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Saudi Arabia: UPDATED - 14 young patients injured by high-powered handheld lasers

Over about two years, fourteen patients were seen at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, with eye injuries due to handheld blue (450 nm) blue lasers with powers of up to 1200 milliwatts (1.2 watts). Ten of the patients required surgery to improve their eyesight, while the other four improved with observation alone.

According to HealthNewsDigest.com, “All injuries occurred during play and involved teenage boys and young males, between the ages of 11 and 30. Some injuries were accidental, but others involved a playmate intentionally pointing the laser beam at the victim's eye. The distance between the victim's eye and the laser beam ranged from 1.7 feet to 20 feet (a half-meter to 6 meters). Those who suffered retinal holes were injured at the closest distance, around half meter, or 1.7 feet. Generally, injury from greater distance resulted in less serious damage, the authors of the report say.”

The report was presented August 24 2013 during a Toronto meeting of the American Society of Retina Specialists by Fernando Arevalo, M.D. He is professor of ophthalmology at the Wilmer Eye Institute, Johns Hopkins School of Medicine, in Baltimore Maryland and is also affiliated with the Saudi hospital. Dr. Arevalo hopes that his findings, which were provided to the Minister of Health, will result in changes to how Saudi Arabia regulates handheld lasers.
He said that beginning around 2011, young people were coming to the emergency room “every few weeks or so.” The mean age of the fourteen patients was 17.

After examinations including fundus photography, spectral-domain optical coherence tomography, and fluorescein angiography, the following maculopathies were found:
  • an intraocular hemorrhage (five eyes with subhyaloid hemorrhage and two eyes with a subinternal limiting membrane hemorrhage)
  • a full-thickness macular hole (four eyes)
  • an outer retinal disruption (one eye)
  • an epiretinal membrane (one eye)
  • a schisis-like cavity (one eye).

All patients improved either due to surgery or healing over time. Surgical treatment of five eyes was done with Nd:YAG hyaloidotomy (on the five eyes with subhyaloid hemorrhage) and pars plana vitrectomy with or without tamponade on five other eyes.

According to Dr. Arevalo, “The initial best-corrected visual acuity had a mean of 20/290, and the final best-corrected visual acuity in all cases had a mean of 20/40.”

From Medscape Medical News

UPDATED November 13 2013: The study was published online November 4 2013 in Ophthalmology, under the title “High-Power Handheld Blue Laser-Induced Maculopathy: The Results of the King Khaled Eye Specialist Hospital Collaborative Retina Study Group.” The abstract is free while the entire article is about USD $32 to access and download. HealthNewsDigest.com has a good summary of the paper. It states that “the authors of the report are planning on asking the Saudi government to consider a ban on the sale of blue laser devices.”

UPDATED August 4 2015: A similar study, covering the 14 cases above plus three newer cases, was published in the July 2015 American Journal of Ophthalmology under the title “Full-Thickness Macular Hole Secondary to High-Power Handheld Blue Laser: Natural History and Management Outcomes.” A summary of the study, along with links to the source is here.