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.
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.