Pam Harrison

August 26, 2013

TORONTO, Ontario — Experts predict that, if left unregulated, handheld lasers purchased online could cause an epidemic of ocular injuries.

"These lasers are available, they are sold as toys, they're not expensive. Adolescents buy them and play with them," Fernando Arevalo, MD, professor of ophthalmology at the Wilmer Eye Institute, Johns Hopkins School of Medicine, in Baltimore, told Medscape Medical News. He is also affiliated with the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia.

Dr. Arevalo presented a case series of various maculopathies caused by high-powered handheld lasers here at the 31st Annual Meeting of the American Society of Retina Specialists.

Fourteen patients, with a mean age of 17 years, presented to the King Khaled Eye Specialist Hospital because of laser exposure. They underwent a full ophthalmic evaluation, including fundus photography, spectral-domain optical coherence tomography, and fluorescein angiography.

Clinical findings revealed a full-thickness macular hole in 4 eyes, an outer retinal disruption in 1 eye, an epiretinal membrane in 1 eye, a schisis-like cavity in 1 eye, and intraocular hemorrhage in 7 eyes, 5 with subhyaloid hemorrhage and 2 with a subinternal limiting membrane hemorrhage.

"The initial best-corrected visual acuity had a mean of 20/290, and the final best-corrected visual acuity in all cases had a mean of 20/40," Dr. Arevalo reported. In fact, all patients had some improvement in visual acuity, he added.

However, 71% of the patients (10 eyes) required surgical intervention to achieve improvement in visual acuity. The remaining 29% (4 eyes) improved with observation alone.

Surgeons performed Nd:YAG hyaloidotomy on the 5 eyes with subhyaloid hemorrhage and pars plana vitrectomy with or without tamponade on the other 5 eyes.

Eye Injuries on the Rise

"About 2 years ago, we started seeing these injuries every few weeks or so in young patients who would present to the emergency room with a lesion in the retina," Dr. Arevalo told Medscape Medical News.

At first, the Saudi team thought the injuries were due to a laser pointer much like the ones physicians use when lecturing. However, it turned out that they were caused by handheld lasers with power of up to 1200 mW, which is "much higher than other class 4 lasers," Dr. Arevalo explained. "Because of the power, it causes a lot of damage, even with a very brief exposure."

The laser also has a wavelength of 450 nanometers. Because it is blue, it is absorbed into the central field pigment where it can burn the retina.

We hope this will lead to changes in the regulation of handheld laser sales.

"It's very hard to ban Internet sales," Dr. Arevalo pointed out. However, in an effort to curtail potential injuries from handheld lasers, the group at King Khaled has shared its findings with hospital administrators.

The hospital, in turn, is close to the Minister of Health in Saudi Arabia. "We hope this will lead to changes in the regulation of handheld laser sales," Dr. Arevalo said.

Amy Schefler, MD, from Retina Consultants of Houston, who is clinical assistant professor of ophthalmology at the University of Texas, said that she has not seen any injuries with the blue laser, but has seen similar injuries from the YAG laser used for hair removal.

She agrees with Dr. Arevalo that it's tough to regulate Internet sales. "I'm no expert in government regulation of Internet purchases, but it's obviously challenging," Dr. Schefler said. "Probably education is the most effective thing."

Dr. Arevalo and Dr. Schefler have disclosed no relevant financial relationships.

31st Annual Meeting of the American Society of Retina Specialists. Presented August 24, 2013.


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