title: The New Pretender: A Large UK Case Series of Retinal Injuries in Children Secondary to Handheld Lasers.
abstract: OBJECTIVE
  To characterize a large single-center series of retinal injuries in children secondary to handheld laser devices, with emphasis on potential prognostic factors.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Sixteen children (24 eyes) with retinal injuries secondary to handheld lasers were identified from our electronic patient record system. Case notes, digital fundus photography, and spectral-domain optical coherence tomography images were reviewed.
  
  
  RESULTS
  The mean age of affected children was 12.7 years (range 9-16 years), with 12 male and 4 female subjects. Mean follow up was 5.4 months (range 1-23 months). Five children (31%) were referred as suspected retinal dystrophies. The mean logMAR visual acuity at presentation was 0.30 (20/40) (range -0.20 [20/12.5] to 1.6 [20/800]). Eleven children (69%; 15 eyes) had "mild" injuries with focal retinal disruption confined to the photoreceptor and ellipsoid layers; such injuries were associated with a better prognosis, the mean visual acuity at presentation being 0.10 (20/25). "Moderate" injuries were seen in 3 eyes of 2 children, with retinal disruption confined to the outer retinal layer but diffuse rather than focal in nature. Three patients (4 eyes) had "severe" injuries, with subfoveal outer retinal architecture loss and overlying hyperreflective material in inner retinal layers.
  
  
  CONCLUSIONS
  Retinal injuries secondary to handheld laser devices may be difficult to diagnose and are likely underreported. It is important that such data are in the public domain, so regulatory authorities recognize the importance of laser retinopathy as an avoidable cause of childhood visual impairment and take steps to minimize the incidence and impact of laser injuries.
authors: Department of Ophthalmology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
authors: Naz
authors: N
authors: Raoof
authors: Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
authors: Patrick
authors: P
authors: Bradley
authors: Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
authors: Maria
authors: M
authors: Theodorou
authors: Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Ophthalmology Department, UCSF School of Medicine, Koret Vision Centre, San Francisco, California.
authors: Anthony T
authors: AT
authors: Moore
authors: Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; University College London Institute of Ophthalmology, London, United Kingdom. Electronic address: michel.michaelides@ucl.ac.uk.
authors: Michel
authors: M
authors: Michaelides
mesh_terms: D000293:Adolescent; D002648:Child; D057286:Electronic Health Records; D005131:Eye Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D007834:Lasers / Q000009:adverse effects*; D008297:Male; D012160:Retina / Q000000981:diagnostic imaging / Q000293:injuries* / Q000528:radiation effects; D012164:Retinal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*; D006113:United Kingdom / Q000453:epidemiology; D014792:Visual Acuity