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Retinal Injury From the Use of a Laser Skin Resurfacing Device During Medical Tourism
TAKE-HOME MESSAGE
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This case report highlighted the severe retinal damage that can occur from a handheld Nd:YAG device that is used for laser skin resurfacing. The injury occurred in a medical spa in Vietnam; no eye protection was used during the treatment.
- This case report highlights the risk of retinal injuries from the use of handheld lasers, especially when used in countries where safety guidelines are not in place.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Laser skin resurfacing is a popular cosmetic procedure for noninvasive skin rejuvenation. Since health insurance plans often do not cover these types of procedures, patients often pay out of pocket. Consequently, there is an incentive to go abroad, where prices are more affordable. However, practitioners in destination countries may lack rigorous training on laser safety, regulatory oversight, or licensing, especially on devices used for "cosmetic" procedures. In certain cases, this can lead to tragic outcomes, especially when underqualified practitioners operate medical-grade laser devices.
CASE PRESENTATION
A 29-year-old woman suffered a retinal burn from a handheld Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser pulse device used to perform skin resurfacing treatment at a medical spa in Vietnam. The patient was not adequately informed about the potential risk to her vision and was not provided with any eye protection. A momentary, unintended laser exposure to the patient's right eye led to irreversible vision loss due to a macular burn. This incident caused immediate pain, followed by the sudden appearance of floaters, along with a retinal and vitreous hemorrhage. Despite treatment with off-label bevacizumab for the development of a choroidal neovascular membrane, vision remained at the level of counting fingers because of the presence of the macular scar.
CONCLUSION
When utilizing laser-based devices, it is crucial to employ safety measures, such as the wearing of safety goggles or the use of eye shields to protect ocular tissues from potential damage. The growing availability of cosmetic laser devices presents a substantial public health risk, because numerous operators lack adequate training in essential safety standards, or they neglect to follow them. Furthermore, patients seeking services abroad are subject to the regulatory practices of the destination country, which may not always enforce the requisite safety standards. Further research is needed to determine regional and global incidence of laser-related injuries to help direct educational and regulatory efforts.
Additional Info
Disclosure statements are available on the authors' profiles:
Retinal injury from a laser skin resurfacing device during medical tourism: a public health concern
BMC Ophthalmol 2024 Mar 26;24(1)134, LH Lambert, BL Tompkins, IC Uber, KG Kapoor, DJ RamseyFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Laser treatments in healthcare are becoming widespread. They are used for diagnostic, cosmetic, preventive, and therapeutic applications: to shrink or destroy tumors, polyps, or precancerous growths; relieve symptoms of cancer; remove kidney stones; remove parts of the prostate; treat pain, including back nerve pain; promote regeneration; resurface skin; prevent blood loss; seal lymph vessels; whiten teeth; and treat eyes, including repair of detached retinas, refractive surgery, laser capsulotomy, and selective laser trabeculoplasty.1,2 Lasers also have many uses in the industrial sector.3
Laser safety is essential for clinicians, members of the surgical team, staff, and patients. Laser safety is more than wearing safety glasses or goggles and posting warning signs in the treatment room. Safety is a system that includes equipment, technical skills, cognitive skills, ongoing education and training, competency training, consistent use of control measures, and commitment to best practices.4
The basic categories of safety controls in laser environments are engineering controls (equipment, barriers, viewing system safety, and shields), administrative and procedural controls (training and checklists), and personal protective equipment (laser safety glasses and goggles). Laser protective eyewear uses high optical density filter materials or reflective coatings to block the laser wavelength(s). The use of all these controls, based on the ANSI Z136.1-2022 laser standard, reduces the risk of accidents from direct, scattered, or reflected laser radiation.
This case report illustrated irreversible retinal laser damage to a patient's unprotected eye during a laser skin resurfacing procedure. This cosmetic procedure was performed outside the US, apparently to reduce the cost. The patient experienced a macular burn from a momentary, accidental Nd:YAG laser exposure. Despite receiving treatment with off-label bevacizumab to possibly prevent a choroidal neovascular membrane, the patient's vision in the right eye was reduced from 20/20 to counting fingers.
Clinicians need to be knowledgeable and implement and practice safe laser procedures in their clinics.5–10 Additionally, they should prescribe laser protection for their patients and advise patients of the risks of having laser procedures performed overseas. They also need to know the symptoms of ocular laser burns (eye pain, redness, photosensitivity, blurred vision, and new floaters or scotomas) and possible treatments, such as intravitreal or high-dose systemic steroids. Unfortunately, there are no guidelines for the treatment of laser macular burns. The restoration of vision following these burns is unlikely; therefore, prevention is essential.
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