A Mysterious Central Scotoma in a Teenage Male Patient
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Laser-pointer maculopathy was first reported in 1999 and commonly presents in young male patients. Exposure is often unintentional but can be intentional in patients with a history of behavioral problems. The reported age at onset ranges from 7 to 36 years, but the condition may not be exclusive to this demographic.2-4 Fundoscopy reveals focal retinal pigment epithelium damage with yellow or gray discoloration. Additional ocular manifestations include a full-thickness macular hole, macular hemorrhage, epiretinal membrane, schisis formation, and cystoid macular edema.

Here presents an interesting case published in JAMA ophthalmology of a teenage boy who was referred for 3 months of bilateral reduced central visual acuity characterized as atraumatic, painless, constant, symmetric, and nonprogressive. His parents reported that he had recently been hospitalized for a suspected overdose with the medications atomoxetine, quetiapine, melatonin, fluoxetine, bupropion, and clonazepam, and shortly after, he reported central visual acuity loss. A dilated fundus examination with
normal results had been documented 6 months prior to our examination. His ocular history was unremarkable. His medical history included attention-deficit/ and fluoxetine. The patient was adopted, and detailed family history was unknown. Social history was limited. The patient was born full term. His biological sister has learning and attention difficulties but had a normal fundus examination result.

The patient’s best-corrected visual acuity was 20/50 OD and 20/60 OS. His intraocular pressure, pupils, extraocular movements, visual fields, and color testing results were normal. The anterior segments were unremarkable. The vitreous, optic nerve, and retinal vasculature were normal. A bilateral maculopathy was present, with focal areas of gray-brown discoloration (Figure 1A). Optical coherence tomography (OCT) exhibited an intact foveal
depression with subfoveal disruption of the ellipsoid layer and hyperreflective material extending into the Henle layer (Figure 1B). No subretinal or intraretinal fluid was present.

Laser-pointer maculopathy is a rare complication resulting from ocular exposure to laser light. In this case, the source was a green laser pointer.

The patient and his parents were questioned about laser-pointer exposure. The patient denied self-injury, although his parents confirmed that he owned a green laser pointer purchased online and spent extensive unsupervised periods playing with the laser in his room. This history, combined with the characteristic fundus andOCT findings, led to the diagnosis of laser-pointer maculopathy. Full-field electroretinography was later obtained, with normal results consistent with damage limited to the macula. Six months later, the patient’s visual acuity remains unchanged.

Source: https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2761534