Imaging of Titanium:Sapphire Laser Retinal Injury by Adaptive Optics Fundus Imaging and Fourier-Domain Optical Coherence Tomography

Purpose: To examine and observe the subtle retinal injuries caused by a titanium:sapphire laser with a high-resolution adaptive optics (AO) fundus camera and with Fourier-domain optical coherence tomography (FD-OCT). Design: Observational case series. Methods: Four eyes of 2 individuals who experienced an accidental exposure to reflected light from a titanium:sapphire laser were examined. High-resolution retinal images were obtained with the AO fundus camera and by FD-OCT, and the images were compared with the findings obtained by standard clinical tests, including the Amsler test and fluorescein angiography (FA). Results: The photoreceptor mosaic was absent in a localized area of the fovea in the images obtained by the AO fundus camera, and the photoreceptor outer segments (OS) were disrupted at the corresponding area in the FD-OCT images. The changes were detected not only in the symptomatic eye but also in the asymptomatic fellow eye in both patients. In 3 eyes, the geographic dark area in the AO image decreased during the follow-up examinations. Conclusions: Very small, localized photoreceptor disruptions can be detected in patients with minimal titanium:sapphire laser injury by cross-sectional imaging using OCT, but their extent was delineated more precisely by en face AO imaging. Because the area of the photoreceptor disruption is very small, especially in the nonsymptomatic fellow eye, it is strongly recommended that laser workers-even those without visual symptoms-be examined by FD-OCT, an AO camera, or both if they have not worn protective goggles while using a laser.