To the Editor:
Handheld laser pointers are commonly used in lecture halls and are considered to be harmless and safe. However, laser pointers can cause severe eye injury, as demonstrated by the case of a 15-year-old boy. The boy had ordered a handheld laser pointer with green light on the Internet to use as a toy for popping balloons from a distance and burning holes into paper cards and his sister's sneakers. The boy's life changed when he was playing with his laser pointer in front of a mirror to create a laser show, during which the laser beam hit his eyes several times. He noticed immediate blurred vision in both of his eyes. Hoping that the visual loss would be transient and afraid of telling his parents, he waited 2 weeks before seeking an ophthalmic assessment, when he could no longer disguise his bad vision. His visual acuity was so poor in his left eye that he was only able to count fingers at a distance of 3 ft, and it was 20/50 in his right eye. A funduscopic examination revealed a dense subretinal hemorrhage in his left macula and several tiny round scars in the pigment epithelium of the foveolar region of his right eye (Figure 1B). The clinical findings were consistent with severe bilateral retinal laser injury. After 4 months, the boy's visual function remained impaired but improved to 20/32 in the right eye spontaneously and to 20/25 with a remaining scar just beside the center of the fovea in the left eye after one intravitreal injection of ranibizumab (Figure 1C).
In the past, laser pointers sold to the public had a maximal output of 5 mW, which is regarded as harmless because the human eye protects itself with blink reflexes. The measured output of the laser in this case was 150 mW. The use of lasers that are threatening to the eye is normally restricted to occupational and military environments; laser accidents outside these fields are very rare. However, powerful laser devices, with a power of up to 700 mW, are now easily obtainable through the Internet, despite government restrictions. These high-power lasers are advertised as laser pointers and look identical to low-power pointers (Figure 1D). The much higher power of such devices may produce immediate, severe retinal injury. Despite their potential to cause blinding, such lasers are advertised as fun toys and seem to be popular with teenagers. In addition, Web sites now offer laser swords and other gadgets that use high-power lasers.
Neither the owners nor the potential victims of such dangerous toys can distinguish harmless laser pointers from hazardous ones, and we may see more such eye injuries in the near future.
