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Examination revealed a large hole in the macula, a small area in the retina that helps with discerning detail in faces and while reading or driving, the doctors said in a case report
published Wednesday in the New England Journal of Medicine. Further imaging revealed two more injured areas below the macular hole.
Macular holes are typically treated with surgery that is accompanied with an almost 100% risk of cataract formation, Dr. Sofia Androudi, a physician involved with the case, wrote in an email. Cataracts cause blurry vision by clouding the eyes' clear lenses.
However, in this case, because the macular hole resulted from the laser burn, the nerves in the eye that absorb light were totally damaged, said Androudi, an assistant professor of ophthalmology at the University of Thessaly in Greece. "This means that even if the surgery would be successful, the boy would not be able to see."
The boy's vision was measured at 20/20 in his right eye and 20/100 in his left, according to the report. A person with a visual acuity of 20/100 would have to be within 20 feet of a point of focus in order to see what a person with normal vision can see at 100 feet.
Children are often reluctant to report eye injuries or symptoms, Androudi said, and she suspected that the patient had injured his eye at least a year before coming in for treatment. But even if he had come in earlier, there was no available therapy for his case, she said. Eighteen months after he came in, there were no changes to the boy's vision.
"When you have something as powerful like a laser, it's so powerful that it is converted to heat like a burn," said Dr. Thomas C. Lee, director of the Vision Center at Children's Hospital Los Angeles, who was not involved with the care of this patient. "That