Strait of Juan de Fuca Laser Incident - Clinical Assessment

Clinical Assessment

The case was analyzed in the August 2004 Archives of Ophthalmology by medical laser researchers including Dr. Bruce Stuck, then Director of the U.S. Army Medical Research Detachment of the Walter Reed Army Institute of Research, responsible for the Army Medical Department’s laser and radio frequency radiation biological effects research program. Although the analysis of "Case 5" did not explicitly state Daly's name or the military nature of the ship photography, the case description is clearly that of the Strait of Juan de Fuca laser incident.

The researchers noted the photographer's (Daly's) case history: “A retina specialist found 3 tiny (10- to 20-μm) RPE window defects in one eye on a fluorescein angiogram and ascribed them to laser injury. Findings from optical coherence tomography were normal. Amsler grid test results were highly variable, and the locations of grid abnormalities and RPE defects were inconsistent.... New RPE defects developed after the incident. The photographer had not been diagnosed previously as having reactive arthritis (Reiter syndrome), which can produce small RPE defects.... No evidence of laser injury was found in the years after the incident by 17 other ophthalmologists, including 5 neuro-ophthalmalogists and 8 retina specialists. A trial was held 5 years after the incident in which the retina specialist who made the initial diagnosis steadfastly maintained all the photographer’s symptoms were due to retinal laser injury. A jury ruled against the photographer’s claim for damages against the ship’s owner."

The Analysis section of the article stated that "A costly, time-consuming chain of events was precipitated by the initial retina specialist's (1) failure to attach significance to an association between the photographer's symptoms and his complex past medical history, (2) quick diagnosis of a laser injury, (3) subsequent attribution of the photographer's growing list of pains and visual complaints to a laser injury, and (4) diagnosis of laser exposure in the photographer's associate based on symptoms in the absence of retinal or angiographic abnormalities. As noted previously herein, the few tiny RPE defects on which the initial diagnosis was based are common. Even if these defects were due to threshold laser effects, they could not have caused the photographer's reported problems or millions of patients would be afflicted with similar problems after routine retinal laser surgery.… The patient had real complaints, but they were caused by preexisting autoimmune problems rather than by laser injury.”