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The most serious injury that the boy caused was a large hole in his macula, shown with the yellow arrows.
Two other areas of injury were not immediately visible in a funduscopic exam of the retina (photo A, using ordinary white light) but were clearly visible using fundus autofluorescence imaging (blue arrows in photo B, using a narrow wavelength of light). The round area to the left in both photos is the optic disc, a natural feature where the optic nerve begins — it is not laser damage.
The macula is where central vision occurs. The fact that the injury occurred in the macula indicates that the boy looked directly into the laser light with his left eye. Damage to the macula is serious as this area provides high resolution, color vision in the center of the visual field.
The injury reduced the boy’s vision to 20/100 in the injured left eye; his right eye remained at 20/20. The boy’s ophthalmologists felt the hole was too large and too much time had passed since the injury for surgery. (The doctors suspected that the boy had injured his eye at least a year earlier.) Because surgery might make things worse, causing a cataract without improving the macula, they “favored conservative management.”
There was no improvement in vision even 1 1/2 years after the injury was first presented to the ophthalmologists.
The power of the laser pointer, and other details of the incident, were not described in the one-paragraph report published June 21 2018. One of the authors told CNN the boy’s father “had bought the laser as a toy from a street merchant.”
From the New England Journal of Medicine (N Engl J Med 2018; 378:2420, DOI: 10.1056/NEJMicm1714488) Authors: Sofia Androudi, M.D., Ph.D., and Eleni Papageorgiou, M.D., Ph.D. Additional reporting by CNN.
In the first case, the macular area of a boy’s eyes were damaged so that he could not see an object at 10 cm. The damage was confirmed by retinal examination.
In the second case, a 15-year-old high school student also has burns on his macular area, from when a classmate aimed a laser pen at him. He could only see objects within 50 cm, and there were scars consistent with those left by clinical lasers.
Both cases were reported by Xie Airui, an eye specialist at the Ineye Hospital of Chengdu University of Traditional Chinese Medicine. Both cases occurred between September 2017 and May 2018.
According to a May 31 2018 news story, laser pens have become popular with some schoolchildren in Chengdu. Many stationery shops sell them for prices between USD $0.80 and $31.00. in 2014 the General Administration of Quality Supervision, Inspection and Quarantine warned consumers about laser pointer hazards. “But no market supervisors have taken up the matter in a serious way, according to Xu Bin, a lawyer in Chengdu.”
From China Daily via Ecns.cn
After the “read more” link are more stories, plus speculation that the cause might be ultraviolet light, or chemical irritation from fog or smoke.
NYE laser show leaves 200 students in Andhra with eye irritation
The children's eyes began watering and had turned red when they got up the next morning.
Around 40 students of a private school in Andhra Pradesh's Parvathipuram village in Vizianagaram district had to be given medical treatment, after their eyes began to swell on Monday morning [January 1 2018].
The 40 students, along with 200 others, began complaining of irritation and pain in their eyes, after they were reportedly exposed to lights and lasers during a show, as part of the school's New Year's Eve celebrations.
The children's eyes began watering, and had turned red when they got up the next morning.
As the children began complaining, worried parents staged a protest and demanded answers from the school.
Following this, doctors rushed to the school and administered first-aid, before assuring those who had gathered, that the kids would not lose eyesight.
“We prescribed eye drops and ointment for the affected children,” a doctor told the Times of India.
Meanwhile, Vizianagaram district Collector Vivek Yadav was informed of the incident, and directed the Revenue Divisional Officer (RDO) of Parvathipuram, P Sudarsan Dora, to visit the school along with Mandal Educational Officer P Krishna Murthy.
Circle Inspector G Rambabu also visited the school along with the officials, and spoke to the children, to collect more details regarding the case. Further details are awaited.
Click the “read more” link to see additional updated stories, plus speculation on the possible cause. Click to read more...
An optometrist who examined the boy said “It was clear after taking a close look at Carlo’s eyes that he had suffered some sort of damage. I could see there were slight burns to the surface of the eye [cornea] and the retina, the light sensitive tissue at the back of the eye, had been damaged.”
According to the optometrist, the boy is likely to need glasses when he is older due to the “irreversible” damage.
Carlo’s mother said “I had no idea laser pens could do so much damage to the eyes. If we had known, we’d never have let him buy one. The damage was slight when it was detected so Carlo hadn’t complained of any issues, but thank goodness it got picked up when it did.”
From the Leicester Mercury and the Express
The undated attack was discussed in an October 9 2017 press release from Dr. Valev’s institution, the University of Bath. The goal of the press release was to warn the public about laser pointers which may seem safe but are too powerful and/or emit infrared light in addition to visible light.
Dr. Valev and colleagues tested laser pointers at the university, and found the potentially unsafe conditions.
As part of the press release, Dr. Valev related a laser pointer attack that occurred in his home. He said his daughter was asleep at the time so no light entered her closed eyes. Dr. Valev said “… I got only momentarily dazed, but suddenly everything became red. I was thinking that perhaps I was experiencing a medical condition, but my wife saw someone shining a pointer at me from outside our home.”
Click the “read more” link to read the entire press release. Click to read more...
On September 12 2017, a boy turned around and aimed the laser at the girl’s face. She covered her face but he deliberately aimed at her eyes. When she arrived at school, the girl told her teacher that her eye was sore and blurry. It remained that way throughout the day.
She went to an emergency center that night, and an ophthalmologist the next day. The prognosis was that there was no physical damage and her vision should improve.
About a week later, a local optician examined her and said there was damage to her peripheral vision on the left side, and it was likely to be permanent.
The girl’s father told The Press and Journal, “I was angry. I was shocked on Saturday, I was hoping it would get better. My daughter was upset. It has knocked her confidence. What I’m really bothered about is the availability of these pens. These laser pens are a danger and people should be aware. I’m intending to write to local MSPs and the MP about it. I don’t think any children should be able to buy them. You can buy them in supermarkets and on Amazon – I don’t think that’s right. I think the legislation has to be changed.”
A survey of UK ophthalmologists reported more than 150 incidents of eye injuries involving laser pointers since 2013, the vast majority of these involving children.
From an October 12 2017 article in The Press and Journal
US: Calif. teacher loses credentials for, among other things, shining laser pointer in students' eyes
Carlos Cameron Duncan was said to have been aggressive to his students at Euclid Elementary School, to have verbally abused them, and to have used physical force, among other charges. He resigned March 8 2016. His credential revocation was reconsidered and sustained in April 2017.
There was no indication of any claim of injury from the laser pointer shining.
From a September 30 2017 article in the Daily Bulletin
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.
Click to read more...
Lynsey McClure had imported the lasers from a Chinese supplier who said they complied with U.K. regulations limiting laser pens to 1 milliwatt of power. Her brother, who was not charged, sold them in a stall during a school fair in December 2015. The headmaster asked her brother to stop selling the laser, but he continued.
Jonathan Marshall, 7, purchased one of the lasers. It was later found to have an output of 127 milliwatts.
His mother said Jonathan was playing with it at home when the beam went into his eye for “a fraction of a second.” He has a retinal burn which interferes with his vision.
McClure pleaded guilty to nine product safety and consumer protection violations, including selling an unsafe product and failing to disclose the power of the laser.
The case appears to be the first where a person has been prosecuted for an illegal laser sale that led to an injury.
From the Sunday Times (subscription required to read the entire article) and the JC.com
The 44-year-old driver stared into the laser several times, as he tried to identify the person holding the laser. He suffered blurred vision in his right eye immediately after the exposure, but waited 6 months before having his first complete eye exam.
The exam showed “spot-like retinal pigment epithelium disturbances temporal to the fovea of the right eye, with no abnormalities in his left eye.” The authors stated that “The subjective complaints and objective ophthalmological findings of this patient were consistent and strongly suggested that the repetitive exposure of the eye to the reflected laser spot 6 months previously had caused subtle but detectable injury to the macula.”
The authors concluded with two “Learning points”:
- “We suggest that no laser pointers of any class are made available to children, since they are unlikely to understand the risks of permanent retinal damage.”
- “For the safety of users and the general public, even low-energy handheld laser pointers should not be sold to children.”
The authors did not identify the location of the incident, but it may be Germany since three of the four authors’ institutions were in Germany. Additional analysis and commentary is below (click the “Read More…” link).
From Thanos S, Böhm MRR, Meyer zu Hörste M, et al. “Retinal damage induced by mirror-reflected light from a laser pointer” BMJ Case Reports. Retrieved online: 2015 Nov 05, doi:10.1136/bcr-2015- 210311.
Click to read more...
Italy: Prosecutor investigating manslaughter charges in three cases of eye damage to children from laser pointers
The cases were reported in mid-September 2015 by the St. Ursula Ophthalmology Hospital in Bologna. One of the children was 10; the other two were 13.
The injuries were caused by laser pointers bought by their parents (in two cases) or grandmother (in the third case) in markets in Florence or Bologna. One child had a slight loss of vision, another had significant loss in both eyes, and a third has almost lost his sight and is legally blind.
A public prosecutor, Valter Giovannini, has opened an investigation for aggravated manslaughter against unknown assailants. This seems to indicate that in all three cases, the laser pointer bought by or for the children was used against them by another person.
As a result of the report, Carabinieri NAS (Nuclei Antisofisticazioni e Sanità or “Anti Fraud Squad”), a special police force operating under the Italian ministry of health, seized fifteen illegally-sold laser pointers.
The hospital warned the public not to purchase green laser pointers sold “on the street, in the stalls and fairs.” A spokesperson said higher-powered pointers such as those aimed at players in stadiums were to be avoided. Professional laser pointers used in lectures should not be a problem.
From Corriere di Bologna. Thanks to Alberto Kellner Ongaro for bringing this to our attention.
In addition, the man left notes, money and candy for the girl, and used binoculars to look into their home.
To avoid having their child testify at a trial, the victim’s parents agreed to a plea bargain deal. Pico pleaded guilty to promotion of obscenity in a minor. He received a 30-day jail sentence, was registered as a sex offender, was forbidden to have any contact with persons 18 or younger, and was required to have mental health treatment.
From KKTV 11 News and The Gazette
The zoo had previously applied to the Norwegian Radiation Protection Authority (NRPA) for approval to use the glove, and for exemption from labeling and classification requirements. The request was rejected.
However, the zoo went ahead with the production.
In a September 17 2014 story, Norwegian newspaper Verdens Gang (VG) quoted NRPA staffer, Sindre Øvergaard, who attended a performance in July 2014. He said it swept over the audience three times: “I and my partner got it right in the eye. We noticed there was a very bright light, and it hurt a little.”
Since he had been involved in the zoo’s original application to NRPA, Øvergaard told VG “that they [the zoo] took it to use is simply indefensible.”
The case was reported to the police. The zoo says a subcontractor told them the glove (shown below) was approved.