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 13-year-old male with attention deficit disorder (ADD) presented to the Emergency Medicine Department accompanied by his mother complaining of visual disturbance after staring into the beam from a toy laser for a few hours earlier that day. The patient stated that the toy laser belonged to a friend but the injuries were self-inflicted. The BCVA was 6/60 in the right eye improving to 6/36 with pinhole, and 6/12 in the left eye. SD-OCT images on presentation showed full-thickness hyper-reflective damage involving both fovea (Fig. ). The patient was on methylphenidate 57 mg daily treatment for ADD and was known to Child and Adolescent Mental Health Services (CAMHS). He attended mainstream school with additional classroom support but was not classified as having special educational needs, with no statement of educational needs undertaken previously. Six weeks later, his BCVA had improved to 6/12 right and 6/9 left. An improvement in SD-OCT images was observed, notably an improvement in inner retinal layers. However, the centre involving outer lamellar layer defects on OCT and fundus changes persisted throughout 24 months of follow-up but decreased.