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Retinal imager reveals new information on neurofibromatosis

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PHOENIX – Multispectral imaging showed that, contrary to the literature, retinal findings can be seen with neurofibromatosis type 1, according to a presenter here at Academy 2012.

Jerome Sherman, OD, at a symposium sponsored by PRIMARY CARE OPTOMETRY NEWS, shared a case report of a 25-year-old female who came to see him due to blurred vision.

She was correctable to 20/20 but mentioned that her neurologist recommended an eye exam due to the fact that she had neurofibromatosis type 1.

“The world’s literature says that with type 1, the fundus is OK,” Sherman said. However, he saw spots on the retina with the Optomap (Optos) and the Annidas RHA multispectral imaging system.

The patient’s fundus photos and autofluorescence looked normal, Sherman said. The Optomap green separation looked normal, but the composite and red separation showed two dozen spots. “This is invisible to ophthalmoscopy,” he said.

“The lesions are at the level of the choroid,” he continued. “We know it’s under the retinal pigment epithelium because the autofluorescence is OK.”

Sherman said multispectral imaging uses 10 LEDs, each one a different color that penetrates to a different zone. In this patient, red 1, red 2, red3, red4 and infrared 1, 2 and 3 showed spots, he said.

“After I saw the spots on the retina, I asked her if she had spots anywhere else on her body,” Sherman said. “She had spots all over her abdomen and neck. They were flat, coffee-colored lesions; some were elevated.”

Sherman said there are 3,000 patients in the New York area with neurofibromatosis type 1. “There are lots of drugs to treat this,” he said. “We’re going to try to examine them after treatment to see if it affects the spots.”

Sherman said the literature indicates that spots are not visible in the fundus with type 1.

“There are a lot of things going on in the choroid that we’ve never seen in the past,” he said. “This completely new technology has a lot of potential.”