A 13-year-old boy presented to our clinic complaining of decreased vision in both eyes 1 day after having intentionally gazed directly into the beam of a green laser pointing device (wavelength 532 nm), that had a maximum power rating of 5 mW (US Food and Drug Administration class 3A or IEC class 3R) stated on its labeling. He held the laser 5 cm away from his eyes for an estimated 30–60 seconds. Prior to this incident, the boy had reported no visual complaints. His last ocular examination had revealed visual acuity of 20/20 in both eyes.\nCurrent examination revealed best-corrected visual acuity of 20/50 in the right eye and 20/30 in the left eye. Anterior segments were normal in both eyes. Fundus examination showed bilateral, yellowish, oval-shaped, drusenoid-like lesions with attenuation of the foveal reflex ( and ).\nImaging studies were done on presentation to our practice 18 hours after exposure to the laser device. Optical coherence tomography (3D OCT; Topcon, Tokyo, Japan) of both eyes showed disruption of the outer retinal layer with nonspecific retinal thickening ( and ); red-free photographs demonstrated hypopigmented foveal dots bilaterally ( and ); fluorescein angiography showed early foveal hyperfluorescence in both eyes with late ill-defined leakage ( and ); and autofluorescence images showed heterogeneous hyperfluorescence in the macula of both eyes ( and ). Finally, a computerized 10–2 visual field threshold test (Humphrey Automated Perimeter; Humphrey Instruments, San Leandro, CA, USA), showed small pericentral scotomata in the right eye and a normal field in the left eye.\nThe patient was treated with an oral steroid (Prednisone; H.J. Harkins Company, Inc., Grover Beach, CA, USA) 1 mg/kg for 4 weeks then tapered over 2 months. At 3 months, visual acuity remained impaired but improved to 20/30 in the right eye and 20/25 in the left eye.\nAt 3 months, optical coherence tomography showed improvement of the retinal thickening in both eyes. The hyperreflective line representing the inner segment/outer segment junction was disrupted in the right eye and the left eye ( and ). The visual field improved and no scotoma was detected in the right eye.
An 11-year-old male, with a diagnosis of pathological demand avoidance (PDA) and migraine, presented to a community optometrist with a 2-day history of a black spot in the central vision of his right eye. The optometrist reported that the best corrected visual acuity (BCVA) in the right eye was reduced to 6/10 Snellen having been normal at a prior visit. Left was 6/5 Snellen. New pigmentary changes at both macula were observed by the optometrist and referral was made to the hospital eye service (HES). He was taking pizotifen prescribed for migraine. There was no relevant past ocular, medical or family history. Six weeks later, in the HES review, he described a persistent ‘blur’ in the central vision of the right eye. Unaided VAs were 6/9 right and 6/5 left. Pigmentary changes were noted at the central macula in both eyes. SD-OCT and imaging revealed bilateral outer lamellar layer defects (Fig. ). Electrodiagnostic tests were normal but with limited co-operation. His mother accompanied him for all HES visits. In due course and following direct questioning he admitted to constructing a device made from Lego™ consisting of a laser pointer with a condensing lens used just prior to the onset of visual symptoms. The patient’s mother revealed that she had purchased the laser pointer online for him. During follow-up he reported symptomatic improvement and the VA remained stable. Centre involving structural defects at both macula persisted on clinical examination and OCT imaging to most recent follow-up 24 months later. (Supplementary Image ). The mother confirmed the laser had been purchased from a well-known UK online retailer and was still available for online purchase a year following the incident.