What are the risks of photic injury following retinography?

Photic Injury Following Retinography

There are documented cases of photic retinopathy from various light sources including operating room microscopes, but no specific reports of retinal photic injury following standard retinography procedures in current clinical guidelines.

Understanding Photic Retinopathy

Photic retinopathy refers to light-induced damage to the retina, particularly affecting the macula, resulting from exposure to intense light sources. While retinography is a common diagnostic procedure, the risk of photic injury specifically from this procedure is not prominently addressed in ophthalmology guidelines.

Documented Sources of Photic Injury

• Operating Room Microscopes: Conclusive evidence exists showing photic retinopathy from operating microscope exposure, with documented cases after 60-minute exposures 1
• Other Common Causes:
  • Solar retinopathy (sun exposure)
  • Laser pointer-induced maculopathy
  • Arc welding maculopathy 2
  • Surgical light sources during both anterior and posterior segment procedures 3

Clinical Features of Photic Injury

When photic injury does occur, it typically presents with:

• Focal outer retinal defects visible on spectral-domain OCT (SD-OCT) at the junction of inner and outer photoreceptor segments 4
• Oval gray lesions in the posterior pole at the level of the retinal pigment epithelium 1
• Potential permanent foveal structural injury leading to irreversible visual acuity loss 4
• Central or paracentral scotomas 1

Risk Factors for Photic Injury

Several factors may increase the risk of photic retinopathy:

• Light Characteristics:

  • Ultraviolet and short-wavelength visible light are more dangerous than longer wavelength light 5
  • Higher intensity light sources
  • Longer duration of exposure

• Patient Factors:

  • Pre-existing retinal disease may increase susceptibility 6
  • Absence of natural lens (aphakia) or artificial lens without UV protection
  • Advanced age

Prevention and Monitoring

While specific guidelines for preventing photic injury during retinography are not established, general principles include:

• Minimize unnecessary exposure time during imaging procedures
• Use appropriate filters when available
• Be particularly cautious in patients with pre-existing retinal disease
• Consider alternative imaging methods when appropriate:
  • OCT provides high-resolution imaging of retinal architecture without prolonged light exposure 6
  • Ultrasonography in cases of media opacity 6

Diagnostic Approach When Suspected

If photic injury is suspected following retinography:

1. Comprehensive dilated fundus examination to assess for:

   • Retinal changes at the level of the pigment epithelium
   • Macular abnormalities

2. Optical Coherence Tomography (OCT) to evaluate:

   • Focal outer retinal defects
   • Changes at the junction of inner and outer photoreceptor segments
   • Central macular thickness

3. Visual field testing to map any scotomas

Conclusion

While photic retinopathy is a recognized complication of intense light exposure during ophthalmic procedures, particularly from operating microscopes and endoilluminators 5, 3, current ophthalmology guidelines do not specifically highlight retinography as a significant risk factor for photic injury. Nevertheless, clinicians should remain aware of this potential complication, particularly in vulnerable patients or when prolonged imaging is required.