Laser pointer–induced macular injury

doi:10.1016/S0002-9394(98)00254-2

American Journal of Ophthalmology

Volume 127, Issue 1, January 1999, Pages 95-96

https://doi.org/10.1016/S0002-9394(98)00254-2 Get rights and content

Abstract

PURPOSE: To report a patient with a macular injury caused by a laser pointing device.

METHODS: Case report. A healthy 34-year-old man was examined 2 days after he deliberately gazed into the beam of a laser-pointing device with his left eye for an estimated 30 to 60 seconds. His uncorrected visual acuity in each eye was 20/20. He reported a transient central scotoma in the left eye and headache after laser exposure.

RESULTS: Both eyes were unremarkable except for a focal retinal pigment epithelial disturbance at the nasal edge of the fovea in the left eye. Fundus fluorescein angiography demonstrated window- defect type hyperfluoresence in the same location.

CONCLUSIONS: Laser-pointing devices may cause macular injury when used inappropriately. Conformance with consumer safety recommendations should minimize potential hazards.

References (4)

J.A. Wolfe
Laser retinal injury
Mil Med
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United States Code of Federal Regulations. Title 21, chapter 1, part 1040, section...

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Cited by (54)

Retinal injury from handheld lasers: a review
2021, Survey of Ophthalmology
Citation Excerpt :
Retinal damage and vision loss may occur following exposure to powerful light sources, including sunlight, illumination from surgical microscopes, and lasers.1,4,6–8,11–13 High-powered handheld laser devices or laser pointers have become widely available to the public, resulting in increasing reports of retinal injury in children and adults.16-21,23-26,28,30,35,39-42,44,45,58 Handheld laser maculopathy may be characterized by a diverse spectrum of clinical and multimodal imaging findings which, in conjunction with a frequently undisclosed history of laser exposure, can make prompt diagnosis of this condition challenging.29,46,48,53,54,56–61,63–67
Retinal photic injury induced by handheld lasers is a burgeoning public health concern due to the wider accessibility of high-powered devices. Retinal damage from thermal energy can cause potentially severe and permanent vision loss in children and young adults who are particularly vulnerable because of comorbid behavioral, learning, and psychiatric impairments. Understanding the spectrum of specific clinical and imaging features of such laser injuries aids in prompt and accurate diagnosis. Multimodal retinal imaging is important for the identification of the outer retinal abnormalities that characterize this condition. We reviewed 171 reported cases in the English and non-English language literature published from 1999, when handheld laser injury was first described, to December, 2018. Risk factors, demographic and clinical characteristics, as well as multimodal imaging findings, were collected and summarized. These findings both provide insights for public health awareness and guide areas of future investigation.
Optical coherence tomography angiography findings of choroidal neovascularization secondary to laser injury: A case report
2020, American Journal of Ophthalmology Case Reports
Citation Excerpt :
As reported by Turaka et al., the morphology of retinal damage from the laser pointers may vary.4 Clinical findings include: disruption of the foveal ellipsoid zone (the most common OCT finding), subretinal hemorrhage,5 retinal edema, scars in the retinal pigment epithelium (RPE),6 foveal granularity,7 perifoveal drusenoid like deposits/pigment clumps,8,9 or ring-shaped hypopigmented lesions in fovea10,11 and rarely choroidal neovascularization (CNV).2,12–18 The treatment of CNV secondary to laser injury is still debated.
To report a case of choroidal neovascularization (CNV) secondary to laser injury imaged by optical coherence tomography angiography (OCTA) and treated by intravitreal anti-vascular endothelial growth factor (VEGF).
A 14-year-old boy presented with vision loss and central scotoma in the right eye (RE) in the last month, after having stared at the beam of a laser pointer. At presentation, his best-corrected visual acuity (BCVA) in the RE was 20/40 and spectral-domain OCT (SD-OCT) showed an interruption of ellipsoid zone and the presence of an hyperrelfective lesion in subfoveal region. OCTA examination revealed the presence of a high-flow lesion on both outer retina to choriocapillaris (ORCC) and choriocapillaris segmentations. The patient was treated by one anti-VEGF injection: at one month follow-up his BCVA in the RE was 15/20. SD-OCT revealed the complete resolution of hyperreflective lesion and no detectable flow on OCTA.
Retinal laser injury may be complicated by CNV. OCTA may non-invasively assess the presence of CNV, as well as treatment-response.
Solar retinal phototoxicity masquerading as self-inflicted handheld laser-induced lesions
2020, American Journal of Ophthalmology Case Reports
Citation Excerpt :
Self-inflicted handheld laser-induced injuries have been initially reported in 19991,2 and since then, the number of reported cases is increasing.3–20
To report multimodal imaging of lesions due to the unprotected observation of the sun with an astronomical telescope, mimicking self-inflicted handheld laser-induced macular lesions.
A 44-year old man was diagnosed with chronic central serous chorioretinopathy leaving a relative scotoma in his left eye, with visual acuity limited to 20/40. He complained of a sudden visual loss to 20/400. Fundus examination showed a yellowish discoloration of the fovea. Fundus autofluorescence pictures showed hyper-autofluorescent spots that were hyperfluorescent both on fluorescein and indocyanine-green angiography. Spectral-domain optical coherence tomography (SD-OCT) showed hyper-reflective foveal outer layers, and OCT-angiography showed dark areas at the choriocapillaris. Multimodal imaging was highly suggestive of self-inflicted handheld laser-induced lesions that were ruled out by the patient. He remembered having observed the sun during an astronomical session, looking for solar winds. The main astronomical telescope was protected by a specific filter, but the aiming side-telescope was incidentally not protected by any filter.
The unprotected observation of the sun with an astronomical telescope may result in visual loss due to macular burns that may mimic self-inflicted handheld laser-induced lesions. This hypothesis should be searched before concluding denied self-injuries.
Photic maculopathy: A review of the literature (II)
2018, Archivos de la Sociedad Espanola de Oftalmologia
La retina humana, como tejido transductor de la energía lumínica, está especialmente expuesta a la toxicidad inducida por la exposición a la luz. La maculopatía solar ha sido durante milenios la única forma de maculopatía fótica, muchas veces en relación con la observación de un eclipse. Durante el último siglo los avances tecnológicos han conducido a la aparición de nuevas formas de retinopatía fótica, en relación con la exposición a nuevas formas de luz artificial como los dispositivos de soldar o emisores de láser. En los últimos años la generalización del uso de punteros láser ha hecho que repunte el interés por esta dolencia. El objetivo de esta revisión es ofrecer una visión integrada de los diversos tipos de maculopatía fótica. La revisión se presenta dividida en 2 partes, debido a la extensión del tema tratado. En esta segunda parte se presentan la maculopatía fótica secundaria a explosiones nucleares, a láser, las formas iatrogénicas de maculopatía fótica y la retinitis foveomacular.
The human retina, as transducer of light energy, is especially exposed to light toxicity. Solar maculopathy has been the only form of photic maculopathy for millennia, often secondary to the observation of an eclipse. During the last century, technological advances have led to the appearance of new forms of photic maculopathy, related to the exposure to new forms of artificial light, such as welding devices and lasers. In recent years the general use of laser pointers has led to an upturn in interest in this pathology. The aim of this review is to offer an integrated view of the different types of photic maculopathy. Due to the extension of the topic, the review is presented divided into 2 parts. In this second part, atomic bomb maculopathy, laser maculopathy, iatrogenic forms of photic maculopathy, and foveomacular retinitis are presented.
Multimodal imaging in handheld laser-induced maculopathy
2015, American Journal of Ophthalmology
To describe the clinical and imaging findings in 3 patients with maculopathy secondary to handheld laser exposure.
Retrospective, observational case series.
We evaluated the multimodal imaging including fundus autofluorescence and spectral-domain optical coherence tomography (OCT) for 3 patients with histories of exposure to handheld lasers.
An 18-year-old woman with a history of repetitive self-inflicted handheld laser exposure was found to have bilateral outer retinal streaks in the macula and the superior peripheral retina on both ophthalmoscopy and multimodal imaging. Initial spectral-domain OCT revealed vertical hyper-reflective bands at the level of the outer retina corresponding to the streaks. An 11-year-old boy who played with a green laser developed a yellow foveal lesion and outer retinal streaks in the superior macula. Spectral-domain OCT showed vertical hyper-reflective bands in the outer retina corresponding to the streaks. A 14-year-old boy developed bilateral focal foveal lesions and ellipsoid loss on spectral-domain OCT following peer-inflicted laser injury.
In a series of 3 patients, outer retinal streaks were associated with self-inflicted handheld laser injury. In contrast, accidental and peer-inflicted laser injuries were found to result in focal foveal lesions.
High-power handheld blue laser-induced maculopathy: The results of the king khaled eye specialist hospital collaborative retina study group
2014, Ophthalmology
To report various types of maculopathy caused by momentary exposure to a high-power handheld blue laser.
Consecutive case series.
Fourteen eyes of 14 patients.
Patients with a history of eye exposure to a blue laser device (450 nm and a power range of 150–1200 mW) to a single institution were included. Evaluation included a full ophthalmic examination, fundus photography, macular spectral-domain optical coherence tomography, and fundus fluorescein angiography.
Analysis of the types of maculopathy and vitreoretinal pathologic features.
All patients were young males. The most common setting for injury was accidental at play. The types of maculopathies encountered were: a full-thickness macular hole (FTMH) in 4 eyes, a premacular subhyaloid hemorrhage in 5 eyes, premacular sub–internal limiting membrane hemorrhage in 2 eyes, an outer retinal disruption at the fovea in 1 eye, an epimacular membrane in 1 eye, and a schisis-like cavity in 1 eye. Best-corrected Snellen visual acuity at presentation ranged from 20/40 to 4/200 (mean, 20/290). Only 4 eyes (29%) improved spontaneously with increase in vision, whereas 10 eyes (71%) required intervention. The latter consisted of neodymium:yttrium–aluminum–garnet hyaloidotomy in the 5 eyes with subhyaloid hemorrhage and pars plana vitrectomy (PPV) for the eyes with FTMH and epimacular membrane. All 4 FTMH were closed successfully after PPV. Final mean best-corrected visual acuity in all cases was 20/35 (range, 20/15–20/300).
Exposure to high-power handheld laser devices can cause a variety of maculopathies that can reduce central vision permanently. Although vision may improve spontaneously, most cases require intervention. Unrestricted access to commercially available high-power handheld laser devices is dangerous and public awareness should be encouraged.

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¹: Dr Luttrull is in private practice in Ventura, California.

²: Dr Hallisey is in private practice in Camarillo, California.

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Brief ReportsLaser pointer–induced macular injury

Abstract

Laser retinal injury

Mil Med

Brief Reports
Laser pointer–induced macular injury