Cone Photoreceptor Integrity Assessed With Adaptive Optics Imaging After Laser Pointer-Induced Retinal Injury

Vitellas, Carol; Doble, Nathan; Wells-Gray, Elaine M.; Challa, Nayanika; Davidorf, Frederick H.; Choi, Stacey S.

doi:10.1097/icb.0000000000001025

Cited by 6 publications

(4 citation statements)

References 19 publications

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“…Another case report visualizing laser retinal injury with adaptive optics imaging showed a decrease in lesion size from 11 to 20 months after exposure. 18 From 6-(191 days) to 10-month (265 days) research laboratory visits, our patient showed improvement of retinal sensitivity measured with adaptive optics microperimetry, whereas retinal appearance remained relatively stable.…”

Section: Management Of Laser Retinal Injurymentioning

confidence: 70%

Case Report: Multimodal, Longitudinal Assessment of Retinal Structure and Function following Laser Retinal Injury

Wang

Mason

et al. 2023

Optom Vis Sci

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SIGNIFICANCE:This case report demonstrates the use of novel imaging techniques and functional tests to longitudinally evaluate retinal structure and function after laser retinal injury. The structural and functional prognosis could be predicted with clinical findings, high-resolution retinal imaging, and functional testing. PURPOSE:We present a laser retinal injury case in which an adaptive optics scanning laser ophthalmoscope and adaptive optics-based psychophysics were used to examine and monitor retinal structure and function after accidental exposure to a 1-W infrared laser beam.CASE REPORT: A 23-year-old patient was unwittingly exposed to a 1-W, 852-nm continuous-wave laser at work as they noticed a small central blurry spot in the right eye. An initial eye examination was done 1 day after exposure, and the right eye's acuity was 20/25 −2 . Posterior segment evaluation revealed disrupted outer retina near the right eye's fovea. Adaptive optics imaging 2 weeks after the exposure revealed a 0.50 Â 0.75°elliptical area with irregular borders and abnormal cone reflectivity just below the fovea. Starting at 1-month follow-up, structural recovery was observed on optical coherence tomography (OCT). Subsequent adaptive optics imaging showed significant recovery of cone reflectivity. Importantly, adaptive optics microperimetry showed measurable detection thresholds at all affected retinal locations at 6 months. By 10 months, all sites exhibited normal sensitivities.CONCLUSIONS: Retinal structure and function from laser injury can be visualized and measured with OCT, adaptive optics imaging, and psychophysics. An intact Bruch's membrane on OCT and measurable retinal sensitivity by adaptive optics microperimetry may serve as good biomarkers for retinal recovery.

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Section: Management Of Laser Retinal Injurymentioning

confidence: 70%

Case Report: Multimodal, Longitudinal Assessment of Retinal Structure and Function following Laser Retinal Injury

Wang

Mason

et al. 2023

Optom Vis Sci

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“…To thoroughly establish safety, more sensitive tests are required, such as multifocal ERG and single‐cell resolution adaptive optics imaging. In a published case of laser‐induced maculopathy, Vitellas et al 41 . used adaptive optics imaging to show that the inner and outer segments of cone photoreceptors were lost following direct viewing of a laser pointer.…”

Section: Discussionmentioning

confidence: 99%

“…To thoroughly establish safety, more sensitive tests are required, such as multifocal ERG and single-cell resolution adaptive optics imaging. In a published case of laser-induced maculopathy, Vitellas et al 41 used adaptive optics imaging to show that the inner and outer segments of cone photoreceptors were lost following direct viewing of a laser pointer. While the laser pointer was a higher risk class (Class 3A) than LLRL devices for myopia, the case illustrates the need for more sensitive testing to evaluate potential retinal damage.…”

Section: Wavelengthmentioning

confidence: 99%

Red light instruments for myopia exceed safety limits

Ostrin,

Schill

2024

Ophthalmic Physiologic Optic

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PurposeLow‐level red light (LLRL) therapy has recently emerged as a myopia treatment in children, with several studies reporting significant reduction in axial elongation and myopia progression. The goal of this study was to characterise the output and determine the thermal and photochemical maximum permissible exposure (MPE) of LLRL devices for myopia control.MethodsTwo LLRL devices, a Sky‐n1201a and a Future Vision, were examined. Optical power measurements were made using an integrating sphere radiometer through a 7‐mm diameter aperture, in accordance with ANSI Z136.1‐2014, sections 3.2.3–3.2.4. Retinal spot sizes of the devices were obtained using a model eye and high‐resolution beam profiler. Corneal irradiance, retinal irradiance and MPE were calculated for an eye positioned at the oculars of each device.ResultsBoth devices were confirmed to be Class 1 laser products. Findings showed that the Sky‐n1201a delivers laser light as a point source with a 654‐nm wavelength, 0.2 mW power (Ø 7 mm aperture, 10‐cm distance), 1.17 mW/cm2 corneal irradiance and 7.2 W/cm2 retinal irradiance (Ø 2 mm pupil). The MPE for photochemical damage is 0.55–7.0 s for 2–7 mm pupils and for thermal damage is 0.41–10 s for 4.25–7 mm pupils. Future Vision delivers the laser as an extended source subtending 0.75 × 0.325°. It has a 652‐nm wavelength, 0.06 mW power (Ø 7 mm aperture, 10 cm distance), 0.624 mW/cm2 corneal irradiance and 0.08 W/cm2 retinal irradiance (Ø 2 mm pupil). MPE for photochemical damage is 50–625 s for 2–7 mm pupils.DiscussionFor both of the LLRL devices evaluated here, 3 min of continuous viewing approached or surpassed the MPE, putting the retina at risk of photochemical and thermal damage. Clinicians should be cautious with the use of LLRL therapy for myopia in children until safety standards can be confirmed.

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“…Focal lesions in the retina have been conducted in a number of popular animal models including mouse 63,64 , macaque [65][66][67] and cats. 68,69 Laser damage is also clinically relevant as it is both experienced with accidental laser exposure 70,71 as well as purposeful ablation used in photocoagulation and as a therapy for retinal ischemic disease, retinopathy of prematurity 72 and diabetic retinopathy 73 . Thus our results shed light toward the immune response that may be imparted due to phototoxic damage.…”

Section: Focal Retinal Lesions For Tracking the Immune Responsementioning

confidence: 99%

Photoreceptor loss does not recruit neutrophils despite strong microglial activation

Power,

Elstrott,

Schallek

2024

Preprint

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In response to central nervous system (CNS) injury, tissue resident immune cells such as microglia and circulating systemic neutrophils are often first responders. The degree to which these cells interact in response to CNS damage is poorly understood, and even less so, in the neural retina which poses a challenge for high resolution imaging in vivo. In this study, we deploy fluorescence adaptive optics scanning light ophthalmoscopy (AOSLO) to study fluorescent microglia and neutrophils in mice. We simultaneously track immune cell dynamics using label-free phase-contrast AOSLO at micron-level resolution. Retinal lesions were induced with 488 nm light focused onto photoreceptor (PR) outer segments. These lesions focally ablated PRs, with minimal collateral damage to cells above and below the plane of focus. We used in vivo (AOSLO, SLO and OCT) imaging to reveal the natural history of the microglial and neutrophil response from minutes-to-months after injury. While microglia showed dynamic and progressive immune response with cells migrating into the injury locus within 1-day after injury, neutrophils were not recruited despite close proximity to vessels carrying neutrophils only microns away. Post-mortem confocal microscopy confirmed in vivo findings. This work illustrates that microglial activation does not recruit neutrophils in response to acute, focal loss of photoreceptors, a condition encountered in many retinal diseases.

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Cone Photoreceptor Integrity Assessed With Adaptive Optics Imaging After Laser Pointer-Induced Retinal Injury

Cited by 6 publications

References 19 publications

Case Report: Multimodal, Longitudinal Assessment of Retinal Structure and Function following Laser Retinal Injury

Case Report: Multimodal, Longitudinal Assessment of Retinal Structure and Function following Laser Retinal Injury

Red light instruments for myopia exceed safety limits

Photoreceptor loss does not recruit neutrophils despite strong microglial activation

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