Here’s an interesting case of a 14yo male referred in with progressive visual loss RE for 3 months and new onset central visual loss LE 1 week. ⁠

Images 1 and 2 show colour photos of the pathology at 2 different time points of the same condition – with the RE illustrating chronic changes whereas the LE demonstrating acute retinal whitening. The linear streaks on the colour images 1 and 2 are almost pathognomonic of this condition and the curvilinear hyperreflective bands along Henle’s layer on OCT of the LE (image 5) provide further evidence. ⁠ Images 3 & 4 demonstrate the hyperautofluorescent streaks with the acute findings, mostly on the LE.

Fluorescein angiography (image 6) as well as OCT angiography (image 7) show a secondary choroidal neovascular membrane in the RE. ⁠
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On further questioning, the patient admitted to repeated self exposure to a high-powered Handheld Laser purchased online. ⁠

With only a single aflibercept injection followed by close observation for 6mths this patient went from 6/120 to 6/9 in the RE (?!!).

This is a fairly classic example of Handheld Laser Induced Maculopathy (HLIM), a condition on the rise internationally due to their online availability.⁠

We had 2 HLIM cases referred for second opinions in 1 month. Anyone else notice an increase in these presentations??

What’s your preferred management? Steroids? Observation?

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