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The most serious injury that the boy caused was a large hole in his macula, shown with the yellow arrows.
Two other areas of injury were not immediately visible in a funduscopic exam of the retina (photo A, using ordinary white light) but were clearly visible using fundus autofluorescence imaging (blue arrows in photo B, using a narrow wavelength of light). The round area to the left in both photos is the optic disc, a natural feature where the optic nerve begins — it is not laser damage.
The macula is where central vision occurs. The fact that the injury occurred in the macula indicates that the boy looked directly into the laser light with his left eye. Damage to the macula is serious as this area provides high resolution, color vision in the center of the visual field.
The injury reduced the boy’s vision to 20/100 in the injured left eye; his right eye remained at 20/20. The boy’s ophthalmologists felt the hole was too large and too much time had passed since the injury for surgery. (The doctors suspected that the boy had injured his eye at least a year earlier.) Because surgery might make things worse, causing a cataract without improving the macula, they “favored conservative management.”
There was no improvement in vision even 1 1/2 years after the injury was first presented to the ophthalmologists.
The power of the laser pointer, and other details of the incident, were not described in the one-paragraph report published June 21 2018. One of the authors told CNN the boy’s father “had bought the laser as a toy from a street merchant.”
From the New England Journal of Medicine (N Engl J Med 2018; 378:2420, DOI: 10.1056/NEJMicm1714488) Authors: Sofia Androudi, M.D., Ph.D., and Eleni Papageorgiou, M.D., Ph.D. Additional reporting by CNN. This story was picked up by many other news sites around the world.
Police released four videos from officers’ body-worn cameras, showing how the incident progressed. A detailed look at the laser light seen in videos is below. First though, a summary of the incident.
The fatal incident
Police had been called by Richards’ landlord because Richards had not been seen for a few days. Confronted by two police officers in his Bronx apartment bedroom, Richards stood motionless and silent throughout most of the incident. He had a knife in one hand and the toy gun behind his back.
Body-worn video shows the scene.
Police asked him dozens of times to drop the knife and put his hands up. After about 10 minutes, they noticed the gun.
An officer told Richards “"Drop that gun, dude. Drop that gun. I don't want to shoot you if you've got a fake gun in your hand. You hear me? But I will shoot you if that's a real gun."
Two additional officers then arrived; one pulled out a stun gun. Richards appeared to raise his arm and aim the laser pointer towards the officers. The officer with the stun gun fired. After a few seconds, and a possible second laser “shot” from Richards, a second officer fired nine bullets, a third officer fired seven bullets, and the fourth officer did not fire.
Richards died at the scene.
The imitation pistol with laser pointer lies at the scene; NYPD photo.
Northport Police Chief Bill Ricca told LaserPointerSafety.com that the laser beam went into the officer’s face and eyes. The officer was temporarily blinded. He did not feel discomfort, but did go to an eye doctor for an exam which showed no ill effects.
Ricca said that the situation could have been much worse: “If the laser was aimed at the cop’s chest so the cop could see what was going on, I’m sure he might have shot at the kid. We would have had a real bad incident.”
The laser “gun” used in the incident.
An Internet search of similar “laser pointer guns” turns up a similar lighter costing about $7.00.
From Northport Patch and a September 16 2016 phone interview with Chief Bill Ricca
A 12-year-old Austrian boy has suffered "massive and lasting" damage to his eyes after playing with a laser pointer, with his vision reduced by 60 percent, doctors said.
"We think that he was playing with a mirror and that the rays were reflected," said Yosuf El-Shabrawi, chief doctor at the Klagenfurt am Wörthersee clinic in Carinthia, southern Austria.
"His injuries cannot be treated. We can only hope that the worst of the injuries heal themselves and that his condition improves," El-Shabrawi said in a statement on Tuesday.
The boy's father bought the laser pointer on the Internet where it was advertised as a toy for playing with cats.
After a week the boy, named as Lukas, complained of a constant black mark in his field of vision.
The laser pointer in question was labelled as "Class 2" with an output under the European Union legal limit, but it lacked a so-called EN standardisation certificate, El-Shabrawi said.
AFP story on The Local, the Rakyat Post, iAfrica.com, and other news sources
An example of a gun-shaped laser pointer. This particular unit emits a 100 mW beam and costs USD $68. An Internet search turns up a wide variety of gun-shaped novelty and toy laser pointers, including some that also have a lighter built in, and a gag pointer that shocks the user when they pull the trigger.
According to the abstract, “Clinically, three children had an acute vitelliform-like maculopathy which resolved to leave sub-foveal retinal pigment epithelium changes with reduced vision. One case was complicated by a choroidal neovascular membrane.”
- Case 1 was of a nine-year-old boy who on December 22 2013 was tested with normal vision of 6/5 (U.S. 20/17 -- better than 20/20) but on December 26 complained of vision loss and was found to have 6/12 (20/40) in the left eye and 6/15 (20/50) in the right eye. The family said he was given a laser pointer as a “toy” and had been playing with it on Christmas Day. The child denied looking directly into the laser beam. The family had three laser pens: a 57 mW blue 405nm, a 42 mW green 532 nm, and a 72 mW red 650nm. All exceeded the British Standard of 5 mW for a Class 3R laser. The boy was prescribed steroids. Nine months after the initial complaint, the best corrected vision was 6/9.5 (20/32), and optical coherence tomography showed persistent outer retinal layer disruption at the fovea. [The boy was later identified in press coverage as William Jackson, from Wadsley. Details are at The Star.]
- Case 2 was of an 11-year-old boy. He had decreased vision in both eyes of 6/7.5 (20/25). Eight weeks later he had sub-foveal retinal pigment epithelium changes. His vision was 6/12 (20/40) in the right eye and 6/15 (20/50) in the left eye. He said that a friend had aimed a laser into both of his eyes before the decreased vision occurred. The doctors were not able to examine what they characterized as the laser “toy”.
- Case 3 was of a 15-year-old girl. She aimed a laser pen into both eyes for 30 seconds. The next day she had scotomas (vision loss or spots) in both eyes. Her right eye was 6/7.5 (20/25) and her left eye was 6/6 (20/20). Upon examination, a vitelliform-like maculopathy (abnormality in the macula or central vision area) was seen. She did not return for follow-up visits.
- Case 4 was of an 8-year-old boy who had reduced vision of 6/12 (20/40) in his right eye, and normal vision of 6/6 (20/20) in his left eye. The right fovea was seen to have retinal pigment epithelial changes “consistent with laser burns.” The boy admitted he had played with a laser pointer a few months before, but said he did not point it directly at his eye.
- Case 5 was of a 13-year-old boy who had noticed declining vision in his right eye. It was found to be 6/36 (20/120); his left eye was 6/6 (20/20). He admitted aiming a laser pointer into his right eye. A fibrosed choroidal neovascular membrane was found at the right fovea.
The authors noted that “The retinal damage reported following such injuries is variable. This is due to variety of laser powers and wavelengths as well as ocular factors such as fundal pigmentation, blink responses, pupil size, and proximity of the laser burn to the fovea. Assessment of alleged laser eye injury requires accurate history and examination. Treatment for such laser retinal injuries is uncertain. Oral corticosteroids are sometimes administered.”
The authors stated that some laser devices are marketed as “toys”. They said they are aware of other children in the U.K. with retinal injuries from imported laser pointers. They conclude: “We suggest that children should not be given laser pointers as toys.”
From “‘Toy’ laser macular burns in children”, in Eye (2014) 1-4, by N. Raoof, TKJ Chan, NK Rogers, W Abdullah, I Haq, SP Kelly and FM Quhill. A downloadable PDF version is here. A story from the Bolton News gives some additional comments from author SP Kelly.
A December 2006 incident has come to our attention. A 15-year-old Japanese boy suffered a retinal injury and visual loss after deliberately looking into a 5 mW violet (410 nm) light emitting diode for a total of about 40 seconds. The LED was in a pen was sold as a toy called “Secret Pen”. The toy appears to consist of an LED light which can excite ink that is invisible under ordinary light but which fluoresces under ultraviolet and near-UV light. The 410 nm wavelength caused photochemical damage to the retina.
According to a 2011 paper in Retinal Cases & Brief Reports, the LED was aimed into the teen’s eye from a distance of about 1 cm. It was held there for about 20 seconds as he deliberately stared into the light. This exposure was repeated the next day. About two weeks later, decreased vision (20/50 on the Snellen scale) was noted in the right eye.
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The lasers were not labeled. The North Somerset Council warned the beam “could be seen 100m away” and “can actually cause serious and permanent damage to the eye.”
From the Weston Mercury 24