Assessment of Alleged Retinal Laser Injuries

Abstract

ccidental retinal laser injuries are easily diagnosed when there are known laser sources, typical macular injuries, and visual deficits consistent with retinal findings. Decisions are more difficult when retinal findings are subtle or absent, despite reported visual problems and somatic complaints. Inaccurate diagnosis of an ocular laser injury can precipitate a costly, lengthy sequence of medical and legal problems. Analysis of laser-tissue interactions and the characteristics of unambiguous retinal laser injuries provide 6 key questions to facilitate difficult diagnoses. Case reports demonstrate the usefulness of answering these questions before making diagnostic decisions. Retinal laser lesions that cause serious visual problems are readily apparent ophthalmoscopically and angiographically. Accidental, intentional, or clinical retinal laser lesions do not cause chronic eye, face, or head pains. Diagnosis of a retinal laser injury should be evidence based, not a matter of conjecture or speculation.

Is the mechanism of ‘poppers maculopathy’ photic injury?

“…In both 'poppers maculopathy' and photic maculopathy, there is focal disruption of the IS-OS junction centred at the fovea. [1][2][3][4] Moreover, the size, shape, echogenicity, and temporal evolution of the SD-OCT lesions appear indistinguishable in the two conditions. Patients also present with the same symptoms (scotoma, reduced vision, and phosphenes) and have the same slit-lamp findings (a pale yellow foveal lesion).…”

“…Patients also present with the same symptoms (scotoma, reduced vision, and phosphenes) and have the same slit-lamp findings (a pale yellow foveal lesion). [1][2][3][4] Indeed, it appears that in people using poppers, the two conditions can only be reliably distinguished by eliciting a history of excess light exposure and not by clinical features.…”

“…In the two French series, 2,3 all patients 'denied staring at bright lights'-yet how reliable is their history? Poppers are frequently combined with psychotropic drugs and alcohol, which can alter consciousness and memory, potentially making history unreliable.…”

Chorioretinal Injury Caused by Presumed Laser Dazzler

“…The features of discrete 500 um laser scars of the retina in our patient are consistent with the characteristics of the laser dazzler. Commercial, industrial, scientific and military laser systems can all potentially cause accidental retinal injuries [6,7]. As such, it is imperative that military members using any type of laser be aware of the risks associated with the improper use of the products.…”

Laser and Its Hazard Potential

“…The extent of intraocular damage however, is dependent on pupil size [31]. Vitreous [32], subretinal [33] or chorioretinal hemorrhages [32], as well as retinal edema or scars can also occur [34], and hypopigmentation [35], pigment clumps [36] and choroidal neovascularization [37] can develop. Even one month after an injury, macular holes may arise [38].…”