Abstract
Purpose
Laser pointer devices have become increasingly available in recent years, and their misuse has caused a number of ocular injuries. Online distribution channels permit trade in devices which may not conform to international standards in terms of their output power and spectral content. We present a case study of ocular injury caused by one such device.
Methods
The patient was examined approximately 9 months following laser exposure using full-field and multifocal electroretinography (ERG and MF-ERG), electrooculography (EOG), and optical coherence tomography (OCT), in addition to a full ophthalmological examination. MF-ERG, OCT, and the ophthalmological examination were repeated 7 months after the first examination. The output of the laser pointer was measured.
Results
Despite severe focal damage to the central retina visible fundoscopically and with OCT, all electrophysiological examinations were quantitatively normal; however, qualitatively the central responses of the MF-ERG appeared slightly reduced. When the MF-ERG was repeated 7 months later, all findings were normal. The laser pointer was found to emit both visible and infrared radiation in dangerous amounts.
Conclusion
Loss of retinal function following laser pointer injury may not always be detectable using standard electrophysiological tests. Exposure to non-visible radiation should be considered as a possible aggravating factor when assessing cases of alleged laser pointer injury.
References
Ham WT Jr, Ruffolo JJ Jr, Mueller HA, Guerry D 3rd (1980) The nature of retinal radiation damage: dependence on wavelength, power level and exposure time. Vis Res 20(12):1105–1111
International Electrotechnical Commission (2014) Safety of laser products: Part 1—Equipment classification and requirements. Vol IEC 60825-1
United States Food and Drug Administration (2015) Code of Federal Regulations Title 21. Chapter I: Food and Drug Administration, Subchapter: J—Radiological Health, Part 1040—Performance standards for light-emitting products
Laser Institute of America (2007) American National Standard for Safe Use of Lasers. Vol ANSI Z136.1. Orlando, FL
Ajudua S, Mello MJ (2007) Shedding some light on laser pointer eye injuries. Pediatric Emerg Care 23(9):669–672. doi:10.1097/PEC.0b013e31814b2dc4
Dirani A, Chelala E, Fadlallah A, Antonios R, Cherfan G (2013) Bilateral macular injury from a green laser pointer. Clin Ophthalmol 7:2127–2130. doi:10.2147/OPTH.S53024
Petrou P, Patwary S, Banerjee PJ, Kirkby GR (2014) Bilateral macular hole from a handheld laser pointer. Lancet 383(9930):1780. doi:10.1016/s0140-6736(14)60757-1
Luttrull JK, Hallisey J (1999) Laser pointer-induced macular injury. Am J Ophthalmol 127(1):95–96
Dhoot DS, Xu D, Srivastava S (2014) High-powered laser pointer injury resulting in macular hole formation. J Pediatr 164(3):668e661. doi:10.1016/j.jpeds.2013.11.019
Wyrsch S, Baenninger PB, Schmid MK (2010) Retinal injuries from a handheld laser pointer. N Engl J Med 363(11):1089–1091. doi:10.1056/NEJMc1005818
Galang J, Restelli A, Hagley EW, Clark CW (2010) A green laser pointer hazard. NIST Technical Note 1668. National Institute of Standards and Technology, U.S. Department of Commerce
Hadler J, Tobares E, Dowell M (2013) Random testing reveals excessive power in commercial laser pointers. J Laser Appl 25(3):032007. doi:10.2351/1.4798455
Lim ME, Suelzer J, Moorthy RS, Vemuri G (2014) Thermal macular injury from a 154 mW green laser pointer. J AAPOS 18(6):612–614. doi:10.1016/j.jaapos.2014.07.165
Hood DC, Bach M, Brigell M, Keating D, Kondo M, Lyons JS, Marmor MF, McCulloch DL, Palmowski-Wolfe AM, International Society For Clinical Electrophysiology of V (2012) ISCEV standard for clinical multifocal electroretinography (mfERG) (2011 edition). Doc Ophthalmol 124(1):1–13. doi:10.1007/s10633-011-9296-8
Marmor MF, Brigell MG, McCulloch DL, Westall CA, Bach M, International Society for Clinical Electrophysiology of V (2011) ISCEV standard for clinical electro-oculography (2010 update). Doc Ophthalmol 122(1):1–7. doi:10.1007/s10633-011-9259-0
Marmor MF, Fulton AB, Holder GE, Miyake Y, Brigell M, Bach M, International Society for Clinical Electrophysiology of V (2009) ISCEV Standard for full-field clinical electroretinography (2008 update). Doc Ophthalmol 118(1):69–77. doi:10.1007/s10633-008-9155-4
Mohidin N, Yap MK, Jacobs RJ (1997) The repeatability and variability of the multifocal electroretinogram for four different electrodes. Ophthal Physiol Opt 17(6):530–535
Schulmeister K, Jean M (2010) The risk of retinal injury from Class 2 and visible Class 3R lasers, including medical laser aiming beams. Med Laser Appl 25(2):99–110. doi:10.1016/j.mla.2010.01.005
Zuclich JA, Schuschereba ST, Zwick H, Boppart SA, Fujimoto JG, Cheney FE, Stuck BE (1997) A comparison of laser-induced retinal damage from infrared wavelengths to that from visible wavelengths. Lasers Light Ophthalmol 8(1):15–29
Vogel A, Birngruber R (1992) Temperature profiles in human retina and choroid during laser coagulation with different wavelengths ranging from 514 to 810 nm. Lasers Light Ophthalmol 5(1):9–16
Allen RD, Brown J Jr, Zwick H, Schuschereba ST, Lund DJ, Stuck BE (2004) Laser-induced macular holes demonstrate impaired choroidal perfusion. Retina 24(1):92–97
Roider J, Buesgen P, Hoerauf H, Schmidt-Erfurth U, Laqua H, Birngruber R (1999) Macular injury by a military range finder. Retina 19(6):531–535
Ying HS, Symons RC, Lin KL, Solomon SD, Gehlbach PL (2008) Accidental Nd:YAG laser-induced choroidal neovascularization. Lasers Surg Med 40(4):240–242. doi:10.1002/lsm.20626
Kontadakis GA, Karagiannis D, Kandarakis AS (2015) Macular injury with rapid onset of choroidal neovascularization from laser epilation. JAMA Ophthalmol 133(4):488–490. doi:10.1001/jamaophthalmol.2014.5838
Nehemy M, Torqueti-Costa L, Magalhaes EP, Vasconcelos-Santos DV, Vasconcelos AJ (2005) Choroidal neovascularization after accidental macular damage by laser. Clin Exp Ophthalmol 33(3):298–300. doi:10.1111/j.1442-9071.2005.00993.x
Link B, Michelson G, Horn FK, Junemann A (2008) Accidental focal laser injury: a correlation of electrophysiology, perimetry and clinical findings. Doc Ophthalmol 117(1):69–72. doi:10.1007/s10633-007-9104-7
Thanos S, Bohm MR, Meyer Zu Horste M, Schmidt PF (2015) Retinal damage induced by mirror-reflected light from a laser pointer. BMJ Case Rep. doi:10.1136/bcr-2015-210311
Acknowledgments
JVMH was partially funded by the Clinical Research Priority Programme of the University of Zurich. MM was partially funded by the Swiss Confederation program Nano-Tera.ch, which was scientifically evaluated by the Swiss National Science Foundation (SNSF).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Statement of human rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Statement on the welfare of animals
This article does not contain any studies with animals performed by any of the authors.
Informed consent
For this type of study, formal consent is not required.
Conflict of interest
JVMH was partly funded by the Clinical Research Priority Programme of the University of Zürich and has received speaker fees and travel support from Biogen. MM was partially funded by the Swiss Confederation program Nano-Tera.ch, which was scientifically evaluated by the Swiss National Science Foundation (SNSF); subsequent to the work presented here, he has been employed by II–VI Laser Enterprise GmbH, Zurich. JS, MG, and CG-K report no conflicts of interest.
Rights and permissions
About this article
Cite this article
Hanson, J.V.M., Sromicki, J., Mangold, M. et al. Maculopathy following exposure to visible and infrared radiation from a laser pointer: a clinical case study. Doc Ophthalmol 132, 147–155 (2016). https://doi.org/10.1007/s10633-016-9530-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10633-016-9530-5