The New Pretender: A Large UK Case Series of Retinal Injuries in Children Secondary to Handheld Lasers

Purpose: To characterize a large single-center series of retinal injuries in children secondary to handheld laser devices, with emphasis on potential prognostic factors. / Design: Retrospective case series. / Methods: Sixteen children (24 eyes) with retinal injuries secondary to handheld lasers were identified from our electronic patient record system. Case notes, digital fundus photography, and spectral-domain optical coherence tomography images were reviewed. / Results: The mean age of affected children was 12.7 years (range 9–16 years), with 12 male and 4 female subjects. Mean follow up was 5.4 months (range 1–23 months). Five children (31%) were referred as suspected retinal dystrophies. The mean logMAR visual acuity at presentation was 0.30 (20/40) (range −0.20 [20/12.5] to 1.6 [20/800]). Eleven children (69%; 15 eyes) had “mild” injuries with focal retinal disruption confined to the photoreceptor and ellipsoid layers; such injuries were associated with a better prognosis, the mean visual acuity at presentation being 0.10 (20/25). “Moderate” injuries were seen in 3 eyes of 2 children, with retinal disruption confined to the outer retinal layer but diffuse rather than focal in nature. Three patients (4 eyes) had “severe” injuries, with subfoveal outer retinal architecture loss and overlying hyperreflective material in inner retinal layers. / Conclusion: Retinal injuries secondary to handheld laser devices may be difficult to diagnose and are likely underreported. It is important that such data are in the public domain, so regulatory authorities recognize the importance of laser retinopathy as an avoidable cause of childhood visual impairment and take steps to minimize the incidence and impact of laser injuries