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In a separate interview, one of the authors, ophthalmologist Dr. David Almeida, said these cases are “happening more frequently…. It was previously thought this was a one-in-a-million event. It's still probably a rare-to-uncommon reaction, but it's not a never reaction.”
All four children had foveal laser burns. Three of the children had potentially permanent vision loss. These are the cases:
- A 12-year-old boy looked into a green laser pointer for about a minute. He had decreased central vision in both eyes, with 20/20 vision in one eye and 20/30 in another. His vision and macular condition was found to be unchanged after 7 months.
- A 16-year-old teenager similarly had central vision loss in both eyes, after playing with a green laser pointer for about 30 seconds. He was first examined three days after the exposure, scars and atrophy were found on the retina. Two weeks later his vision has worsened. Visual acuity was 20/40 in both eyes with no improvement.
- A 9-year-old boy looked at the reflection of a green laser pointer in a mirror (essentially the same as a direct beam) for an unknown length of time. His vision was 20/50. He was treated with 1% prednisolone three times a day for two weeks. His vision improved to 20/30, but he still had “persistent abnormalities of the photoreceptors.”
- A 12-year-old boy looked into a red laser pointer for about 15 seconds. He had central vision loss, and 20/70 vision. He was given an injection of bevacizumab, which gradually improved his vision and symptoms. After 1 year, he had 20/20 vision.
The authors noted that laser pointers are more available, that users may not be aware of the dangers, and that some users may use pointers improperly.
Visible lasers less than 5 milliwatts (the U.S. legal standard for a laser to be marketed as a “pointer”) are considered to be generally safe due to the bright light reflex, which causes a person to blink and turn away from a bright light. So one question is why these children were injured by laser pointers.
One reason, according to the authors, is that “children increase their chance to retinal injury by staring at the laser beam without blinking or averting the eye for a prolonged duration.”
Another possible cause is that “the labeling of the power output of a laser point may be different from the device’s actual specifications.” They referred to a study of 122 laser pointers, where 90% of green pointers and 44% of red pointers were above the 5 milliwatt U.S. legal limit.
The study said that treatment options were “limited and also controversial.” Use of corticosteroids has shown “mixed results.” It may be enough to observe a patient over time, since many injuries will stabilize.
The authors recommended that laser pointer hazards “should be communicated to health professionals, school teachers, and guardians in an attempt to raise the public awareness of this emerging public health issue. Unsupervised use of these laser pointer devices among children should be discouraged, and there is a need for legislation to limit these devices in the pediatric population.”
From Retinal Injury Secondary to Laser Pointers in Pediatric Patients, Kunyong Xu, Eric K. Chin, Polly A. Quiram, John B. Davies, D. Wilkin Parke III and David R.P. Almeida, in Pediatrics; originally published online September 1, 2016; DOI: 10.1542/peds.2016-1188. A general interest article summarizing the study, with additional comments from Almeida and another ophthalmologist, is at HealthDay.com. The abstract of the Pediatrics article is below; click the “Read More…” link.
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Lynsey McClure had imported the lasers from a Chinese supplier who said they complied with U.K. regulations limiting laser pens to 1 milliwatt of power. Her brother, who was not charged, sold them in a stall during a school fair in December 2015. The headmaster asked her brother to stop selling the laser, but he continued.
Jonathan Marshall, 7, purchased one of the lasers. It was later found to have an output of 127 milliwatts.
His mother said Jonathan was playing with it at home when the beam went into his eye for “a fraction of a second.” He has a retinal burn which interferes with his vision.
McClure pleaded guilty to nine product safety and consumer protection violations, including selling an unsafe product and failing to disclose the power of the laser.
The case appears to be the first where a person has been prosecuted for an illegal laser sale that led to an injury.
From the Sunday Times (subscription required to read the entire article) and the JC.com
The 44-year-old driver stared into the laser several times, as he tried to identify the person holding the laser. He suffered blurred vision in his right eye immediately after the exposure, but waited 6 months before having his first complete eye exam.
The exam showed “spot-like retinal pigment epithelium disturbances temporal to the fovea of the right eye, with no abnormalities in his left eye.” The authors stated that “The subjective complaints and objective ophthalmological findings of this patient were consistent and strongly suggested that the repetitive exposure of the eye to the reflected laser spot 6 months previously had caused subtle but detectable injury to the macula.”
The authors concluded with two “Learning points”:
- “We suggest that no laser pointers of any class are made available to children, since they are unlikely to understand the risks of permanent retinal damage.”
- “For the safety of users and the general public, even low-energy handheld laser pointers should not be sold to children.”
The authors did not identify the location of the incident, but it may be Germany since three of the four authors’ institutions were in Germany. Additional analysis and commentary is below (click the “Read More…” link).
From Thanos S, Böhm MRR, Meyer zu Hörste M, et al. “Retinal damage induced by mirror-reflected light from a laser pointer” BMJ Case Reports. Retrieved online: 2015 Nov 05, doi:10.1136/bcr-2015- 210311.
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Italy: Prosecutor investigating manslaughter charges in three cases of eye damage to children from laser pointers
The cases were reported in mid-September 2015 by the St. Ursula Ophthalmology Hospital in Bologna. One of the children was 10; the other two were 13.
The injuries were caused by laser pointers bought by their parents (in two cases) or grandmother (in the third case) in markets in Florence or Bologna. One child had a slight loss of vision, another had significant loss in both eyes, and a third has almost lost his sight and is legally blind.
A public prosecutor, Valter Giovannini, has opened an investigation for aggravated manslaughter against unknown assailants. This seems to indicate that in all three cases, the laser pointer bought by or for the children was used against them by another person.
As a result of the report, Carabinieri NAS (Nuclei Antisofisticazioni e Sanità or “Anti Fraud Squad”), a special police force operating under the Italian ministry of health, seized fifteen illegally-sold laser pointers.
The hospital warned the public not to purchase green laser pointers sold “on the street, in the stalls and fairs.” A spokesperson said higher-powered pointers such as those aimed at players in stadiums were to be avoided. Professional laser pointers used in lectures should not be a problem.
From Corriere di Bologna. Thanks to Alberto Kellner Ongaro for bringing this to our attention.
In addition, the man left notes, money and candy for the girl, and used binoculars to look into their home.
To avoid having their child testify at a trial, the victim’s parents agreed to a plea bargain deal. Pico pleaded guilty to promotion of obscenity in a minor. He received a 30-day jail sentence, was registered as a sex offender, was forbidden to have any contact with persons 18 or younger, and was required to have mental health treatment.
From KKTV 11 News and The Gazette
The zoo had previously applied to the Norwegian Radiation Protection Authority (NRPA) for approval to use the glove, and for exemption from labeling and classification requirements. The request was rejected.
However, the zoo went ahead with the production.
In a September 17 2014 story, Norwegian newspaper Verdens Gang (VG) quoted NRPA staffer, Sindre Øvergaard, who attended a performance in July 2014. He said it swept over the audience three times: “I and my partner got it right in the eye. We noticed there was a very bright light, and it hurt a little.”
Since he had been involved in the zoo’s original application to NRPA, Øvergaard told VG “that they [the zoo] took it to use is simply indefensible.”
The case was reported to the police. The zoo says a subcontractor told them the glove (shown below) was approved.