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US: Study examines 4 laser-caused eye injuries in children, at one medical practice

A study in the October 2016 journal Pediatrics described four cases where children had laser-related eye injuries, all being presented at a single clinical practice within a two-year period. The authors call this “[t]o our knowledge, the largest reported case series of laser pointer-induced retinal damage in the pediatric population in a developed country to date.”

In a separate interview, one of the authors, ophthalmologist Dr. David Almeida, said these cases are “happening more frequently…. It was previously thought this was a one-in-a-million event. It's still probably a rare-to-uncommon reaction, but it's not a never reaction.”

All four children had foveal laser burns. Three of the children had potentially permanent vision loss. These are the cases:

  • A 12-year-old boy looked into a green laser pointer for about a minute. He had decreased central vision in both eyes, with 20/20 vision in one eye and 20/30 in another. His vision and macular condition was found to be unchanged after 7 months.
  • A 16-year-old teenager similarly had central vision loss in both eyes, after playing with a green laser pointer for about 30 seconds. He was first examined three days after the exposure, scars and atrophy were found on the retina. Two weeks later his vision has worsened. Visual acuity was 20/40 in both eyes with no improvement.
  • A 9-year-old boy looked at the reflection of a green laser pointer in a mirror (essentially the same as a direct beam) for an unknown length of time. His vision was 20/50. He was treated with 1% prednisolone three times a day for two weeks. His vision improved to 20/30, but he still had “persistent abnormalities of the photoreceptors.”
  • A 12-year-old boy looked into a red laser pointer for about 15 seconds. He had central vision loss, and 20/70 vision. He was given an injection of bevacizumab, which gradually improved his vision and symptoms. After 1 year, he had 20/20 vision.

The authors noted that laser pointers are more available, that users may not be aware of the dangers, and that some users may use pointers improperly.

Visible lasers less than 5 milliwatts (the U.S. legal standard for a laser to be marketed as a “pointer”) are considered to be generally safe due to the bright light reflex, which causes a person to blink and turn away from a bright light. So one question is why these children were injured by laser pointers.

One reason, according to the authors, is that “children increase their chance to retinal injury by staring at the laser beam without blinking or averting the eye for a prolonged duration.”

Another possible cause is that “the labeling of the power output of a laser point may be different from the device’s actual specifications.” They referred to a study of 122 laser pointers, where 90% of green pointers and 44% of red pointers were above the 5 milliwatt U.S. legal limit.

The study said that treatment options were “limited and also controversial.” Use of corticosteroids has shown “mixed results.” It may be enough to observe a patient over time, since many injuries will stabilize.

The authors recommended that laser pointer hazards “should be communicated to health professionals, school teachers, and guardians in an attempt to raise the public awareness of this emerging public health issue. Unsupervised use of these laser pointer devices among children should be discouraged, and there is a need for legislation to limit these devices in the pediatric population.”

From Retinal Injury Secondary to Laser Pointers in Pediatric Patients, Kunyong Xu, Eric K. Chin, Polly A. Quiram, John B. Davies, D. Wilkin Parke III and David R.P. Almeida, in Pediatrics; originally published online September 1, 2016; DOI: 10.1542/peds.2016-1188. A general interest article summarizing the study, with additional comments from Almeida and another ophthalmologist, is at HealthDay.com. The abstract of the Pediatrics article is below; click the “Read More…” link.


Abstract: Retinal Injury Secondary to Laser Pointers in Pediatric Patients
Kunyong Xu, Eric K. Chin, Polly A. Quiram, John B. Davies, D. Wilkin Parke III, David R.P. Almeida
Pediatrics. October 2016 issue, 2016;138(4):e20161188

This case report describes 4 male children (age, 9–16) who had laser-related retinal injury to the macula of 1 eye or both eyes due to the mishandling of the laser pointer devices at a single vitreoretinal clinical practice.

The presenting symptoms associated with laser pointer injury include central vision loss, central scotoma, and metamorphopsia.

Clinical findings of laser-related retinal injury include reduced visual acuity, disruption of the photoreceptor ellipsoid zone, retinal pigment epithelium atrophy, and choroidal neovascular membrane formation. Disruption of the foveal ellipsoid zone (photoreceptor inner segment/outer segment layer) is the most common finding on optical coherence tomography imaging.

Three patients had potential irreversible vision loss.

Laser pointers are readily available and appropriate use of laser pointers in the pediatric population must be emphasized due to the potential irreversible retinal injury. Health professionals, school teachers, and parents should raise public awareness of this emerging public health issue by educating children about the dangers of laser pointers. Laser pointer devices among children should be discouraged and limited due to the possibility of permanent harm to themselves and others. Legislation and laws may be required to better control the sale and use of these devices.