September signals the end of summer as children head back to school. But for one 10-year-old boy, the anxiety of stepping into middle school will carry more than the usual trepidation of navigating multiple classes and teachers and simply needing to be more grown up.
One snowy day last winter, John, a smart, inquisitive, energetic, kind-hearted, good-natured boy, was playing with a laser pointer—a gift intended to amuse the family cat. In an instant, his world changed irrevocably: He pointed the laser at a mirror, causing beams of light to reflect off the surface and enter his eyes, damaging his retinas. There was no pain; nor was any injury immediately apparent.
As the snow continued to fall, John’s mom suggested he read. He said he couldn’t read and instead went out to play in the snow. But eventually it became clear that his inability to read reflected a sudden vision change, and his father took him to a local emergency department (ED). From there he was referred to a second ED, and then to an academic medical-center ophthalmologist. Five hours of vision testing revealed John had lost his central vision. The initial diagnosis was Best disease, a hereditary condition that causes progressive macular dystrophy and harms central vision, visual acuity, and color perception.
John’s parents were advised to pursue genetic testing because their daughter could be at risk. Seeking a second opinion, they took him to another ophthalmologist, who conducted a test for Best disease. When the test came back negative, he asked them, “Does the family have a laser pointer at home?” (It turns out he’d treated three similar cases.) His examination revealed retinal burns in a star pattern—the same light pattern emitted by the laser toy. John’s vision measured 20/800 (compared to the normal 20/20). His parents’ hopes for a return to normal vision plummeted when unofficial testing revealed the laser toy was emitting 24 times more milliwatts (mW) than expected.
Vowing to enhance any possible healing, John’s family kicked into high gear to help him adapt to his new reality. An early challenge was figuring out how to tell his friends about his accident. He didn’t want to tell anyone. Teachers, the school nurse, and a few close friends helped him decide how to limit what he’d tell others; he decided to tell them only about his current condition and need for adaptive devices. He wore a baseball cap, and the school changed the lighting over his desk to reduce photosensitivity effects. The nurse helped maintain a schedule for resting his eyes and applying cold compresses. Special computer equipment helped him see up close the information teachers were reviewing. To the amazement of many, he played baseball last spring, relying on reflexes and his limited peripheral vision.
John’s family wants to help others understand the dangers of lasers and the adjustment people must make after losing some or all of their sight. His older sister created a video to educate classmates about what happened and about John’s new visual reality. By covering up the central portion of the camera’s lenses, she demonstrated vision loss and showed how it affects various activities.
John’s mother convinced the online retailer that sold the laser pointer to remove it from the website. She filed a report with the Consumer Product Safety Commission, which triggered notification of the Food and Drug Administration (FDA). In 2009, the agency issued a report about the hazards of laser pointers. Its December 2010 notification about eye and skin injuries from handheld lasers read in part: “Other incidents that the FDA is aware of include: A child’s eyes were damaged from reflected beams after directing a 150-mW laser pointer into a mirror.” Early indications from the FDA suggest John’s case and the excessive mW have drawn enough attention to influence policymakers to restrict these lasers from being imported into the U.S.
We can help John’s mom raise awareness of the hazards of laser pointers by spreading the word to prevent a similar tragedy. She’s busy cherishing John’s amazing resilience and is grateful for the support of others who are helping him feel empowered.
John’s role in all of this? To accept the extraordinary challenges, and help others understand he is still that terrific boy, but with one change—his gradually improving 20/200 vision. He’ll just need to be a little more careful as he makes his way through middle school this fall.
Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN