Assessment of adverse events for a home-use intense pulsed light hair removal device using postmarketing surveillance.

BACKGROUND AND OBJECTIVES: Home-use intense pulsed light (IPL) hair removal devices are convenient for consumers. Consumer safety associated with home-use IPL devices, however, remains a subject of interest. In this descriptive analysis, we assessed the most commonly reported adverse events (AEs) for a home-use IPL device from postmarketing surveillance and qualitatively compared these with AEs from clinical studies and medical device reports of home-use IPL treatments. MATERIALS AND METHODS: For this analysis of voluntary reports, we queried a distributor's postmarketing database for IPL devices for the period beginning January 1, 2016, to December 31, 2021. All sources of comments, for example, phone, e-mail, company-sponsored web sites, were included in the analysis. AE data were coded according to the Medical Dictionary for Regulatory Activities (MedDRA) terminology. Also, we conducted a PubMed search to identify AE profiles from existing literature on home-use IPL devices and we searched the Manufacturer and User Facility Device Experience (MAUDE) database for reports on home-use IPL devices. These results were qualitatively compared to the data in the postmarketing surveillance database. RESULTS: A total of 1692 cases involving IPL were identified from voluntary reports of AEs between 2016 and 2021. The shipment-adjusted reporting rate for AE cases (number of AE cases/100,000 shipped IPL devices) was 67/100,000 during this 6-year period. The most commonly reported AEs were pain of skin 27.8% (470/1692), "thermal burn" 18.7% (316/1692), and erythema 16.0% (271/1692). Among the top 25 AEs reported, no unexpected health events were observed. The reported AEs were qualitatively similar to the pattern seen in clinical studies and the MAUDE database associated with such home-use IPL treatments. CONCLUSION: This is the first such report documenting AEs for home-use IPL hair removal from a postmarketing surveillance program. These data are supportive of the safety of such home-use low-fluence IPL technology.

Optical performance of welding curtains and existing standards.

Welding curtains and screens are intended to protect workers, other than the welder, from the effects of optical radiation generated by the welding process. The national and international standards for welding screens and curtains have different requirements. The aim is to compare the protection requirements of examples of welding curtain material and to assess compliance with the international and national standards. Spectral transmittance values (ultraviolet, visible, and infrared) of 21 samples were obtained from the records of an ISO/IES 17025 accredited test laboratory and performance/compliance was assessed according to each of the standards. In the ultraviolet, 10 samples passed and seven failed all standards. In the visible/infrared region, four samples passed and 10 failed all standards. Four samples passed the U.S. and international standards but failed the Australian/New Zealand standard in the blue-light transmittance requirement. One sample failed both the U.S. and Australian/New Zealand standards but the result for the international standard was borderline, one sample passed ISO but failed the blue-light requirements, and one failed ISO but passed the blue-light requirements. The derivations of the various requirements are not well documented. The Australia/New Zealand standard is significantly more stringent in the ultraviolet and blue-light regions. A review of the optical radiation hazards and revision of the standards are indicated. It is possible that curtains, other than those tested, that comply with the international standard might transmit hazardous levels of blue light and, conversely, adequate ultraviolet and blue-light protection is available with curtains that do not comply with the international standard.

Ultraviolet safety assessments of insect light traps.

Near-ultraviolet (UV-A: 315-400 nm), "black-light," electric lamps were invented in 1935 and ultraviolet insect light traps (ILTs) were introduced for use in agriculture around that time. Today ILTs are used indoors in several industries and in food-service as well as in outdoor settings. With recent interest in photobiological lamp safety, safety standards are being developed to test for potentially hazardous ultraviolet emissions. A variety of UV "Black-light" ILTs were measured at a range of distances to assess potential exposures. Realistic time-weighted human exposures are shown to be well below current guidelines for human exposure to ultraviolet radiation. These UV-A exposures would be far less than the typical UV-A exposure in the outdoor environment. Proposals are made for realistic ultraviolet safety standards for ILT products.

The dental curing light: A potential health risk.

Powerful blue-light emitting dental curing lights are used in dental offices to photocure resins in the mouth. In addition, many dental personnel use magnification loupes. This study measured the effect of magnification loupes on the "blue light hazard" when the light from a dental curing light was reflected off a human tooth. Loupes with 3.5x magnification (Design for Vision, Carl Zeiss, and Quality Aspirator) and 2.5x magnification (Design for Vision and Quality Aspirator) were placed at the entrance of an integrating sphere connected to a spectrometer (USB 4000, Ocean Optics). A model with human teeth was placed 40 cm away and in line with this sphere. The light guide tip of a broad-spectrum Sapphire Plus (Den-Mat) curing light was positioned at a 45° angle from the facial surface of the central incisor. The spectral radiant power reflected from the teeth was recorded five times with the loupes over the entrance into the sphere. The maximum permissible cumulative exposure times in an 8-hr day were calculated using guidelines set by the ACGIH. It was concluded that at a 40 cm distance, the maximum permissible cumulative daily exposure time to light reflected from the tooth was approximately 11 min without loupes. The weighted blue irradiance values were significantly different for each brand of loupe (Fisher's PLSD p < 0.05) and were up to eight times greater at the pupil than when loupes were not used. However, since the linear dimensions of the resulting images would be 2.5 to 3.5x larger on the retina, the image area was increased by the square of the magnification and the effective blue light hazard was reduced compared to without the loupes. Thus, although using magnification loupes increased the irradiance received at the pupil, the maximum cumulative daily exposure time to reflected light was increased up to 28 min. Further studies are required to determine the ocular hazards of a focused stare when using magnification loupes and the effects of other curing lights used in the dental office.

ICNIRP Statement on Short Wavelength Light Exposure from Indoor Artificial Sources and Human Health.

ABSTRACT: Concerns have been raised about the possibility of effects from exposure to short wavelength light (SWL), defined here as 380-550 nm, on human health. The spectral sensitivity of the human circadian timing system peaks at around 480 nm, much shorter than the peak sensitivity of daytime vision (i.e., 555 nm). Some experimental studies have demonstrated effects on the circadian timing system and on sleep from SWL exposure, especially when SWL exposure occurs in the evening or at night. The International Commission on Non-Ionizing Radiation Protection (ICNIRP) has identified a lack of consensus among public health officials regarding whether SWL from artificial sources disrupts circadian rhythm, and if so, whether SWL-disrupted circadian rhythm is associated with adverse health outcomes. Systematic reviews of studies designed to examine the effects of SWL on sleep and human health have shown conflicting results. There are many variables that can affect the outcome of these experimental studies. One of the main problems in earlier studies was the use of photometric quantities as a surrogate for SWL exposure. Additionally, the measurement of ambient light may not be an accurate measure of the amount of light impinging on the intrinsically photosensitive retinal ganglion cells, which are now known to play a major role in the human circadian timing system. Furthermore, epidemiological studies of long-term effects of chronic SWL exposure per se on human health are lacking. ICNIRP recommends that an analysis of data gaps be performed to delineate the types of studies needed, the parameters that should be addressed, and the methodology that should be applied in future studies so that a decision about the need for exposure guidelines can be made. In the meantime, ICNIRP supports some recommendations for how the quality of future studies might be improved.

The potential 'blue light hazard' from LED headlamps.

Many dental personnel use light-emitting diode (LED) headlamps for hours every day. The potential retinal 'blue light hazard' from these white light headlamps is unknown. METHODS: The spectral radiant powers received from direct and indirect viewing of an electronic tablet, an LED curing light, a halogen headlamp, and 6 brands of LED headlamps were measured using integrating spheres attached to fiberoptic spectroradiometers. The spectral radiant powers were measured both directly and indirectly at a 35 cm distance, and the maximum daily exposure times (tMAX) were calculated from the blue weighted irradiance values. RESULTS: The headlamps emitted very different radiant powers, emission spectra, and color temperatures (K). The total powers emitted at zero distance ranged from 47 mW from the halogen headlamp to 378 mW from the most powerful LED headlamp. The color temperatures from the headlamps ranged from 3098 K to 7253 K. The tMAX exposure times in an 8 h day when the headlamps were viewed directly at a distance of 35 cm were: 810 s from the halogen headlamp, 53 to 220 s from the LED headlamps, and 62 s from the LED curing light. Light from the LED headlamps that was reflected back from a white reference tile 35 cm away did not exceed the maximum permissible exposure time for healthy adults. Using a blue dental dam increased the amount of reflected blue light, but tMAX was still greater than 24 h. CONCLUSIONS: White light LED headlamps emit very different spectra, and they all increase the retinal 'blue light hazard' compared to a halogen source. When the headlamps were viewed directly at a distance of 35 cm, the 'blue light hazard' from some headlamps was greater than from the LED curing light (tMAX = 62 s). Depending on the headlamp brand, tMAX could be reached after only 53s. The light from the LED headlamps that was reflected back from a white surface that was 35 cm away did not exceed the maximum permissible ocular exposure limits for healthy adults. CLINICAL RELEVANCE: Reflected white light from dental headlamps does not pose a blue light hazard for healthy adults. Direct viewing may be hazardous, but the hazard can be prevented by using the appropriate blue-light blocking glasses.

Threshold Ocular Exposure to Near Infrared Radiation for Causing Acute Opacification in the Rabbit Lens.

Surveys and epidemiological studies have reported an increased prevalence of cataracts in the glass and steel industries, which are associated with exposure to intense infrared radiation (IR). Indeed, animal studies have demonstrated that IR exposure can produce acute changes in the crystalline lens that are likely to lead to cataract formation. However, little is known about threshold IR exposure for causing acute cataractous changes, which is important in the prevention of IR-induced cataract, especially as a basis for short-term IR exposure limits. Previously, we exposed rabbit eyes to 808 nm wavelength IR at different irradiances for 6 min to determine the threshold irradiance to cause acute lens opacification. Presently, we similarly determined the threshold irradiance for exposure durations of 3 min, 1 min, 30 s, 10 s and 4 s. The threshold irradiance increased steadily with decreasing exposure duration, from 1.1 W cm-2 at 6 min to 4.1 W·cm-2 at 4 s. These threshold values are consistent with ICNIRP exposure limits to avoid IR-induced cataract formation in the tested range of exposure duration, but suggest that it may be necessary to lower the exposure limits for shorter exposure durations.

Intraocular and crystalline lens protection from ultraviolet damage.

OBJECTIVES: Although the risks of excess solar ultraviolet (UV) exposure of the skin are well recognized, the need for eye protection is frequently overlooked, or when sunglasses are also recommended, specific guidance is wrong or is not explained. Guidance from the World Health Organization at its InterSun webpage advises people to wear "wrap-around" sunglasses under many conditions. The objective of this study was to examine the need for UV filtration in prescription lenses, contact lenses, and sunglasses. METHODS: The geometry of UV exposure of both eyes, solar position, ground reflection, pupil size, and lid opening were studied. Because an accurate determination of cumulative ocular exposure is difficult, the cornea itself can serve as a biologic dosimeter, because photokeratitis is not experienced on a daily basis but does under certain ground-surface and sunlight conditions. From a knowledge of the UV-threshold dose required to produce photokeratitis, we have an upper level of routine ocular exposure to ambient UV. RESULTS: From ambient UV measurements and observed photokeratitis, the upper limits of UV exposure of the crystalline lens or an intraocular lens implant are estimated. The risk of excess UV exposure of the germinative cells of the lens is greatest from the side. Sunglasses can actually increase UV exposure of the germinative region of the crystalline lens and the corneal limbus by disabling the eyes' natural protective mechanisms of lid closure and pupil constriction! The level of UV-A risk is difficult to define. CONCLUSIONS: Proper UV-absorbing contact lenses offer the best mode for filtering needless exposure of UV radiation of the lens and limbus.

UV-B exposure to the eye depending on solar altitude.

PURPOSE: To assess the validity of the solar ultraviolet index (UVI) as a determiner of eye risk under different conditions of facial profiles and orientation, and reflected light. METHODS: Ocular UV radiation (UVR) exposure was measured as a function of the time of the day (solar altitude) using a two-dummy-type mannequin dosimetry system with embedded UVR (260-310 nm) sensors, in September and November in Kanazawa, Japan, on a motorized sun-tracking mount with one dummy face directed toward the sun and the other away from the sun. RESULTS: A bimodal distribution of UV-B exposure was found in September for the face directed toward the sun, which differed dramatically from the pattern of ambient UVR exposure and measurements taken on the top of the head and those for the eye taken later in the year. Although the overall level was lower, a higher solar altitude is associated with higher UVR exposure in the condition facing away from the sun. CONCLUSIONS: The UVI is based on ambient solar radiation on an unobstructed horizontal plane similar to our measures taken on the top of the head, which differed so much from our measures of ocular exposure that UVI as a determiner of eye risk is deemed invalid. The use of the UVI as an indicator for the need for eye protection can be seriously misleading. Doctors should caution patients with regard to this problem, and eye protection may be warranted throughout the year.

A Need to Revise Human Exposure Limits for Ultraviolet UV-C Radiation†.

The COVID-19 pandemic has greatly heightened interest in ultraviolet germicidal irradiation (UVGI) as an important intervention strategy to disinfect air in medical treatment facilities and public indoor spaces. However, a major drawback of UVGI is the challenge posed by assuring safe installation of potentially hazardous short-wavelength (UV-C) ultraviolet lamps. Questions have arisen regarding what appear to be unusually conservative exposure limit values in the UV-C spectral band between 180 and 280 nm. We review the bases for the current limits and proposes some adjustments that would provide separate limits for the eye and the skin at wavelengths less than 300 nm and to increase both skin and eye limits in the UV-C below 250 nm.

Cataract Formation by Near-infrared Radiation in Rabbits.

Surveys and epidemiological studies have shown an increased prevalence of cataracts in workers in the glass and steel industries. These cataracts are associated with exposure to intense infrared radiation (IR) emitted from heated materials and industrial furnaces. Thermal model calculations predicted that near and far IR would cause cataract with different mechanisms. The present study investigated cataract formation by near IR. Eyes of pigmented rabbits were exposed to IR at a wavelength of 808 nm. Morphological changes in the anterior segment of the eye were assessed by slit-lamp microscopy, and temperature distributions in the anterior chamber of the eye were observed during IR exposure using microencapsulated thermochromic liquid crystals. Cortical cataract appeared below the exposed area of the iris in eyes that had been exposed for 6 min to an irradiance of 1.27 W cm-2 or higher. The monitored temperature in the anterior chamber began to increase in the region adjacent to the exposed area of the iris with the onset of IR exposure. These results demonstrate that 808-nm IR is absorbed and converted to heat within the iris, which is then conducted to the lens and produce a cataract, as Goldmann theory states.

UV-Photokeratitis Associated with Germicidal Lamps Purchased during the COVID-19 Pandemic.

PURPOSE: To report photokeratitis caused by the improper use of germicidal lamps purchased during the COVID-19 pandemic. METHODS: Case series. RESULTS: Seven patients presented with acute ocular surface pain after exposure to UV-emitting germicidal lamps. Visual acuity was 20/30 or better in 13 of 14 eyes (93%). Anterior segment examination revealed varying degrees of conjunctival injection and diffusely distributed punctate epithelial erosions (PEEs) in every patient. No intraocular inflammation was identified across the cohort and all fundus examinations were normal. Treatment varied by provider and included artificial tears alone or in combination with antibiotic ointments and/or topical steroids. Five patients were followed via telehealth, one patient returned for an in-office visit, and one patient was lost to follow-up. Five of six patients endorsed complete resolution of symptoms within 2-3 days. CONCLUSIONS: Patients should follow manufacturer recommendations when using UV-emitting germicidal lamps and avoid direct exposure to the ocular surface.

Intercomparison of instruments used for safety and performance measurements of ultraviolet germicidal irradiation lamps.

Public health concerns such as multidrug-resistant tuberculosis, bioterrorism, pandemic influenza, and sick building syndrome have brought about increased interest in the use of ultraviolet germicidal irradiation (UVGI) to prevent the spread of airborne infection. UVGI lamps require that radiometric measurements be performed to ensure their safe and effective use. This study evaluates 10 detectors that measure the ultraviolet radiation hazard of low-pressure mercury UVGI lamps, including a polychromator spectroradiometer, narrowband detectors designed to measure the ultraviolet radiation in a short range of wavelengths, and broadband detectors with a varying spectral response designed to follow the UV hazard action spectrum. The angular responses, spectral responses, and linearity of the detectors were measured and compared. The agreement between the measured angular responses and the ideal cosine responses varied widely among the detectors, and in general, the detectors with diffusing optics agreed significantly better with the ideal cosine response. The spectral responses at 254 nm also varied widely among the detectors, and, in general, the narrowband detectors agreed more closely with the 254 nm irradiances measured under the same conditions by a double monochromator spectroradiometer. All detectors displayed good linearity. The angular and spectral response data were then used to develop correction factors for the effective irradiance measurements of two UVGI sources, each measured at 10, 20, and 30 cm. The measured effective irradiances were compared with those measured by a double monochromator spectroradiometer with an integrating sphere input optic. Prior to correction, the effective irradiances measured by the detectors varied widely, ranging from 0.29 to 2.7 times those measured by the spectroradiometer. The application of cosine and spectral response correction factors significantly improved the agreement for the effective irradiances measured by all of the detectors, typically to within 10-20%. Awareness of these detector characteristics can play a key role in ensuring the accuracy of health hazard measurements of UVGI lamps.

Pupil Size in Outdoor Environments.

When addressing the risk of laser-induced retinal injury in daylight, an individual's pupil size (diameter) is of great importance since the retinal illumination varies as the square of the pupil size. Pupil size was measured under daylight conditions for 87 subjects to fill the data gap in over a century of laboratory pupillometry studies. Photography with a fixed chin/head rest and digital camera platform was employed to measure pupil diameter of subjects viewing a full-field neutral screen. The digital images of the pupils of 87 subjects were measured using computer software. Screen luminance values ranged between 790 cd m to 4,300 cd m. The average pupil size for this study was 2.39 mm for an average luminance of 1,473 cd m. Pupil size measurements ranged from 1.44 mm to 3.03 mm. The data were stratified over luminance intervals, sex, eye color, and age.

Is a differentiated advice by season and region necessary?

The ultraviolet radiation component in the solar spectrum varies greatly with season. In the summer, the significant short-wavelength (UV-B) radiation at midday can produce erythema in sensitive skin in less than 20 min in middle latitudes, and yet in winter months, the same midday exposure dose would require hours of exposure. The challenge for public health authorities is to provide simple, understandable messages for sensitive individuals to limit excessive exposure at appropriate times of the day during spring and summer months and yet not to take needless precautions or limit exposure during fall and winter months at mid and circumpolar latitudes. The appropriate exposure for beneficial effects is not possible to achieve at many latitudes during winter months, but is readily achieved in summer months. Simple messages should be tailored to the local times of day, reflecting the locale and season. One simple means to communicate the relative UV-B exposure relates to the length of one's shadow (the "Shadow Rule"). Further challenges are presented when apparently mixed messages would be justified for different skin phototypes.

Radiometric quantities and units used in photobiology and photochemistry: recommendations of the Commission Internationale de L'Eclairage (International Commission on Illumination).

To characterize photobiological and photochemical phenomena, standardized terms and units are required. Without a uniform set of descriptors, much of the scientific value of publications can be lost. Attempting to achieve an international consensus for a common language has always been difficult, but now with truly international scientific publications, it is all the more important. As photobiology and photochemistry both represent the fusion of several scientific disciplines, it is not surprising that the physical terms used to describe exposures and dosimetric concepts can vary from author to author. There are, however, international organizations that were established to minimize the confusion produced by poor or inconsistent technical terminology. This note is to review the standardized terms and provide a background on how such terms are developed, with the hope that all readers will attempt to follow the standardized terminology.

Light-emitting-diode induced retinal damage and its wavelength dependency in vivo.

AIM: To examine light-emitting-diode (LED)-induced retinal neuronal cell damage and its wavelength-driven pathogenic mechanisms. METHODS: Sprague-Dawley rats were exposed to blue LEDs (460 nm), green LEDs (530 nm), and red LEDs (620 nm). Electroretinography (ERG), Hematoxylin and eosin (H&E) staining, transmission electron microscopy (TEM), terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), and immunohistochemical (IHC) staining, Western blotting (WB) and the detection of superoxide anion (O2-·), hydrogen peroxide (H2O2), total iron, and ferric (Fe3+) levels were applied. RESULTS: ERG results showed the blue LED group induced more functional damage than that of green or red LED groups. H&E staining, TUNEL, IHC, and TEM revealed apoptosis and necrosis of photoreceptors and RPE, which indicated blue LED also induced more photochemical injury. Free radical production and iron-related molecular marker expressions demonstrated that oxidative stress and iron-overload were associated with retinal injury. WB assays correspondingly showed that defense gene expression was up-regulated after the LED light exposure with a wavelength dependency. CONCLUSION: The study results indicate that LED blue-light exposure poses a great risk of retinal injury in awake, task-oriented rod-dominant animals. The wavelength-dependent effect should be considered carefully when switching to LED lighting applications.

Laser-Induced Photic Injury Phenocopies Macular Dystrophy.

OBJECTIVE: To describe the phenotypes associated with laser-induced retinal damage in children. METHODS: Five patients with maculopathy and reduced visual acuity associated with laser pointer use were evaluated. Best-corrected visual acuity, retinal structure, and function were monitored with color fundus, infrared (IR), and red-free images, fundus autofluorescence (AF), spectral domain-optical coherence tomography (SD-OCT), and full-field electroretinography (ERG). RESULTS: All five laser pointer injury patients had retinal lesions resembling a macular dystrophy (one bilateral and four unilateral). These lesions were irregular in shape but all had a characteristic dendritic appearance with linear streaks radiating from the lesion. Photoreceptor damage was present in all patients, but serial OCT monitoring showed that subsequent photoreceptor recovery occurred over time in the eyes of at least four patients. One patient also had bilateral pigment epithelial detachments (PED). Both hyper- and hypoautofluorecence were observed in the laser damage area. CONCLUSIONS: In general, OCT and IR images are quite useful to diagnose laser damage, but AF is not as sensitive. Laser pointer damage in children can occasionally be misdiagnosed as a macular dystrophy disease, but the distinctive lesions and OCT features are helpful for differentiating laser damage from other conditions.

Exposure geometry and spectral environment determine photobiological effects on the human eye.

Photobiological effects upon the human retina, cornea and lens are highly dependent on the optical exposure geometry as well as spectral characteristics of the exposure. The organ of sight is exquisitely sensitive to light because it performs well in very low nighttime illumination levels and yet it also must adapt to extremely bright environments where light exposures are greater by many orders of magnitude. The eye has evolved to protect itself reasonably well against excessive exposure in bright environments. The retina is minimally exposed in extremely bright environments and the cornea and lens are surprisingly well protected in harsh environments. Although these protective mechanisms are good, they are not perfect and adverse changes from both acute and chronic exposures to sunlight still exist. The geometrical protective factors must be understood and appreciated whenever assessing potential adverse effects of environmental UV radiation and light on ocular structures. These natural ocular protective factors also work with the ever-changing spectrum of sunlight and the different spectral distribution of light and UV radiation across the eye's field of view. Spectral characteristics of the ocular media are also important. One can visualize a series of intraocular color filters that progressively filter shorter wavelengths and thereby aid in color vision, reduce the impact of chromatic aberrations and significantly reduce the optical radiation hazards to the lens and retina.

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.