Retinal Injuries in Children Secondary to Handheld Lasers
American Journal of Ophthalmology, November 2016
Raoof et al. reviewed the records of children injured by recreational handheld lasers to determine potential prognostic factors. They also proposed a system for grading injuries based on findings of optical coherence tomography. The authors emphasized that such retinal injuries may be difficult to diagnose and likely are underreported.
Among the 12 boys and 4 girls in this single-center study, 24 eyes were affected. Mean age was 12.7 years (range, 9- 16 years). Mean visual acuity at presentation was 0.30 (20/40); range, –0.20 (20/12.5) to 1.6 (20/800). The most common symptoms were central scotoma (11 children) and blurred vision (3 children). Two patients were asymptomatic and were referred because their optometrist detected macular changes.
Because laser retinopathy can masquerade as various other conditions, the authors call it “the new pretender.” The differential diagnosis is extensive and includes Best disease, Stargardt disease, cone-rod dystrophies, solar retinopathy, and infectious causes such as toxoplasma chorioretinitis. Diagnosis may be delayed by children’s reluctance to admit playing with lasers.
Eleven children (15 eyes) had mild injuries, defined as focal retinal disruption confined to the photoreceptor and ellipsoid layers; these had the most favorable prognosis. Two children (3 eyes) had moderate injuries, characterized by diffuse retinal disruption confined to the outer retinal layer. Three patients (4 eyes) had severe injuries, with subfoveal outer retinal architecture loss and overlying hyperreflective material in the inner retinal layers.
Patients with mild injury and good visual acuity at presentation maintained good vision throughout follow-up. Those with severe injury did not experience visual improvement. However, the mean follow-up period was short (5.4 months), and later improvement has occurred in other cases. Because of the small number of severe and moderate injuries in this study, prognostic assumptions cannot be drawn for them.
In conclusion, laser-related retinal injuries may be underreported and difficult to diagnose. Regulatory authorities should recognize the importance of laser retinopathy as an avoidable cause of childhood visual impairment and should implement efforts to reduce these injuries. Awareness should be raised among clinicians, parents, teachers, and children.
The original article can be found here.