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 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.