema may be a first day transient disadvantage in femtosecond laser–assisted cataract surgery.

Enhanced photocatalytic inactivation of bacteria on Fe-containing TiO2 nanoparticles under fluorescent light

In this paper, the photocatalytic activity of Fe-TiO2 nanoparticles (NPs) under fluorescent light was studied using Escherichia coli and Staphylococcus aureus. Fe-TiO2 NPs were synthesized using a sol-gel method and characterized with X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), UV-visible diffuse reflectance spectroscopy (UV-vis DRS) and transmission electron microscopy. The efficiency of photocatalytic inactivation towards E. coli was studied under different physicochemical parameters. The photocatalytic inactivation rate increased with increasing Fe content in TiO2 NPs and the highest inactivation was achieved for 3.0 mol% Fe-TiO2 NPs under fluorescent light. These results demonstrate that the presence of an optimum concentration of Fe in TiO2 matrix enhances the photocatalytic inactivation of TiO2 NPs under fluorescent light.

The Photobiology of Lutein and Zeaxanthin in the Eye

Lutein and zeaxanthin are antioxidants found in the human retina and macula. Recent clinical trials have determined that age- and diet-related loss of lutein and zeaxanthin enhances phototoxic damage to the human eye and that supplementation of these carotenoids has a protective effect against photoinduced damage to the lens and the retina. Two of the major mechanisms of protection offered by lutein and zeaxanthin against age-related blue light damage are the quenching of singlet oxygen and other reactive oxygen species and the absorption of blue light. Determining the specific reactive intermediate(s) produced by a particular phototoxic ocular chromophore not only defines the mechanism of toxicity but can also later be used as a tool to prevent damage.

Photodynamic therapy: occupational hazards and preventative recommendations for clinical administration by healthcare providers

OBJECTIVE

Photodynamic therapy (PDT) as a medical treatment for cancers is an increasing practice in clinical settings, as new photosensitizing chemicals and light source technologies are developed and applied. PDT involves dosing patients with photosensitizing drugs, and then exposing them to light using a directed energy device in order to manifest a therapeutic effect. Healthcare professionals providing PDT should be aware of potential occupational health and safety hazards posed by these treatment devices and photosensitizing agents administered to patients.

MATERIALS AND METHODS

Here we outline and identify pertinent health and safety considerations to be taken by healthcare staff during PDT procedures.

RESULTS

Physical hazards (for example, non-ionizing radiation generated by the light-emitting device, with potential for skin and eye exposure) and chemical hazards (including the photosensitizing agents administered to patients that have the potential for exposure via skin, subcutaneous, ingestion, or inhalation routes) must be considered for safe use of PDT by the healthcare professional.

CONCLUSIONS

Engineering, administrative, and personal protective equipment controls are recommendations for the safe use and handling of PDT agents and light-emitting technologies.

Construction of an inexpensive, hand-held fundus camera through modification of a consumer "point-and-shoot" camera

PURPOSE

To construct a low-cost, easy-to-use, high-image-quality mydriatic fundus camera with "point-and-shoot" operation, and to evaluate the efficacy of this camera to accurately document retinal disease.

METHODS

A prototype portable fundus camera was designed by interfacing a novel optical module with a Panasonic Lumix G2 consumer camera. Low-cost, commercially available optics were used to create even illumination of the fundus, providing a 50° retinal field of view. A comparative study assessing the image quality of the prototype camera against a traditional tabletop fundus camera was conducted under an Institutional Review Board (IRB)-approved study.

RESULTS

A stand-alone, mydriatic camera prototype was successfully developed at a parts cost of less than $1000. The prototype camera was capable of operating in a point-and-shoot manner with automated image focusing and exposure, and the image quality of fundus photos was comparable to that of existing commercial cameras. Pathology related to both nonproliferative and proliferative diabetic retinopathy and age-related macular degeneration was easily identified from fundus images obtained from the low-cost camera.

CONCLUSIONS

Early prototype development and clinical testing have shown that a consumer digital camera can be inexpensively modified to image the fundus with professional diagnostic quality. The combination of low cost, portability, point-and-shoot operation, and high image quality provides a foundational platform on which one can design an accessible fundus camera to screen for eye disease.

Ocular aldehyde dehydrogenases: protection against ultraviolet damage and maintenance of transparency for vision

Aldehyde dehydrogenase (ALDH) enzymes catalyze the NAD(P)(+)-dependent oxidation of a wide variety of endogenous and exogenous aldehydes to their corresponding acids. Some members of the ALDH superfamily of enzymes are abundantly expressed in the mammalian cornea and lens in a taxon-specific manner. Considered to be corneal and lens crystallins, they confer protective and transparent properties upon these ocular tissues. ALDH3A1 is highly expressed in the cornea of most mammals, with the exception of rabbit that expresses exclusively ALDH1A1 in the cornea. ALDH1A1 is present in both the cornea and lens of several animal species. As a result of their catalytic and non-catalytic functions, ALDH3A1 and ALDH1A1 proteins protect inner ocular tissues from ultraviolet radiation and reactive oxygen-induced damage. In addition, these corneal crystallins contribute to cellular transparency in corneal stromal keratocytes, supporting a structural role of these ALDH proteins. A putative regulatory function of ALDH3A1 on corneal cell proliferation has also been proposed. Finally, the three retinaldehyde dehydrogenases cooperatively mediate retinoic acid signaling during the eye development.

Ultraviolet radiation as a risk factor for cataract and macular degeneration

The human eye is constantly exposed to sunlight and artificial lighting. Light transmission through the eye is fundamental to its unique biological functions of directing vision and circadian rhythm, and therefore, light absorbed by the eye must be benign. However, exposure to the intense ambient radiation can pose a hazard particularly if the recipient is over 40 years of age. This radiation exposure can lead to impaired vision and transient or permanent blindness.Both ultraviolet-A (UV-A) and UV-B induce cataract formation and are not necessary for sight. Ultraviolet radiation is also a risk factor for damage to the retinas of children. The removal of these wavelengths from ocular exposure will greatly reduce the risk of early cataract and retinal damage. One way this may be easily done is by wearing sunglasses that block wavelengths below 400 nm (marked 400 on the glasses). However, because of the geometry of the eye, these glasses must be wraparound sunglasses to prevent reflective UV radiation from reaching the eye. Additional protection may be offered by contact lenses that absorb significant amounts of UV radiation.In addition to UV radiation, short blue visible light (400-440 nm) is a risk factor for the adult human retina. This wavelength of light is not essential for sight and not necessary for a circadian rhythm response. For those over 50 years old, it would be of value to remove these wavelengths of light with specially designed sunglasses or contact lenses to reduce the risk of age-related macular degeneration.

A survey of the optical hazards associated with hospital light sources with reference to the Control of Artificial Optical Radiation at Work Regulations 2010

Workplace exposure to coherent and incoherent optical radiation from artificial sources is regulated under the Artificial Optical Radiation Directive (AORD) 2006/25/EC, now implemented in the UK under the Control of Artificial Optical Radiation at Work Regulations (AOR) 2010. These regulations set out exposure limit values. Implementing the AOR (2010 Health and Safety Statutory Instrument No 1140 www.legislation.gov.uk/uksi/2010/1140/pdf/uksi_20101140_en.pdf) requirements in a hospital environment is a potentially complex problem because of the wide variety of sources used for illumination, diagnosis and therapy. A survey of sources of incoherent optical radiation in a large hospital is reported here. The survey covers examples of office lighting, operating theatre lighting, examination lamps, and sources for ultraviolet phototherapy and visible phototherapies, including photodynamic therapy and neonatal blue-light therapy. The results of the survey are used to inform consideration of the strategy that a hospital might reasonably adopt both to demonstrate compliance with the AOR (2010) and to direct implementation effort.

Scattered ultraviolet emissions during refractive surgery using a high-frequency, wavefront-optimized excimer laser platform

PURPOSE

To evaluate occupational ultraviolet (UV) exposure during photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) with the Allegretto Wave Eye-Q 400 Hz excimer laser.

SETTING

Walter Reed Center for Refractive Surgery, Washington, DC, USA.

METHODS

Intraoperative UV measurements were performed during PRK with epithelial removal using an Amoils brush, PRK with epithelial removal using 20% ethanol, or femtosecond LASIK. A LaserStar power/energy meter with a silicone detector (model PD-10) was used for the measurements. The maximum pulse energy 25.4 cm from the corneal surface was recorded for each surgical procedure. Measurements were evaluated using a worst-case scenario for exposure of operating room personnel, and the results were compared with the occupational exposure limit set by the International Commission on Non-Ionizing Radiation Protection.

RESULTS

Measurements were taken during 15 cases of each procedure. The mean maximum exposure was 129.38 nJ/pulse +/- 79.48 (SD) during brush PRK, 69.72 +/- 68.80 nJ/pulse during ethanol PRK, and 29.17 +/- 13.82 nJ/pulse during LASIK. The mean maximum exposure per eye was 0.085 mJ/cm(2), 0.046 mJ/cm(2), and 0.01 mJ/cm(2), respectively. The worst-case cumulative exposure during a heavy workday of 20 patients (40 eyes) was calculated at 3.92 mJ/cm(2), 1.51 mJ/cm(2), and 0.79 mJ/cm(2) for brush PRK, ethanol PRK, and LASIK, respectively.

CONCLUSION

Results indicate that the excimer laser platform used in the study may yield greater UV exposure than previous systems; however, the levels did not exceed occupational exposure limits.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

The effects of the bacterial interaction with visible-light responsive titania photocatalyst on the bactericidal performance

Bactericidal activity of traditional titanium dioxide (TiO₂) photocatalyst is effective only upon irradiation by ultraviolet light, which restricts the potential applications of TiO₂ for use in our living environments. Recently carbon-containing TiO₂ was found to be photoactive at visible-light illumination that affords the potential to overcome this problem; although, the bactericidal activity of these photocatalysts is relatively lower than conventional disinfectants. Evidenced from scanning electron microscopy and confocal Raman spectral mapping analysis, we found the interaction with bacteria was significantly enhanced in these anatase/rutile mixed-phase carbon-containing TiO₂. Bacteria-killing experiments indicate that a significantly higher proportion of all tested pathogens including Staphylococcus aureus, Shigella flexneri and Acinetobacter baumannii, were eliminated by the new nanoparticle with higher bacterial interaction property. These findings suggest the created materials with high bacterial interaction ability might be a useful strategy to improve the antimicrobial activity of visible-light-activated TiO₂.

Scattered UV irradiation during VISX excimer laser keratorefractive surgery

PURPOSE

To evaluate the potential occupational health hazards associated with scattered ultraviolet (UV) radiation during photorefractive keratectomy (PRK) using the VISX Star S3 excimer laser.

SETTING

The Laser Vision Center, National Naval Medical Center, Bethesda, Maryland, USA.

METHODS

Intraoperative radiometric measurements were made with the Ophir Power/Energy Meter (LaserStar Model PD-10 with silicon detector) during PRK treatments as well as during required calibration procedures at a distance of 20.3 cm from the left cornea. These measurements were evaluated using a worst-case scenario for exposure, and then compared with the American Conference of Governmental Industrial Hygeinists (ACGIH) Threshold Value Limits (TVL) to perform a risk/hazard analysis.

RESULTS

During the PRK procedures, the highest measured value was 248.4 nJ/pulse. During the calibration procedures, the highest measured UV scattered radiation level was 149.6 nJ/pulse. The maximum treatment time was 52 seconds. Using a worst-case scenario in which all treatments used the maximum power and time, the total energy per eye treated was 0.132 mJ/cm2 and the total UV radiation at close range (80 cm from the treated eye) was 0.0085 mJ/cm2. With a workload of 20 patients, the total occupational exposure at 80 cm to actinic UV radiation in an 8-hour period would be 0.425 mJ/cm2.

CONCLUSIONS

The scattered actinic UV laser radiation from the VISX Star S3 excimer laser did not exceed occupational exposure limits during a busy 8-hour workday, provided that operating room personnel were at least 80 cm from the treated eye. While the use of protective eyewear is always prudent, this study demonstrates that the trace amounts of scattered laser emissions produced by this laser do not pose a serious health risk even without the use of protective eyewear.

Guest editorial: Notes on the macular pigment

Potential functions of the macular pigment are reviewed. Its role as a protector of the retina in respect of the blue-light hazard, and its relation to the rods and the cones, are examined. It is tentatively suggested that its presence in the human retina originated in the wild as a result of diet and not as a special evolutionary process: the pigment does not appear to be able to offer any significant photic protection, and the effect on chromatic aberration, as recently reported, may be negligible. Its relation to the spectral placing of photopigments is also examined.

Light-induced damage to the retina: role of rhodopsin chromophore revisited

The presence of the regenerable visual pigment rhodopsin has been shown to be primarily responsible for the acute photodamage to the retina. The photoexcitation of rhodopsin leads to isomerization of its chromophore 11-cis-retinal to all-trans-retinal (ATR). ATR is a potent photosensitizer and its role in mediating photodamage has been suspected for over two decades. However, there was lack of experimental evidence that free ATR exists in the retina in sufficient concentrations to impose a risk of photosensitized damage. Identification in the retina of a retinal dimer and a pyridinium bisretinoid, so called A2E, and determination of its biosynthetic pathway indicate that substantial amounts of ATR do accumulate in the retina. Both light damage and A2E accumulation are facilitated under conditions where efficient retinoid cycle operates. Efficient retinoid cycle leads to rapid regeneration of rhodopsin, which may result in ATR release from the opsin "exit site" before its enzymatic reduction to all-trans-retinol. Here we discuss photodamage to the retina where ATR could play a role as the main toxic and/or phototoxic agent. Moreover, we discuss secondary products of (photo)toxic properties accumulating within retinal lipofuscin as a result of ATR accumulation.

Scattered laser radiation and broadband actinic ultraviolet plasma emissions during LADARVision excimer refractive surgery

PURPOSE

To evaluate the potential occupational health hazards associated with scattered actinic ultraviolet (UV) laser radiation and broadband actinic UV plasma emissions during refractive surgery.

SETTING

Center for Refractive Surgery, Walter Reed Army Medical Center, Washington, D.C., USA.

METHODS

Intraoperative radiometric measurements were made with the Ophir Power/Energy Meter (LaserStar Model with silicon detector, Model PD-10) and the International Light Radiometer/Photometer (Model IL 1400 with actinic ultraviolet detector, Model SEL240) with and without UV blocking filters (BLK 270 and Schott types WG-280 and WG-230). Measurements made during laser calibration as well as laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) procedures were evaluated using a worst-case scenario and then compared with the American Conference of Governmental Industrial Hygeinists (ACGIH) Threshold Value Limits (TLV) to perform a risk/hazard analysis.

RESULTS

Most optical emissions were between 193 nm and 280 nm, and approximately 25% of the measurement result was due to broadband emissions greater than 270 nm for calibration targets. About 25% of optical emissions during LASIK were beyond 230 nm. No emissions beyond 230 nm were observed during PRK. Ultraviolet scattered radiation level was similar between PRK and LASIK. Maximum measured values of 80 nJ/pulse at 14 cm for PRK and 45 nJ/pulse at 38 cm for LASIK were used as the absolute worst-case analysis for exposure. Assuming the worst-case exposure conditions are equal to the maximum measured value during these studies at a workload of 20 patients per day, the cumulative occupational exposure at close range of actinic UV radiation did not exceed the 8-hour occupational exposure limit of 3 mJ/cm(2) for any 24-hour period.

CONCLUSIONS

Scattered UV laser radiation did not exceed occupational exposure limits at distances greater than 30 cm from either laser calibration targets or patient treatments over a workday. Laser eye protection is not necessary to protect operating room personnel since exposure levels are very low even under a worst-case scenario.

Ocular phototoxicity

The human eye is constantly exposed to sunlight and artificial lighting. Therefore the eye is exposed to UV-B (295-320 nm), UV-A (320-400 nm), and visible light (400-700 nm). Light is transmitted through the eye and then signals the brain directing both sight and circadian rhythm. Therefore light absorbed by the eye must be benign. Damage to the young and adult eye by intense ambient light is avoided because the eye is protected by a very efficient antioxidant system. In addition, there are protective pigments such as the kynurenines, located in the human lens, and melanin, in the uvea and retina, which absorb ambient radiation and dissipate its energy without causing damage. After middle age there is a decrease in the production of antioxidants and antioxidant enzymes. At the same time, the protective pigments are chemically modified (lenticular 3-hydroxy kynurenine pigment is enzymatically converted into the phototoxic chromophore xanthurenic acid; melanin is altered from an antioxidant to pro-oxidant) and fluorescent chromophores (lipofuscin) accumulate to concentrations high enough to produce reactive oxygen species. We have known for some time that exposure to intense artificial light and sunlight either causes or exacerbates age-related ocular diseases. We now know many of the reasons for these effects, and with this knowledge methods are being developed to interfere with these damaging processes.

Optical radiation hazards of welding arcs

Welding, a widely used industrial process, is one of the most intense artificial sources of optical radiation. Each type of welding process emits a different spectrum and intensity of optical radiation. For most processes, ultraviolet and visible radiation are the main components of the emission. Such factors as arc current, shielding gas, and base metal influence the emission spectrum. Adverse effects are confined to the skin and eyes, with welders suffering from a higher proportion of optical radiation associated eye conditions than do non-welders. Erythema is a common skin condition among welders, but conditions like skin cancer are rare. An evaluation of optical radiation from welding consists of determining an effective irradiance and a maximum permissible exposure duration, which can be very short (from seconds to minutes). Control measures include the use of screens to localize the hazards, and the use of personal protective equipment, such as protective clothing, safety spectacles, and welding helmets. Recent studies indicate that optical radiation can infiltrate into helmets and workers may be exposed to excessive levels. Overall, further investigation into adverse health effects and safety equipment design is warranted.