Page 5 - BPR

CUAJ – CUA Best Practice Report Bhojani et al
BPR: Laser eye safety

Laser manufacturers/EAU guidelines and CSA recommendations
Ho:YAG laser manufacturers recommend that all intraoperative personnel wear proper laser eye
safety goggles. Similarly, the EAU guidelines on lasers and technologies published in 2014
states that “all intra-operative personnel should wear proper eye protection to avoid corneal or
retinal damage.” Additionally, in the EAU guidelines, it is mentioned that this is particularly
important for the Nd:YAG laser but also recommended for the Ho:YAG laser[11]. Finally, CSA,
also mandates that all interoperative personnel wear proper laser safety goggles. This
recommendation comes from the Occupational Health and Safety Act under ANSI Z136 which is
a series of laser standards. It should be noted that most laser standards focus on the theoretical
basis for safety and use a mathematical approach[6].

Summary and recommendations
To date, after over 20 years of extensive use no injuries to the eye have ever been reported with
the Ho:YAG laser, with only a minority of surgeons reporting routine use of laser safety goggles.
Furthermore, based on recent experimental data it is evident that there is no damage to the
unprotected eye unless the laser is fired very close to the eye (within 5cm of the cornea). The
majority of participants in international polls do not use laser eyewear protection. The mandate
to have all operating room personnel wear laser safety eyewear is not based on contemporary
evidence. Moreover, particularly for operating surgeons who may already be wearing
prescription glasses, placing laser goggles over their own glasses leads to significant visual
impairment and could affect the surgeon’s ability to identify important visual cues. It has been
determined that standard prescription eyeglasses are as protective as laser safety goggles, with
this wavelength. For those personnel who do not wear prescription glasses, and if likely to be in
close proximity to the laser fibre (within 5 cm) they may wish to consider protective eyewear.