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UK: 200+ laser pen injuries illustrate the risk to children, especially with behavioral problems

A paper published online in March 2019 by the journal "Eye" found that children with behavioral, learning or mental health problems are at special risk from misuse of laser pointers. Such children may not understand the eye injury hazard, and may not be able to follow label or parental instructions for keeping the laser pen from their eyes.

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."
The authors note that "[w]hile laser burns, including self-inflicted, can affect adults it is opined that children are at greater risk of laser pointer injuries than adults as they are intrigued by their appearance, and lack protective mechanisms of blinking and gaze aversion that adults exhibit and furthermore have clear ocular media which provides little protection from laser injury." They also report that parents of the four children they examined were unaware of the eye hazard risks and/or that their child had a laser pointer in their possession.

The primary goal of the authors was to highlight the risk to children with certain problems. They write "…although we found a small number of case reports that noted existing psychological, psychiatric, behavioural or learning problems in those affected; to our knowledge no reports to date highlight the risk of handheld laser possession in such children or explore a relationship between these diagnoses and laser eye injuries."

Further, there may be a delay in diagnosing vision problems if parents or doctors do not associate laser pointer misuse with such problems, as they found in two of their four cases.

The paper ends with a section on "Implications for policy" (broken into bulleted points and paragraphs below for ease of reading):

  • The recognition by UK Government for the need for more robust regulation of the importation and sale of laser pointers, including online sales is reassuring as is the Laser Misuse (Vehicles) Act 2018 which was recently given Royal Assent.
  • There is a need for ophthalmologists to closely question all patients especially children with retinal outer lamellar layer defects (best appreciated on SD-OCT imaging) for any history of laser pointer exposure before considering further tests for macular disorders.
  • Importantly there is a need for increased public awareness and education of the ocular hazards of laser pointers.

In particular, parents, and especially parents of children with conditions that may increase risk of self-injurious behaviour, should be aware that powerful and often incorrectly classified handheld lasers pointers can be dangerous to sight. Specifically, the availability of high powered and also mislabelled laser pointers remains a concern. Because such lasers are readily available, children likely to self-harm may be at a greater risk of shining laser beam into their eyes, perhaps for longer periods of time.

We urge the manufacturers of handheld laser pointers and their vendors to consider our concerns. We urge the regulators, manufacturers and distributors of laser pointers—including online merchants—to be more vigilant given this novel concern of vision loss in at-risk children.

From "Retinal burns from laser pointers: a risk in children with behavioural problems", E. Linton, A. Walkden, L. R. Steeples, A. Bhargava, C. Williams, C. Bailey, F. M. Quhill & S. P. Kelly, Eye volume 33, pages 492–504 (2019). Online at https://www.nature.com/articles/s41433-018-0276-z