Laser pointer-induced maculopathy: More than meets the eye

Purpose: To describe the clinical findings in patients with laser-induced retinal injury. Methods: Consecutive patients presenting to a tertiary center between January 2014 and December 2015 following inadvertent ocular exposure to a laser pointer were included. Evaluation included a full ophthalmic examination and spectral-domain optical coherence tomography (SD-OCT). Results: Seven young patients (8 eyes) were identified. Their mean age was 18.7 years (median: 16 years; range: 12 to 36 years). In most cases, patients were exposed for several seconds to a 5-mW green laser. At presentation, all patients complained of a central/paracentral scotoma. Snellen best corrected visual acuity (BCVA) at presentation ranged from counting fingers to 6/6. In 5 eyes, a round, well-defined deep yellowish-orange discoloration at the level of the retinal pigment epithelium in the foveola, ranging from 150 to 350 μm in diameter, was noted on ophthalmoscopic examination. Additional findings were macular subhyaloid hemorrhage in 2 eyes and a full-thickness macular hole with cystoid macular edema in 1 eye. In all cases, baseline SD-OCT revealed disruption involving the photoreceptor inner segment/outer segment junction/ellipsoid zone band, and extended toward the inner aspect of the retinal pigment epithelium band, ranging from focal interruption to extensive full-thickness macular hole. All patients received oral corticosteroid treatment with prednisone (0.5 to 1 mg/kg). Follow-up ranged between 2 and 12 months. Over time, improvement in visual acuity to 6/8 and 6/6 was noted in all eyes but one, which remained poor at counting fingers from 2 meters. The visual improvement was associated with complete or near-complete restoration of the integrity of macular structure noted on SD-OCT. Conclusions: Commercial handheld laser pointers may inflict notable macular injury and damage vision permanently. Although good visual recovery was often noted, access to commercially available laser devices is potentially hazardous, especially to minors, and public awareness should be raised.