Taking a Closer Look at Cosmetic Laser Retinopathy

Rishi P. Singh, MD, FASRS, hosted Jimmy Chen, MD, on Evidence Based Retina to review a case of choroidal neovascularization following at-home cosmetic laser exposure, seen at Mass Eye and Ear. Dr. Chen presented the case from initial presentation through 5 months of follow-up.

“I think this is one of the first reported cases of a home cosmetic laser device that caused a [choroidal neovascular membrane] associated with laser retinopathy.”

Cosmetic laser retinopathy fast facts

Laser causes retinal injury primarily through photocoagulation; standard therapeutic lasers use 532nm (green) light, while the implicated device instead emitted red and infrared energy (620 to 850nm), operating on a principle related to, but distinct from, photobiomodulation, intended to stimulate collagen activity for skin rejuvenation.
The device is an FDA-cleared class II medical device marketed for at-home skin rejuvenation, priced around $4,600.
To the presenting team's knowledge, this is among the first reported cases of an at-home, over-the-counter cosmetic laser device causing choroidal neovascularization (CNVM).
A similar 2024 case involving a professional-grade Nd:YAG laser abroad had a dramatically worse outcome: After seven total anti-VEGF injections, that patient remained at counting fingers at 1 year.¹
A 2022 case report that compiled 14 published cases of laser hair removal-related retinal injury found CNVM developed in six patients, with outcomes ranging from full recovery to persistent vision loss.²

Case presentation: cosmetic laser retinopathy

A closer look at the case A 45-year-old woman with no past medical or ocular history presented to the Mass Eye and Ear emergency room with a 1-week history of central scotoma OD.

Additional history revealed she had recently purchased a $4,600 over-the-counter LED skin phototherapy device for at-home cosmetic use; while checking whether the device was working, she heard a pop near her right eye, initially noticed no change, and developed central vision changes several days later.

Visual acuity was 20/150 pinhole to 20/50 OD and 20/40 pinhole to 20/30 OS.
Normal pressures, pupils, and anterior segments.
Dilated exam showed subretinal hemorrhage and a PED adjacent to the fovea OD, with parafoveal RPE changes but no hemorrhage OS, and OCT confirmed a probable CNVM with subfoveal fluid OD.

Figures 1-2: Optos ultra-widefield fundus photos OD and OS, at presentation.

^{Figure 1: Courtesy of Jimmy Chen, MD.}

^{Figure 2: Courtesy of Jimmy Chen, MD.}

Figure 3: OCT OD showing CNVM with subfoveal subretinal fluid (SRF).

^{Figure 3: Courtesy of Jimmy Chen, MD.}

Dr. Singh noted that the infrared reflectance (IR) image showed a faint, well-demarcated ring extending beyond the obvious central PED, evidence the initial injury zone was likely larger than what later coalesced into the visible lesion, a detail easy to miss without looking past the color fundus photo. The patient received a single intravitreal bevacizumab injection in the emergency department.

1- to 5-month follow-ups

At 1 month, the hemorrhage had resolved and vision improved to 20/70 pinhole to 20/40 OD; fluorescein angiography showed staining without frank leakage, consistent with a resolving injury rather than active CNVM leakage (Figure 4).

^{Figure 4: Courtesy of Jimmy Chen, MD.}

Rather than completing the standard three-injection loading series, the team chose close observation. Vision continued to improve, reaching 20/70 pinhole to 20/25 at 2 months and holding at 20/70 pinhole to 20/30 through 3 and 5 months, with some pigment migration on later imaging.

Figure 5: OCT and IR imaging OD at the 2-month follow-up (OD).

^{Figure 5: Courtesy of Jimmy Chen, MD.}
Figure 6: OCT and IR imaging OD at the 3-month (top) and 5-month (bottom) follow-up.

^{Figure 6: Courtesy of Jimmy Chen, MD.}

“Most often, in choroidal neovascular membranes, we give two or three injections in a row as a kind of loading dose. In this case, she had one injection and did much better. So there's really not a good answer for this patient.”

That outcome contrasts sharply with a similar case Dr. Chen referenced in the discussion. A 2024 report described a 29-year-old woman whose retina was burned by a professional Nd:YAG laser during a cosmetic treatment abroad; despite seven total anti-VEGF injections over a year, her vision never recovered past counting fingers.¹

A 2022 case report that compiled 14 published cases of laser hair removal-related retinal injury found similarly variable outcomes, from complete resolution to persistent vision loss, depending on injury severity and treatment timing.²

Key takeaways

At-home cosmetic laser devices, though FDA-cleared as class II devices, can cause serious retinal injury, including CNVM, without direct or sustained eye contact.
A central scotoma in an otherwise healthy patient warrants a detailed device-use history, including recently purchased cosmetic or wellness devices.
Infrared reflectance imaging can reveal the true extent of a laser injury beyond what is visible on color fundus photography or the central lesion alone.
A single anti-VEGF injection, rather than a full loading series, may be sufficient in some cases of laser-related CNVM; outcomes vary widely, and individualized follow-up is essential.
As at-home cosmetic devices become more common, ophthalmologists should counsel patients on the importance of not looking directly into these devices and wearing appropriate eye protection.

In closing

As these devices become more common at home, laser retinopathy should be added to the differential for unexplained central vision loss. Watch the complete video for the full case discussion, and see Eyes On Eyecare's guide to anti-VEGF therapy for more on treatment decision-making.

This article was written by Keren Beki based on the recorded conversation between Drs. Singh and Chen.