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 ).
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.