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Papers cited by the AAO in support of their claim that laser toy eye injuries have been a documented problem


(Note: this page provides some additional supporting evidence and discussion for the page “Are laser toys an actual hazard?”)

On December 18 2013, the American Academy of Ophthalmology kindly responded to an earlier inquiry by LaserPointerSafety.com, asking for citations of injuries due to laser toys. The AAO provided the following information:


“The Academy’s PR team extensively researched the issue in developing the press release and found that laser toy eye injuries has been a problem documented a number of times in medical journals. Here are links to some of examples we found:”

 
Retinal Injuries from a Handheld Laser Pointer
N Engl J Med 2010; 363:1089-1091September 9, 2010DOI: 10.1056/NEJMc1005818
http://www.nejm.org/doi/full/10.1056/NEJMc1005818
 
Nihon Ganka Gakkai Zasshi. 2001 Oct;105(10):653-8.
[Laser pointer and laser safety standard].
http://www.ncbi.nlm.nih.gov/pubmed/11692611
 
Harefuah. 2001 Jan;140(1):28-9, 86.
[Retinal injury induced by laser pointers].
http://www.ncbi.nlm.nih.gov/pubmed/11242894
 
Int Ophthalmol. 2012 Jun;32(3):293-7. doi: 10.1007/s10792-012-9555-z. Epub 2012 Apr 1.
Laser pointer induced macular damage: case report and mini review.
Turaka K, Bryan JS, Gordon AJ, Reddy R, Kwong HM Jr, Sell CH.
http://link.springer.com/article/10.1007%2Fs10792-012-9555-z

http://www.ncbi.nlm.nih.gov/pubmed/10457705


No documented cases of eye injuries from laser toys


LaserPointerSafety.com checked AAO’s references. Here is a summary of what we found:
  • Three of the five papers are from the era 1999-2001. Two of these are from overseas (Israel and Japan). All five of the papers document cases of general-purpose lasers being misused. None of the cases, as far as we can tell, involve a toy that contains a laser, or a laser that was marketed as a toy. Only one of the cited cases, where specific ages are indicated, involves a child as defined by FDA proposed regulations.

In other words, the AAO has not documented any cases of a child being injured by a laser-containing toy, or a laser marketed as a toy. And, it is unclear how three papers from 1999-2001, and two from overseas, are relevant to the AAO’s 2013 warning to U.S. parents about laser toys allegedly being sold in America.
Details are below.
  

Case 1: Not a toy, and not a child


The first reference (New England Journal of Medicine, a 2010 case) states that an injured teenager ordered a laser pointer to use as a toy. It does not say the pointer was sold as a toy. And it was not contained in a toy -- it was just a general-purpose laser pointer.

According to the NEJM abstract, the teen used the laser to pop balloons from a distance and to burn holes into paper cards and his sister’s sneaker. He was harmed when he aimed the laser into a mirror to create a “laser show.”

While these are not serious industrial or scientific uses, they also are legal uses for a general-purpose laser pointer. To give an example, if a teen used a soldering iron to burn patterns into wood, and to pop balloons, misuse of the soldering iron would not make it a “toy.”

In addition the person injured was 15 years old. He is not a child, as defined by the FDA’s June 2013 proposed toy rules banning marketing to children under 14 years of age.

In summary, the device was not a toy, and the teenager was not a child. Neither the device nor the use by a 15-year-old would have been regulated in any way by the FDA’s “laser toy” proposal.

Case 2: Not a toy — a general-purpose laser pointer


The second reference (a Japanese article from 2001) talks about "toy-type laser pointers" but not about toys containing lasers, or lasers marketed as toys. This also appears to be a general purpose laser pointer being misused.

The abstract asserts that “in recent years [e.g., before 2001], cheap laser pointers have been used as toys for children”. Since the paper is in Japanese, we cannot investigate further. However, an assertion is not proof. Are the authors saying that some parents allow their children to [mistakenly] play with laser pointers? They do not appear to be saying that laser pointers are marketed in Japan as toys for children. Also, we do not know what the current situation is in Japan with regard to lasers being used or sold as toys, over a decade later.

The abstract says that, of the four cases described, “all cases except one were young patients.” It does not say how young is young. LaserPointerSafety.com has asked AAO to check the Japanese-language paper to determine how many cases were to children under the age of 14.

Case 3: Not a toy, and not a child


Similarly, the third reference (J Am Optom Assoc. 1999), asserts that laser pointers “originally designed for use during presentations are... even sold as toys (such as pens or on key chains) in drug stores.” The paper is in Hebrew and appears to reference Israel in 1999. It is not possible to determine whether in 1999 laser pointers were being sold as toys in Israeli drug stores. Even if so, this would have little to do with warning U.S. parents in 2013 about what is on the American market.

The person injured was 16 years old, and was using “a laser-pointing device”. As described above, he is not a child. Neither the device nor the use by a 16-year-old would have been regulated or restricted in any way by the FDA’s June 2013 “laser toy” proposal.

Case 4: Not a toy — a general-purpose laser pointer


The fourth reference (International Ophthalmology 2012) presents the case of a 13-year-old boy exposed for more than 60 seconds to a general-purpose laser pointer. He was said to be “playing with friends during halloween.” There was no evidence given that the laser pointer was sold as a toy.

Case 5: No toys, and no reported injuries


Finally, the fifth reference is a 1999 survey to try to find laser pointer injuries. The researchers found “Few, if any, documented cases of permanent retinal damage could be found.” They concluded that “the risk of permanent retinal damage from a laser-pointer beam is minimal.”

The word “toy” is in the title (“Laser pointers: toys, nuisances, or significant eye hazards?”) but does not otherwise appear in the abstract. There is no claim, in the abstract, that laser toys exist or that lasers are marketed as toys.

So this final AAO citation also does not support their contention about laser toys existing, and does not support their contention that laser toys have caused eye injuries.