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A Mysterious Central Scotoma in a Teenage Male Patient

“…1 The reported age at onset ranges from 7 to 36 years, but the condition may not be exclusive to this demographic. [2][3][4] Fundoscopy reveals focal retinal pigment epithelium damage with yellow or gray discoloration. 1,2,[4][5][6][7][8] Additional ocular manifestations include a full-thickness macular hole, premacular hemorrhage, epiretinal membrane, schisis formation, and cystoid macular edema.…”

“…1,2,[4][5][6][7][8] Additional ocular manifestations include a full-thickness macular hole, premacular hemorrhage, epiretinal membrane, schisis formation, and cystoid macular edema. [2][3][4] Ancillary imaging, including OCT, fluorescein angiography, and fundus autofluorescence, should be obtained. The OCT image reveals outer A Fundus photograph B SD-OCT and scanning laser ophthalmoscopy retinal layer disruption and hyperreflective bands from the outer photoreceptors to the Henle layer.…”

“…Blue laser light (450 nm) may be most harmful, given its absorption by foveal xanthophyll pigment and melanin. 3 Commercial laser pointers are classified by the US Food and Drug Administration as a class IIIa laser product, which limits the sale of these devices to the visible wavelength range (400 to 710 nm) with a maximum output power of 5 mW. Despite these restrictions, laser pointers with output powers greater than 5 mW are easily available through online retailers.…”

“…Corticosteroids have been used in some reports with visual improvement, 4,9,10 although spontaneous improvement has occurred with observation alone. 2,3,[6][7][8] Cases with premacular hemorrhage, epiretinal membrane, or a fullthickness macular hole can be treated surgically. 2,3 Prognosis is variable, depending on the initial damage, although dramatic recovery after 4 years has been reported.…”

“…2,3,[6][7][8] Cases with premacular hemorrhage, epiretinal membrane, or a fullthickness macular hole can be treated surgically. 2,3 Prognosis is variable, depending on the initial damage, although dramatic recovery after 4 years has been reported. 6 To prevent additional injury, patients should be counseled on the dangers of ocular exposure to laser light and referrals should be made for additional psychiatric support when appropriate.…”