Across the country, parents warn their laser-pointer wielding children, “You’ll burn your eye out!” And while it may sound overly cautious, some do just that. Retinal injuries from laser pointers are up in recent years, and the damage is both severe and irreversible.1 But at least now doctors are figuring out ways to understand and identify the damage this helpful classroom tool (and popular cat toy) can cause.

The diagnosis—and full extent of damages—is best demonstrated using near-infrared autofluorescence (NIR-AF) imaging, according to a European research team.2 They add that other modalities can give variable results. The team’s study looked at 12 cases across two academic centers of patients who suffered retinal injuries.2 In all 12, NIR-AF successfully identified the laser-pointer lesions. The lesions showed a characteristic appearance with central hyperfluorescence and surrounding hypofluorescence.2 Color fundus photos only showed localized pigmentary changes, and OCT identified some ellipsoid zone interruption and outer nuclear layer changes.2 Using conventional blue autofluorescence imaging, subtle changes were evident.

But the real benefit of NIR-AF for these patients is that it can distinguish between these laser-created lesions and injuries from macular conditions such as poppers retinopathy or solar maculopathy. Those conditions may be difficult to tell apart from laser-created damage on OCT, the research shows.2 

1. Firtel J, Harmening W, Krohne T, et al. Retinal injury following laser pointer exposure. Dtsch Arztebl Int. 2017;114(49): 831-7.

2. De Silva S, Neffendork J, Birtel J, et al. Improved diagnosis of retinal laser injuries using near-infrared autofluorescence. Am J Ophthalmol. June 12, 2019. [Epub ahead of print].