Abstract
Near-infrared reflectance (NIR) is a noninvasive, contactless, and rapid in vivo imaging technique for visualizing subretinal alterations in the photoreceptor layer, retinal pigment epithelium, and choroid. The present report describes the application of this imaging method in retinal and choroidal pathologies affecting young patients where scarce cooperation, poor fixation, and intense glare sensation can result in a challenging clinical examination. A literature search of the MEDLINE database was performed using the terms “near-infrared reflectance” and “spectral-domain optical coherence tomography.” Articles were selected if they described the diagnostic use of NIR in children or young adults. Of 700 publications, 42 manuscripts published between 2005 and 2020 were inherent to children or young adults and were considered in this narrative literature review. The first disease category is the phakomatoses where NIR is essential in visualizing choroidal alterations recognized as cardinal biomarkers in neurofibromatosis type 1, microvascular retinal alterations, and retinal astrocytic hamartomas. Another diagnostic application is the accurate visualization of crystals of various nature, including the glistening crystals that characterize Bietti crystalline dystrophy. Acute macular neuropathy and paracentral acute middle maculopathy represent a further disease category with young adulthood onset where NIR is not only diagnostic but also essential to monitor disease progression. A further interesting clinical application is to facilitate the detection of laser-induced maculopathy where funduscopic examination can be normal or subnormal. In conclusion, NIR imaging has a noninterchangeable role in diagnosing certain retinal diseases, especially in children and young adults where there is scarce collaboration and a lack of evident clinical findings. Moreover, this technique can reveal unique retinal and choroidal biomarkers highly specific to rare conditions.
Highlights
Near-infrared reflectance (NIR) imaging is a noninvasive, noncontact, and rapid in vivo examination currently extensively available for ophthalmologists
A literature search of the MEDLINE database was performed using the terms “near-infrared reflectance (NIR)” and “spectral-domain optical coherence tomography” for articles in English accessed through December 2020. e articles were selected if they described the diagnostic use of NIR in children or young adults
From the early 2000s, a few reports underlined the detection of choroidal abnormalities in this disorder using imaging methods [12, 13] and the first large cohort study was conducted in 2012 by Viola et al [14]. rough the concomitant use of NIR imaging and spectral-domain optical coherence tomography (SDOCT), hyperreflective rounded or patchy nodules were associated with hyperreflective signals in choroidal tissue, respectively (Figures 1 and 2). e prevalence of choroidal nodules detected by NIR was 71% in the paediatric population, a much higher frequency than the National Institute of Health (NIH) ophthalmic diagnostic criteria of 43% for iris Lisch nodules [14]
Summary
Near-infrared reflectance (NIR) imaging is a noninvasive, noncontact, and rapid in vivo examination currently extensively available for ophthalmologists. The technique enables visualizing subretinal alterations located in the retinal photoreceptor layer, the retinal pigmented epithelium (RPE), and choroid [1]. Changes in reflection and absorption of light through retinal tissues enhance visualization of structures beneath the retinal pigment epithelium (RPE) and melanin [1, 3]. Images often correlate with blue-light fundus autofluorescence (FAF); NIR demonstrates superiority in revealing sub-RPE lesions. E glistening appearance is characteristic of crystalline deposits in Bietti crystalline dystrophy [8]. Such similarities in reflectance between inherited retinal dystrophy and age-related changes can be seen in retinitis punctata albescens and reticular pseudodrusen [9]. NIR has gained widespread use in ophthalmology in the last decade. e present report underlines the importance of this imaging method in retinal and choroidal pathologies affecting young patients where scarce cooperation, poor fixation, and intense glare sensation can make fundus examination challenging
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