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The study looked at 77 case reports of laser eye injuries in children. In four of the cases there were reported psychological or behavioral issues.
In addition, the authors had experience with four children with laser eye injuries; in three of these cases there were psychological or behavioral issues.
One of the authors sent a survey to 990 consulting ophthalmologists in the U.K. This found 159 cases of macular injury due to "misuse of a handheld laser device," with 80% of those injured being children or teenagers. In 35% of the cases, the injury was self-inflicted; in 36% it was caused by a third-party. (The remaining 29% seem to be uncategorized although the paper notes that "there were no cases of assault reported." In 67% of the cases where the laser power was known, it was under 50 milliwatts.
The paper cautions that the actual number of laser injuries seen by the ophthalmologists may be higher: "A limitation was the poor response rate and thus data so obtained do not provide the true incidence and clinical features of such cases."
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It begins by summarizing misuse in sports, and in the thousands of incidents per year in the U.S. where lasers are aimed at aircraft.
The authors, Dr. Gregory D. Lee and Dr. David R. Lally, then write “Perhaps the greatest concerns are raised by reports of unsupervised children who have received these lasers as toys or gifts and expose themselves to the laser beams, causing permanent retinal injury with reduced central vision. From 2000 to 2009, there were five reports of 18 patients with injuries due to laser pointer exposure.”
They discuss the types of injuries (thermal, photochemical and mechanical) and locations of retinal injuries. There is a listing of laser classes, with “pointers” — Class 1, 2 or 3R (IIIa) — being distinguished from similar-looking but more powerful Class 3B and 4 “handheld” lasers.
The authors conclude as follows:
“Inappropriately used class 3B or 4 lasers should be considered weapons that can cause serious, permanent bodily injury. Even brief exposures to diffused rays of laser beams can cause temporary flash blindness that may last for hours in airline pilots, endangering the lives of passengers, particularly during takeoff and landing sequences. Cases of short-range laser exposure are becoming more common, often involving children who are inappropriately given these devices as toys, and these patients are referred to retina specialists after the damage has already occurred.
“No definitive experimental study, case report, or animal model has shown improvement in these injuries with any type of treatment, but typically these patients are treated with a short course of corticosteroids or nonsteroidal antiinflammatory drugs. Secondary choroidal neovascularization has been treated successfully with intravitreal anti-VEGF agents.13,14
“Clinicians, particularly retina specialists, can raise awareness of this rising public health issue by educating patients and parents about the hazards of laser pointers. Legislation is currently being written to impose stronger regulations on the distribution and sale of these devices. If a patient presents with findings of a laser-related retinal injury, clinicians should report the incident to the FDA so that investigations can be performed into the manufacturers of these devices. Reports can be made at www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Forms/UCM236066.pdf.”
From Retina Today
The data shows that pilots reported eye effects or injuries in less than 1% of laser illumination incidents. Flashblindness was the most-reported effect, followed by “Pain, burning or irritation in eye.” Blurriness was also frequently listed, along with unspecified “eye injury.”
In 20% of eye effect/injury cases, the person affected sought medical attention.
From the FAA weekly Laser Report
From mid-July 2016 to late August 2016, more than 570 persons have gone to the main government hospital in Srinagar, Kashmir for treatment of eyes that have been damaged by “birdshot” (lead pellets) fired from shotguns into crowds by Indian security forces trying to break up protests and crowds.
An August 28 2016 New York Times article describes some of the lead pellet-caused eye injuries:
“The patients have mutilated retinas, severed optic nerves, irises seeping out like puddles of ink.”
“[A] patient’s eyelids have been stretched back with a metal clamp, so his eyeball bulges out of glistening pink tissue. The surgeon sits with his back very straight, cutting with tiny movements of his fingers. Every now and then, a thread of blood appears in the patient’s eye socket. The patient is 8 years old…. Slowly, as residents stood around him in hushed silence, the surgeon flattened out the boy’s retina, as thin and delicate as a lace doily, and used a laser to reattach it to the back of his eye.
“In most cases, it became clear, the pellets had burst into through the cornea and out through the retina, leaving little hope of fully restoring vision…. ‘Once it goes in the eye, it rotates like this, and destroys everything there inside,’ Dr. Qureshi said. ‘It’s physics. This is a high-velocity body. It releases a high amount of energy inside. The lens, the iris, the retina get matted up.’”
The author, Ellen Barry, notes that “….most countries do not use them on unarmed civilians, as the pellets spray widely and cannot be aimed…. This year, the use of pellets on Kashmiri protesters increased sharply, with the police firing more than 3,000 canisters, or upward of 1.2 million pellets, in the first 32 days of the protests, the Central Reserve Police Force has said.”
From the New York Times
But in addition to this declaration, the authors also provided a succinct summary of the current state of consumer laser pointer misuse, and how ophthalmologists should proceed when studying a patient’s laser exposure.
Experts John Marshall, John O’Hagan and John Tyrer began by noting that low-powered Class 2 (less than 1 milliwatt) and Class 3R (1-5 mW) lasers “are not an eye hazard, and even if used inappropriately will not cause permanent eye damage.”
However, consumer laser devices with Class 3B (5-500 mW) and Class 4 (above 500 mW) powers have begun to cause injuries. “….[C]lass 4 devices are capable of causing irreversible retinal damage if directed into the eye over short ranges, up to several metres. Such devices have resulted in foveal injuries in children with current estimates of 150 cases in the UK. The [UK] media has given significant coverage to this growing problem.”
Ophthalmologists were advised that in cases of close up exposure, there may potentially be permanent damage. A detailed examination would be warranted, although there is no treatment to reverse permanent damage.
The hazards from this short range misuse differ from the hazards of aiming a laser towards pilots. Because the laser-to-aircraft distance is typically “hundreds to thousands of metres”, and because of scattering from the windscreen, eye injuries are nonexistent: “Fortunately, these exposures are at irradiances that are incapable of producing irreversible retinal damage even at distances of 100 m.”
They said that only one case of alleged retinal damage has been reported in pilots. [LPS.com note: this is for publicly available reports involving civilian pilots.] The experts concluded the case is suspect for a number of reasons; they do not believe laser targeting caused the alleged injury.
Marshall, O’Hagan and Tyrer turned from injuries to the hazards of distracting pilots with bright laser lights: “Obviously, if such a distraction occurs at a critical time such as during landing then the result could be devastating.”
For ophthalmologists examining pilots, if there are no permanent abnormalities on an Amsler grid test, the physician should not do any detailed eye exam, as this “would only serve to compromise the pilot's vision for a longer period.” The authors noted that pilots may delay seeing an expert for “many hours or a day or so during which there may be a growing psychological element.”
In an interview with CNN, Marshall said the findings on pilot hazards are based on previous laser safety research as well as a new study done with field experiments at a military base over about three years.
In the BJO editorial, the three experts agreed that current laser safety standards and guidelines are based on valid experiments and science. The standards do not need to be revised, “…but clearly further attempts must be made to educate the public.”
The editorial concluded “The European Commission has mandated the European Standardisation bodies to produce a standard specifically for consumer laser products. This should allow enforcing authorities to remove unsafe products from the market. However, compliance by manufacturers will remain an issue, as will direct imports by the public purchasing unsafe laser products over the internet.”
From the British Journal of Ophthalmology editorial “Eye hazards of laser ‘pointers’ in perspective” by John Marshall, John O’Hagan, and John Tyrer, available in HTML text and as a PDF document. Click on the blue “Read More…” link below for an April 19 2016 press release from the BJO summarizing the paper’s findings relative to pilot hazards.
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Examinations were done within three days of the strikes: “Early Treatment Diabetic Retinopathy Study visual acuity, colour vision, visual fields, intraocular pressure, slit-lamp examination, dilated fundus examination, colour fundus photographs, and ocular coherence tomography.”
The paper concluded, “Our study revealed that laser strikes on aircraft did not result in permanent visual functional or structural deficits. However, laser strikes cause immediate visual effects, including glare, flash blindness, and ocular irritation that can interfere with a pilot’s visual function.”
From the Canadian Journal of Ophthalmology, December 2015, Volume 50, Issue 6, pages 429-432. For the full abstract of the study, click the “Read More…” link.
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Such misdiagnosis has medical and financial consequences from the additional diagnostic workups and DNA sequencing used to detect hereditary genetic disorders such as rod monochromatism, Stargardt disease and occult macular dystrophy.
In addition, the paper describes five cases of where children using laser pointers experienced blurry vision and had eye injuries. “In some cases, the vision was as poor as 20/80, which is bad enough to fail a driving test,” said researcher Dr. Stephen Tsang, who is affiliated with Columbia University and NewYork-Presbyterian Hospital.
Dr. Tsang and his colleagues noted damage patterns similar to tree branches on the children’s retinas:
They suggest that eye-care professionals should ask patients with such patterns if they have been using lasers. Because children may be hesitant to talk in front of their parents, the researchers also suggest talking to a child alone.
A Columbia University press release noted “Since the publication about the five patients, the researchers have seen several more children with laser-induced eye injuries, suggesting that these cases are not isolated phenomena.”
From Columbia University Medical Center Newsroom, Nov. 5 2015. The Ophthalmic Genetics article “Laser induced photic injury phenocopies macular dystrophy” is not yet online as of this date, but can be found at the journal’s website.
Eibhlin McLoone, a consultant ophthalmologist with the Belfast HSC Trust, has treated several of the children and said the devices "are not toys".
"Sadly, I have seen children who have eye damage because they have played with a laser pointer and unfortunately once the eye has been damaged by a laser pen the damage is irreversible," she said.
"Due to the risk of permanent visual impairment, it is vital that the public is aware of the risks associated with laser pointers and that these devices are never viewed as toys."
Ms McLoone added: "Unfortunately, once the laser burn has happened there is no treatment available to reverse it."
From the Belfast Telegraph
The October 7 2014 story was a follow-up to an incident at an NFL football game on October 5, when Buffalo Bills players complained of lasers being aimed at them during a game with the Detroit Lions. The NFL and police were said to be investigating.
USA Today’s Martin Rogers wrote that Dr. Robert Josephberg “has lobbied members of Congress for more than a year to discuss criminalizing intentionally dangerous use of laser pointers, to no avail. Josephberg told the newspaper that intentional shining of a laser at someone should be a felony: “There has been a significant increase in medical journals of reports of blindness caused by the lasers. The use seems to be increasing – and so does the power and availability of the pointers. Congress needs to take note.”
In a February 28 2011 story in the New York Times, Josephberg recounted how he saw a high-school student who had a blind spot from a 50 milliwatt green laser pointer. At first he did not believe that lasers were available that could cause such an injury. But he bought a 100 milliwatt laser for $28 online; Times writer Christine Negroni said “he could hardly believe how easy it was.”
A June 2011 article in the magazine of Westchester (NY) Medical Center, where Josephberg works, quoted the doctor as saying “I contacted new Republican Congresswoman Nan Hayworth of the 19th Congressional District, who is an ophthalmologist herself. We are working with her, trying to write a bill that addresses this problem.”
From USA Today, the New York Times and ”Health & Life” magazine from Westchester Medical Center