A 15-year-old female with no past medical or psychological history was referred following a routine sight test where new discrete pigmentary changes at the right fovea were observed. The patient was asymptomatic. Her past ocular history, medical and family history were unremarkable. The unaided VA was 6/7.5 in both eyes. Two full-thickness centre involving round scars at the right fovea were observed and a third slightly eccentric. SD-OCT revealed defects in the ellipsoid zone in the outer retina in these lesions (Fig. ). The patient admitted to being involved in a ‘competition game’ with three other children about 2 years previously in the home. The ‘game’ consisted of ascertaining which child could withstand a green laser beam in one eye for the longest time. She recalled shining the laser into her right eye for short duration, perhaps 10 s twice. The laser pointer had been purchased online by the patient’s mother.\nThe laser pointer responsible was retrieved from the family and sent for analysis. The analysis found the laser pointer was of wavelength 532 nm with an average power of 47 mW, making it a Class 3B laser. The label on the laser pointer incorrectly stated that it was 'Class II' with a maximum output less than 1 mW (Supplementary Image ). At latest follow-up, at 24 months the macular changes persisted with 6/6 Snellen in each eye (Supplementary Image ).
A 12-year-old boy was referred with a several month history of reduced vision in both eyes. He had a history of expressive and receptive language impairment and was attending a specialist school for children with cognitive impairment and disturbed behaviour. He was under CAMHS for anger and behavioural problems. There was no relevant past ocular or family history. The presenting BCVA were 6/30 right eye and 6/75 left eye. Colour vision was reduced, with only 4/17 Ishihara plates correctly identified in the right eye and 9/17 in the left eye. Bilateral multifocal macular pigmentary changes were noted (Fig. ). To investigate abnormal visual function, electrodiagnostic tests and magnetic resonance imaging (MRI) of the brain and orbits were performed, both of which were normal.\nAt subsequent follow-up and on direct questioning, the boy revealed he had been playing with laser pointers at school, particularly in games involving looking directly into the beam of the laser pointer. His BCVA at 12 months follow-up was 6/19 right eye and 6/48 left eye. Fundus examination showed irregular pigmentation at the right macular and a scar at the left macular. OCT scan showed small, round, punched-out lesions more frequent in the left than the right macula.