LONG-TERM VISUAL RECOVERY IN BILATERAL HANDHELD LASER POINTER-INDUCED MACULOPATHY

To describe the long-term visual, clinical, and optical coherence tomography (OCT) recovery after 4 years in a patient who incurred severe bilateral handheld laser pointer damage.

The findings on clinical examination, color fundus photography, and spectral domain OCT at presentation followed by sequential time points over 4 years are presented.

A 9-year-old healthy boy presented with bilateral reduced vision to count fingers in each eye with yellow irregular lesions. After extensive evaluation, he admitted to multiple, prolonged episodes of staring at a handheld red laser pointer reflected in a mirror. Initial visual acuity was count fingers bilaterally. Clinical examination revealed bilateral yellow streaks radiating from the fovea without hemorrhages or fluid and retinal pigment epithelium pigmentary mottling. Spectral domain OCT showed disruption of the foveal outer retina extending from the outer plexiform layer to the retinal pigment epithelium spanning 896 μm in the right eye and 564 μm in the left eye. Six months after injury, vision had only minimally improved to 20/200 with resolution of outer plexiform layer and outer nuclear layer opacification on OCT. Over the ensuing 4 years, visual acuity slowly recovered to 20/30 in each eye and the regions of outer retinal disruption progressively reduced in size to 295 μm in the right eye and 115 μm in the left eye.

This case illustrates gradual vision and anatomical improvement over 4 years despite initial poor vision after severe laser pointer macular damage. Visual recovery may be related to patient and exposure factors as well as initial OCT features where an intact Bruch membrane can provide a scaffold for photoreceptors to recover, thereby reducing the outer retinal defect.